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HEALTH

INTERVIEW: ‘Italy’s reopenings put economic interests ahead of health protection’

Amid concerns that Italy's lockdown restrictions are being lifted too quickly, The Local asked one of Italy's top health experts just how safe the reopenings really are.

In early March, the Italian government imposed a tough national lockdown after Italy became the first western democracy to suffer an outbreak of the novel coronavirus. Rules were strictly enforced in the country, where Covid-19 has now claimed the lives of at least 32,000 people.

Italy then charted a slow and careful route out of the shutdown. But on May 12th, the country changed course. The government announced that restrictions would be rolled back further and faster than previously planned, with restaurants, bars, and most shops allowed to reopen from May 18th.  Tourism is now set to restart, with interregional and some international travel to be allowed as soon as June 3rd.

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According to Dr Nino Cartabellotta, a leading Italian public health expert, professor, and president of the Gruppo Italiano per la Medicina Basata sulle Evidenze (GIMBE), Italy's Group for Evidence-based Medicine, government decisions on reopening “have placed the country's economic interests ahead of health protection.”

“From May 18th almost everything has reopened, but without certainty that the curve of contagion won't rise again,” he said in an interview with The Local.

“Our government set dates for reopening ignoring the fact that the effects of previous measures can only be seen after two weeks,” he explained.

Italy's prime minister had announced a staged reopening over a number of weeks under the current “phase two” of lockdown.

The government later pushed these reopening dates forward, and Cartabellotta said that this had been done without being able to see the “impact of loosening lockdown on the contagion curve.”

“The consequences of reopening activities on May 4th can be assessed only starting from May 18th. And those of May 18th will be visible no earlier than June 1st.”

“However, from June 3rd, the date on which we’ll begin to glimpse the impact of the reopening of May 18th on the epidemic curve, the green light for interregional travel and reopening of borders will have allowed the free circulation of infected people throughout the country.”

Dr. Nino Cartabellotta. Photo. GIMBE Press Office

 

And Cartabellotta says Italy doesn't yet have adequate systems in place for data monitoring, or testing and tracing.

“We're facing phase two with blunt weapons and without any technological and organizational infrastructure,” he said.

He pointed out that the planned launch of the “Immuni” app, intended to help trace infections, has been stalled “due to the many controversies related to data security and privacy.”

There are also issues with many regions' testing and tracing systems, he said.

Italy's system of reporting official data on the coronavirus outbreak is decentralised, with each of the 20 regional authorities required to send their local data to the national health ministry.

“Italian regions, with a few exceptions, have a very limited propensity for testing and tracing: that is, they carry out too few swabs to identify asymptomatic subjects and trace their contacts,” Cartabellotta explained.

“In this context, the new decree of May 16th entrusted  the responsibility for epidemiological monitoring and consequent actions entirely to the region,”

“This means it is in fact up to each region to monitor the epidemiological situation in its own area, to evaluate the adequacy conditions of its own health system and to introduce wider or more restrictive measures on its activities.”

READ ALSO: Why some Italian regions have reopened sooner than others

Italy's requirements for reopening were also less stringent than those at the Chinese epicentre of the outbreak, he explained.

“In Wuhan, to decide to reopen, they waited for the daily percentage increase in new cases to drop to 0.1 percent. In Italy we settled for 0.6 percent, with considerable variability between regions,” he said.

Authorities in Italy's northern regions, where much of the country's economic activity is concentrated, were among the keenest to reopen – but these areas are also at the highest risk.

Cartabellotta explained: “On May 4, the first day of the lockdown loosening, 80 percent of new cases concentrated precisely in the regions where most of the people returned to work: Lombardy, Piedmont, Emilia Romagna, Veneto and Liguria.”

 

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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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