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Italian doctors doubt testing is Italy’s route out of coronavirus lockdown

Testing is being held up as the world's best bet for ending economically crippling coronavirus lockdown measures. But in Italy, some doctors at the centre of the outbreak say it's not a realistic solution.

Italian doctors doubt testing is Italy's route out of coronavirus lockdown
An Italian health worker shows a swab used to test for the presence of coronavirus. Photo: Miguel Medina/AFP

It's thought that mass testing will be a key part of Italy's “phase two”- the next planned stage of quarantine, in which people must learn to “coexist” with the coronavirus.

It is not yet clear when this phase will begin.

“In phase two, we would like to extend the testing across the country to find those who are infected as early as possible – including those without symptoms,” Italy's ISS public health institute director Silvio Brusaferro said.

However, some doctors at the Italian epicentre of the health crisis doubt that testing is their way out of confinement.

“It is a nonsense,” Milan's Polytechnic Institute professor Davide Manca said. “Conceptually, I am sceptical.”

The reason for Manca's scepticism is plain to see in the math.

Milan's Lombardy region has 10 million people and 11,142 officially registered COVID-19 deaths.
The economically strong area, the size of Belgium, has been under one of the world's strictest lockdowns since early March.

Yet Lombardy has been conducting just 6,500 tests daily over the past 10 days.

Manca estimates it would take more than five years for everyone in Lombardy to get tested just once.
“And you need people tested every 15 days for it to have any meaning,” Manca said in a phone interview.

“Even if you raise that number 10 times, that would still take 200 days for one test. That's six or seven months.”

Manca was talking about the swab tests that doctors insert up people's noses to see who is COVID-19 positive. Their shortage has made Lombardy's death ratios look stark.

The region had conducted 234,870 tests and confirmed 61,326 cases by Wednesday.

A jarring 18.2 percent of those officially infected with the virus have died of COVID-19 – which would seem to be a startlingly high fatality rate for the virus.

Experts have said this estimated mortality rate will go down once more testing is carried out, as we're currently only seeing part of the picture..

The swab shortage means that Lombardy is only testing those most clearly showing symptoms – and therefore those least likely to survive.

READ ALSO:What's the problem with Italy's official coronavirus numbers?

“In addition, Lombardy has not tested the elderly in retirement homes, where the virus has circulated a lot,” Milan's Vita-Salute San Raffaele University professor Roberto Burioni said.

This means that Italy still does not know how many people have really died of the new illness.

Countries are now looking to certify separate blood tests that determine whether someone already has had the virus and so, theoretically at least, have become immune.

These healthy people would presumably be allowed out of their homes first.

But doctors are not certain how well — or for how long – COVID-19 immunity works.

It is possible that those who suffered only a mild case of the illness are only slightly immune for a short time.

READ ALSO:

The new blood test kits are still weeks away from being approved and Italian authorities are focused on scaling up the old-fashioned swabs.

They intend to distribute another 2.5 million of them ahead of “phase two”, and being able to test asymptomatic people is seen as critical for Italy's immediate future.

Many people in Italy think this was their Achilles' heel – not realising in time that the virus could jump between perfectly healthy looking people.

“That is the one thing we did not think of at the start of the pandemic,” San Raffaele's Burioni said.

“The virus had been spreading for many weeks by the time we discovered it,” Lombardy's regional health chief Giulio Gallera added.

“We didn't have the chance to contain the outbreak: an atomic bomb exploded here.”

ANALYSIS: How and when will Italy's lockdown end?

People are now left to wonder when and how it might be safe to finally come out of their homes.

The rising number of daily fines issued to those out on the streets suggests that Italians are growing tired of sitting at home.

But Manca said he still did not understand how the end of confinement would work.

“Herd immunity is very difficult to achieve with COVID,” the professor said.

“You need 90-95 percent (of the population) to have COVID for immunity. That number is too high to reach.”

Member comments

  1. Professor Manca is correct about this, however, the serology tests might change the situation. We really have no idea how long the virus has been in Europe and how what percentage of the population is now immune. It could 1, 10, 20, 50% or more we really don’t know. But the rapid blood test will quickly tell us who is safe to go back to work, who doesn’t need to continue using up the precious PPE supply, and who does not need repeating swab testing which will speed that up too.

