The Blog

2020-

2020-12-13 f
WHEN "SCIENCE" GETS IT WRONG VI
(this report was published on the WHO website 13 May 2020 but was taken down the next day)

An unprecedented challenge: Italy’s first response to COVID-19

ABSTRACT
This report tells the story of the first phase of Italy’s response to the COVID-19 virus, which in many people transformed into the dreaded illness known as COVID-19, leading to unprecedented death tolls across the world. Readers should note that the report is an unfinished story. It was written in the midst of the initial phase of the pandemic in a climate of constant and daily change as the country responded to this unprecedented challenge. While early lessons will surely need to be revisited, this report is a first account of Italy’s immediate experience with COVID-19, dealing with different aspects of the response as the first country that experienced widescale community transmission in Europe.

Foreword
Italy’s first response to COVID-19 occurred at a time of unprecedented challenge, but the country quickly stepped up to the plate. The response called for solidarity and a quick exchange of experiences – something that is at the heart of the European programme of work “United Action for Better Health.”

This unprecedented challenge is now being faced by countries across the WHO European Region and countries in all WHO regions. Our lives have changed since COVID-19 entered our world, and things will never be the same. We have had to shift our work modalities during lockdown mode, and learn how to greet our friends and dear ones while keeping a safe distance. We have understood that despite physical distancing, we need to stay connected not just for social purposes, but also to be able to learn from one another. This “connection” has been a critical part of Italy’s response.

Italy was among the first countries in Europe to identify the virus in its midst and was for months the hardest-hit country in Europe in terms of deaths and cases. Italy was also the first country that the world looked at, and is still looking at, in its search for what works in terms of a country response. Evidence is still scarce in this area, but clearly needs to be accumulated.

Italy has one of the strongest health systems, but when COVID-19 came to its doorstep, it brought this system to near collapse. And this made the world panic.

At the end of the first phase and while entering a transition to so-called normality, it is time to reflect on how Italy responded...

1. Introduction
In early January 2020, Italy watched as a newly identified coronavirus (COVID-19) spread in China. It seemed a slightly worrying, yet distant, phenomenon. On 30 January, the WHO Director-General declared COVID-19 as a Public Health Emergency of International Concern (PHEIC). That same day, two Chinese tourists from Wuhan tested positive for the virus in Rome. Soon after, on 6 February, a third case was detected in an Italian repatriated from Wuhan. COVID-19 was at the country’s doorstep. Cases1 began to be detected in other parts of Italy. Less than two months later, Italy was seeing up to 1000 COVID-19-related deaths per day.

Italy had become the European epicentre of one of the most significant pandemics of our time. It crept up while the world was looking at their smartphones or other devices. COVID-19 personifies globalization...

This report tells the story of Italy’s initial response to the epidemic. It takes stock of lessons learnt from managing the country’s response with a primary focus on public health but also taking into account economic, legislative and social issues. It provides the reader with the when – the chronology of the virus’s arrival in Italy and actions taken – and the how – Italy’s response and efforts to get the epidemic under control. At the time of writing, Italy was barely emerging from the first phase of the epidemic and starting to consider the second, transition phase. The lessons from this first phase are still being accrued, day by day. As the spread of COVID-19 has happened at different moments in time throughout the world, it is hoped that what can be learnt from the events in Italy can be of interest to countries where the epidemic took hold at a later date. The potential of this type of experience, captured during the course of the pandemic, is instrumental in informing early recovery efforts.

The report also presents profiles from all of Italy’s regions that summarize data and activity in areas such as epidemiological profiles, hospital capacities and communication. The Annex cites the data sources from which the regional profiles were compiled.

page 28
Italy had apparently covered all the bases with regard to primary health care and hospitals. People and systems had been repurposed, proving that the health system was flexible. While the ride was still bumpy and the death count remained staggering, there was a glimmer of hope that all these changes and all the sacrifice would soon bear fruit. Long-term-care facilities (in this case, homes for older people) soon emerged as a big blind spot. The risk of COVID-19 for residents and caregivers was most underestimated in the first weeks of the epidemic. While the epidemic had been raging in the community and stressing hospitals to breaking point, silent clusters started to appear in these closed communities.

page 37
The first phase of the COVID-19 epidemic in Italy and the measures put in place to control it had a profound impact on the Italian economy. Physical distancing and movement restrictions affected one third of Italy’s productive sectors, responsible for 27% of the total yearly value added (54). Half of Italy’s active workforce and businesses came to a standstill (55). This included the tourism industry, which in 2018 employed 1.6 million people, 25% on temporary or seasonal contracts. Some 200 000 of the 750 000 small- and medium-sized enterprises were at risk of bankruptcy (56). The National Institute of Statistics projected a 4.5% contraction of the value added in the national economy should lockdown measures be kept in place until June, with a 24% reduction for the restaurant and hospitality industries alone (57). (read more)