ANALYSIS: Is Italy really heading for a coronavirus second wave?

Clare Speak
Clare Speak - [email protected]
ANALYSIS: Is Italy really heading for a coronavirus second wave?
"Follow the procedure. Prevention will save your life.": People line up to take a voluntary Covid-19 swab test in Mondragone, southern Italy. Photo: Ciro Fusco/Ansa/AFP

The number of new Covid-19 cases reported in Italy has risen sharply over the past two weeks. So how bad is the situation, and what happens next?


On Thursday, Italy recorded 840 new cases of Covid-19 - the highest number since lockdown eased. After 642 the previous day, this continued the overall trend of rising case numbers over the last two weeks.
Authorities began tightening restrictions on Sunday, August 16th, after cases rose from 200-300 a day to 600 within a week.
Italy’s strict lockdown - one of the world's longest - is credited with getting the initial major outbreak under control. And over the past few months, the numbers had been steadily dropping even after lockdown was eased, thanks to contact tracing and widespread compliance with safety measures.  
The daily number of new Italian cases had hovered between 175-250 for much of July before starting to rise again.
How bad is the situation in Italy?
Italy is of course not alone in seeing this trend, with many countries including France and Germany now recording new case numbers equal to those last seen in April and May. And Italy''s numbers are now lower than those in many other European countries.
But Italian experts as well as the public are still becoming concerned by the fact that the numbers are moving in the wrong direction.
"We are not in as bad a position as France and Spain, but the current situation is not satisfactory," said Professor Massimo Galli, who heads the infectious diseases department at Milan's Sacco hospital.
"The end of confinement has resulted in an excessive feeling of false security," he told the La Repubblica newspaper. “We have to be careful, otherwise we will find ourselves facing an extremely difficult situation.”
The current figures are still a long way from the numbers seen at the height of the crisis in Italy - with some 6,500 cases a day recorded in late March - but there are understandable fears that if this trend continues a second lockdown could be on the way. 


While Italy remains one of the worst-affected countries in Europe overall, a closer look at the latest data shows that the country’s contagion rate is in fact still relatively low.
In terms of a percentage of the population, Spain has recorded 132.2 new cases per 100,000 inhabitants over the last 14 days, compared to 98 in both Luxembourg and Malta, 60 in Belgium, 41 in France and 20 in the UK, according to data analysis from the European Centre for Disease Protection and Control (ECDC).
In Italy, the number of new cases as a percentage using this measure is just 10 - among the lowest in Europe
14-day COVID-19 case notification rate per 100,000. Source: European Centre for Disease Protection and Control (ECDC)
Is this a second wave?
A feared "second wave" is not simply an increase in new cases, but would mean a return of the problems faced during the emergency phase at the beginning of the outbreak in Italy.
According to contingency planning documents released this week by government health experts, the situation is classed as "high risk" when the contagion index is fluctuating between 1.25 and 1.50 for more than a month, the origin of outbreaks cannot be traced, and the healthcare infrastructure becomes strained.

At the moment the RT number in Italy is 1.1, with regional dfferences, due to the rise in cases. Once the number exceeds the value of 1 at the national level, the country is considered to be "on guard".
Italian government ministers and health experts have repeatedly insisted that new outbreaks in the country can be kept under control, and hospitalisation rates remain low (see below for more details.)
However, the health ministry and the Higher Health Institute (ISS) stated on Thursday that "in addition to the outbreaks attributable to the reimportation of the infection" there are "small transmission chains whose origin remains unknown."
And on Friday, health ministry consultant Walter Ricciard said the first wave wasn't even over yet.
"There is continued talk of a second wave of the virus, but in fact the first wave is actually not over," he told reporters. "We knew that easing (lockdown) measures would have consequences."
Is the number rising because Italy is testing more?
Italy has increased testing again recently, with some 70,000 swabs now being taken daily. Some point to this as a possible explanation for the rise in new infections being recorded.
Improved testing can partly explain it: of the new cases, around half have either no symptoms or mild symptoms - so these are people who would simply not have shown up in figures from March, April and May when testing was focused on seriously ill patients.
But while an increase in testing has clearly influenced the numbers, it cannot alone account for the sharp rise in cases.
Importantly, while the number of tests being carried out has increased, the percentage of swabs coming back positive has also increased.
On June 17th the percentage of tests showing a positive result was 0.42 percent. By August 19th, the figure had more than doubled to 0.9 percent.