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COVID-19 RULES

Is Italy’s government planning to scrap all Covid measures?

The new Italian government has announced the end of some remaining Covid health measures. Here's a look at what will - and won't - change.

Is Italy’s government planning to scrap all Covid measures?

Few Covid-related restrictions remain in Italy today, six months after the nationwide ‘state of emergency’ ended.

The previous government had kept only a handful of precautionary measures in place – which the new government, led by Giorgia Meloni, must now decide whether or not to keep.

The cabinet is holding a meeting on Monday and will issue a decree this week detailing any changes to the health measures.

Many expect the government to scrap all measures entirely by the end of the year, after Meloni and her party criticised the way Mario Draghi’s administration handled the pandemic throughout its tenure. 

Meloni clearly stated in her first address to parliament last Tuesday that “we will not replicate the model of the previous government” when it comes to managing Covid.

READ ALSO: Five key points from Meloni’s first speech as new Italian PM

While she acknowledged that Italy could be hit by another Covid wave, or another pandemic, she did not say how her government would deal with it.

Meanwhile, new health minister Orazio Schillaci issued a statement on Friday confirming the end of several existing measures, saying he “considers it appropriate to initiate a progressive return to normality in activities and behaviour”.

Workplace ban for unvaccinated medical staff

Schillaci confirmed that the ministry will allow doctors, nurses and other healthcare professionals to return to work after being suspended because they refuse to get vaccinated against Covid-19.

Those who refuse vaccination will be “reintegrated” into the workforce before the rule expires at the end of this year, as part of what the minister called a “gradual return to normality”.

They will be allowed to return “in light of the worrying shortage of medical and health personnel” and “considering the trend of Covid infections”, the statement said.

Fines issued to healthcare staff aged over 50 who refused vaccination would also be cancelled, it added.

There were some 1,579 doctors and dentists refusing vaccination at the end of October, representing 0.3 percent of all those registered with Italy’s National Federation of the Orders of Physicians, Surgeons and Dentists (Fnomceo) 

Daily Covid data reports

Schillaci also confirmed in the statement that the health ministry will no longer release daily updates on Covid-19 contagion rates, hospital cases and deaths, saying this would be replaced by a weekly update.

It said it would however make the data available at any time to relevant authorities.

Mask requirement in hospitals to stay?

The requirement to wear face masks in hospitals, care homes and other healthcare facilities expires on Monday, October 31st.

At a meeting on the same day the government is expected to decide whether to extend the measure.

READ ALSO: What can we expect from Italy’s new government?

While the government had looked at scrapping the requirement, it reportedly changed stance at the last minute on Monday after facing heavy criticism from health experts.

Media reports published while the meeting was in progress on Monday said government sources had indicated the measure would in fact be extended.

Confirmation is expected to come later on Monday.

Italy’s face mask rules in care homes and healthcare facilities are up for renewal. Photo by Thierry ZOCCOLAN / AFP

‘Green pass’ health certificate

There is no indication that the new government plans to bring back any requirements to show a ‘green pass’: the digital certificate proving vaccination against or recent recovery from Covid, or a negative test result.

The pass is currently only required for entry to healthcare facilities and care homes, and this is expected to remain the case.

‘Dismantling the measures’

Some of the confirmed changes were strongly criticised by Italy’s most prominent healthcare experts.

Head of the Gimbe association for evidence-based medicine, Nino Cartabellotta, said the focus on cancelling fines for unvaccinated healthcare workers was “irrelevant from a health point of view .. but unscientific and highly diseducative”.

He told news agency Ansa it was “absolutely legitimate” for a new government to discontinue the previous administration’s measures, but that this “must also be used to improve everything that the previous government was unable to do”.

The government should prioritise “more analytical collection of data on hospitalised patients, investments in ventilation systems for enclosed rooms … accelerating coverage with vaccine boosters,” he said.

However, the plan at the moment appeared to be “a mere dismantling of the measures in place,” he said, “in the illusory attempt to consign the pandemic to oblivion, ignoring the recommendations of the international public health authorities”.

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