Why has Italy avoided the surge in Covid cases seen in France and Spain?

Why has Italy avoided the surge in Covid cases seen in France and Spain?
Photo: Vincenzo Pinto/AFP
With new coronavirus infections surging in France, Spain and elsewhere in Europe, the numbers in Italy remain relatively low and stable. What makes Italy so different?

While everyone in Italy is no doubt thankful that the feared “second wave” of contagion has not yet materialised, many are wondering why the country has been less affected while neighbouring France and Spain suffer higher numbers of infections, hospitalisations, and deaths.

Italy is now seeing around 1,500 new cases daily, while France and Spain have each recently reported up to 10,000 cases in a day.
 
 
In terms of the percentage of the population affected, Spain has recorded 292.2 new cases per 100,000 inhabitants over the last 14 days, while the figure was 172.1 in France, 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 33.
 
14-day COVID-19 case notification rate per 100,000. Source: European Centre for Disease Protection and Control (ECDC)
 
So why is this happening?
 
There’s a lot of speculation as to why the situation is comparatively better here in Italy: Are Italians being especially responsible? Are they more inclined to follow rules designed to protect other people? Perhaps they’re particularly keen on disinfecting and hand-washing?
 
But experts say the explanation is far more likely to be a combination of good testing and tracing systems, strictly-enforced safety rules, and the fact that Italy closed everything earlier and reopened later than in neighbouring countries.
 
“There is no evidence that individual and social behaviours like the use of masks, social distancing, or no gatherings, have been better in Italy than elsewhere,” says 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.
 
“The timely, rigorous and prolonged lockdown has worked better here in Italy than in other countries that have hesitated to close, closed less, and reopened earlier,” he tells The Local.
 
He credited Italy’s closure with “reducing mortality, hospital admissions, and the number of new cases to a greater extent than in other European countries.”
 
Warning signs at a vaporetto (water bus) stop in Venice. Photo: AFP
 
Lockdown and reopenings
 
Like Italy, Spain was among the worst-affected countries when the coronavirus struck Europe. And, like Italy, it soon had one the world's strictest lockdowns in place.
 
But in Spain, infections have surged since the lockdown measures were fully removed at the end of June.
 
Italy’s currently far lower rate of infections may be partly explained by the fact it simply reopened many things later.
 
For example, schools in Italy only began reopening on September 14th. In many regions, they’re still closed. 
 
Spain reopened schools at the beginning of September, and in France classes gradually restarted from May.
 
Meanwhile the Italian government only relaxed a total ban on spectators at sporting events on Friday, allowing up to 1,000 fans per game. France allows far larger crowds, with 11,500 per day attending the French Open in Paris.
 
 
 
Italy having a longer and stricter lockdown than other countries gave it an advantage upon reopening, Cartabellotta says.
 
However, he adds that Italy “lost some of its advantage” to some “non-virtuous” behaviour in the country over summer.
 
Italy started gradually easing lockdown rules from May, but some restrictions still remain in place, while other rules were added or reinstated over summer amid concerns that holidaymakers were fuelling the spread of the virus.
 
Cartabellotta, a member of the government’s expert scientific advisory panel, is among those who has repeatedly urged caution throughout lockdown and reopening. In May, he said the government was reopening things too quickly, accusing it of “putting economic interests ahead of public health.”
 
He now warns that, though Italy is not seeing the same numbers as in other countries yet, it is following the same trend – even if it is behind the curve.
 
“Since the beginning of June with the reopening of most activities we have in fact started again, and from the end of July the contagion curve is rising once again, even if less rapidly than in other countries,” he says.
 
Testing and tracing
 
Italian politicians have mainly put the lower infection rate here down to successful testing and tracing and a reinforced national health system.
 
“Italy’s national health service has become much stronger,” said health minister Roberto Speranza in August, as he ruled out future national lockdowns and insisted outbreaks are “under control” at current levels, as their origins can be traced.
 
So far there have been no serious issues reported with Italy's testing procedures.
 
Though the procedures vary by region, as they are managed by local health authorities, anyone who fears they may have symptoms can get a prescription from their doctor for a rapid (and free) test. 
 
There are often queues at drive-in test centres and waits for testing at clinics, but they don't tend to be particularly long.
 
A man visits a drive-through testing centre on his motorbike in Italy. Photo: AFP
 
If someone tests positive, their contacts can be traced and tested within days, preventing further spread, partly thanks to adequate coverage of the country’s Immuni contact-tracing app.
 
However as schools go back during September, parents are starting to report difficulties in obtaining a test for their child and getting the all-clear for them to return to school. 
 
As more schoolchildren are expected to require testing, it is feared that Italy could soon start seeing the problems with obtaining a test currently being reported elsewhere in Europe.
 
There has been widespread concern in France about how hard it is to get a coronavirus test due to demand, particularly in Paris. French Prime Minister Jean Castex admitted last week that the country had to do better.
 
 
 
However unlike Italy, France has open testing available to anyone, regardless of whether they have symptoms, and without needing referral from their doctor.
 
And some say Italy may simply have lower numbers because it is testing fewer people.
 
France and Spain have in fact carried out far more tests than Italy. In the past three months, Spain tested 0.73 people per thousand, and France tested 0.78. The rate in Italy was 0.41 per thousand, according to analysis from the European Data Portal.
 
But the most important number, the percentage of swabs which came back positive in that period, was about the same: one percent in Italy, 1.1 percent in Spain and 1.3 percent in France.
 
What happens next?
 
Dr Cartabellotta says the numbers Italy will see over the next weeks and months “depend on the behaviour of Italians and the ability of testing and tracing.”
 
“It is desirable that regions will not repeat what they did in April and May, when they skimped on tests to avoid the risk of extending the lockdown.”
 
He echoed government ministers who say some renewed closures may be needed in future if cases increase, though another national lockdown isn’t expected to be necessary.
 
“It is unlikely that we will return to 4,500 positive cases per day, but mini-lockdowns cannot be excluded.”
 

 


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