How many patients are being hospitalised?
The number of patients in intensive care is a key figure, both for hospital capacity and for the likely future death toll.
But despite the rise in cases, hospital admissions have remained stable and relatively low. Two more patients were admitted to intensive care in Italy due to Covid-19 on Thursday, for total of 68.
At the peak of the epidemic Italy had more than 4,000 Covid-19 patients in intensive care, which put a massive strain on the healthcare system.
Experts think the lower number of hospitalisations is probably due to the age of the new patients - the average age of newly infected people this month was just 34, according to Italy’s Higher Health Institute (ISS), compared to an overall national average age of 60. 
The ISS also stated that younger people are less likely to experience severe symptoms. However, health experts warn that some young people are being hospitalised, and can suffer long-term health problems as a result of contracting Covid-19.
The biggest concern though is what happens if these younger patient begin to infect older people, who are more likely to become seriously ill.
Where are the new cases - and where are they coming from?
As in earlier stages of the emergency, not every Italian region is affected equally. Once again, the northern regions of Lombardy and Veneto are reporting the highest numbers of new cases at the moment.
The profile of patients has changed however, with the average age of patients now below 40 for the first time, health authorities said.
A large number of clusters in recent weeks have been connected to young Italians returning from Greece, Spain, Malta and Croatia, authorities said.
For this reason, last Friday the government introduced mandatory testing on all arrivals from these four countries . Ministers are also now considering adding France to the list.
Italian health experts insist the biggest risk of new infections comes from cases being imported from abroad, saying the rise is "partly linked to vacationers"..
People visit Rome's Trevi Fountain on August 18th. Photo: AFP

Up to 40 percent of cases "were imported by fellow citizens who had returned from travel abroad," or to Italy's foreign residents returning  from elsewhere,  said Franco Locatelli, President of Italy's Higher Health Council and a member of the government's technical scientific committee (CTS).

Meanwhile Locatelli said "cases imported by migrants, understood as being desperate people who flee, are minimal." 

"No more than 3-5 percent are positive, and some become infected in reception centres where it is more difficult to maintain adequate health measures."

While Italy recorded an increase in cases over Ferragosto, the August weekend when Italian families flock to the country’s beaches and resorts, experts say the rise in cases being seen at the moment cannot be attributed to the holiday.
Testing reveals infections from two to three weeks earlier, meaning it’s too soon yet to see the impact of Ferragosto, or of August vacations in general.
How likely is another lockdown?
This is the question many people are asking as case numbers rise, but so far another national lockdown seems unlikely.
Italian government ministers and health experts have repeatedly insisted that, with the protocols and improved testing systems the country has in place, new outbreaks can be kept under control.
And the World Health Organization (WHO) stated on Thursday that European countries can fight the coronavirus without any need for lockdowns at all.
Italian health authorities have said however that some further business closures “cannot be ruled out” if cases keep rising, as they insist everything possible must be done to ensure the country’s schools can reopen in September as planned.
The health ministry is urging people to continue to take basic precautions - wearing masks in public places, frequent hand-washing, and maintaining a distance from others.




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Anonymous 2020/08/27 16:40
Thank you for including info on hospitalizations since the number of cases without showing the hospitalizations isn't useful.
Anonymous 2020/08/22 16:15
A very useful and clear account. Thank you!
Anonymous 2020/08/21 17:51
This is a very good article -- clear, with data and not overly dramatic. Thank you.

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