Why is Italy faring better than the UK when it comes to fighting a second wave?

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Why is Italy faring better than the UK when it comes to fighting a second wave?
Italy's long and strict lockdown is credited with helping to avoid a new surge in cases. AFP

British Prime Minister Boris Johnson said that coronavirus infection rates were higher in Britain than in Italy because it was a "freedom-loving country" and Brits struggled to follow the rules. But there are other reasons why Italy is faring better than the UK right now.


Johnson has since been widely ridiculed for the comment, but his words have prompted the question: why is Italy - which suffered greatly in the early months of the pandemic - faring better than the UK right now?
Italy has so far suffered around 35,000 coronavirus linked deaths compared to over 41,000 in the UK, but it is the current infection rates that provide the more pertinent contrast between the two countries.
Daily death rates in Italy are averaging in the low teens each day, compared to the UK where deaths are climbing into the 20s and 30s.
But significantly the UK is currently reporting around 5,000 new cases a day, while the figure in Italy is around 1,500.
The UK government believes that number could soon rise to 50,000 infections a day and 200 daily deaths, which is why Johnson announced new restrictive measures on Tuesday.
Italy was the first country outside China to face a major coronavirus outbreak, but has recently managed to keep infection rates relatively low and as such there isn't the same alarm over a second wave.


Even before Johnson's comments there had been been 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?
Or are the deep scars from the first wave prompting Italians and the authorities to do more to avoid a second wave? 
'A timely, rigorous and prolonged lockdown'
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.
Cartabellotta credited Italy’s lockdown with “reducing mortality, hospital admissions, and the number of new cases to a greater extent than in other European countries.”
The UK government has been widely criticised for being slow to impose its own lockdown. When Boris Johnson told the nation on March 23rd to stay at home and avoid contact with others, it was deemed to be too late.
Unlike in the UK, Italy's lockdown was strictly policed with residents needing to fill in forms to leave their homes and facing steep fines if they were caught flouting the rules.
While Italy started gradually easing lockdown rules from May, 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.


Strict face mask rules
In contrast to the UK, Italy has imposed much stricter rules on the wearing of face masks, which have largely been followed by the public. 
A recent government decree keeps Italy's existing rules on face masks in place until at least October 7th: everyone must wear them in enclosed public spaces such as shops, restaurants or public transport. They must also be worn in busy outdoor areas between 6pm-6am.

The decree states that masks must be worn "in the spaces pertaining to places and premises open to the public as well as in public spaces (squares, open spaces, streets, promenades) where due to the physical characteristics it is easier for gatherings to form, including those of a spontaneous and occasional nature".

And people in Italy continue to face stiff fines if they are caught flouting the rules on wearing masks. The penalty is currently 400 euros.

READ ALSO: Italy hands out first fine for not wearing face mask at night

Shops and restaurants are strict about enforcing the rules, as police checks are common. If a customer is found not wearing a mask when required, not only does the customer face being fined, but so does each staff member on the premises.

Meanwhile the UK has only this week decided to make it compulsory for staff in the hospitality sector to wear masks.
Reactive restrictions and clear communication
Italy also took action during the summer to try to stamp out a rise in infections, such as closing all discos and nightclubs in mid-August and putting in place drive-through testing at airports and ferry terminals to swab holidaymakers returning from virus hotspots.


With Italy's national and regional governments granted special powers under a state of emergency - declared in January and extended until mid-October - the authorities were able to enact sweeping rules in response to the latest developments, and restrictions were often tightened further locally as regional governors proved even more cautious than the central government.
Despite the regional variations rules in Italy were generally communicated clearly and emphatically, whereas the UK government has been accused of sending mixed messages to the public - at one point workers were urged to go back to work, before being told to continue working from home.
Track and trace works
But the key factor as to why Italy's rates are lower is that which was angrily rejected by Boris Johnson - the existence of a functioning test and trace system in place, that the WHO has long said is key to tackling infection rates.
In the UK critics have blasted the system, which has been contracted out to private firms. It has seen people forced to drive tens of miles to be tested, or simply told there are no slots, whilst officials have found contacts hard to trace. Laboratories are struggling to process results.
In contrast Italy's test and trace system has largely been deemed a success. 
Andrea Crisanti, a professor of microbiology at the university of Padua told the FT the public health response had focused not just on mass testing but also tracking and tracing anyone who has come into contact with an infected person.

“Once there is a positive we test all those who may have come into contact with them. The real problem of the epidemic are the cases with no symptoms, if you do not intercept these, you do not come out of it,” he said.
Testing in Italy is tightly controlled by the public health service, with private labs and clinics having to seek special authorisation to conduct swab tests, which helps the local authorities stay on top of every new confirmed case.

Drive-through testing in Rome. Photo: Laurent Emmanuel/AFP
Italy now behind the curve instead of ahead
The fact Italy was the first European country to be hit hard by the pandemic, with hospitals in the north of the country overwhelmed by the sheer number of critical cases, will no doubt have left scars among health workers and the government.
There is a determination to avoid a repeat of those scenes back in March in April. But even though Italy now appears behind the curve compared to countries like the UK, instead of ahead of it as was the case in March, the government cannot afford to relax.
Health expert Dr Cartabellotta now warns that, though Italy is not seeing the same numbers as in other countries yet, it is following the same trend.
“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.
Italian government ministers said they expect any rise in new cases in the country to be "gradual" and "controlled".
Regional authorities have also begun trying out localised lockdowns in response to outbreaks, notably in the city of La Spezia on the north-west coast, where schools were recently closed, face masks were made compulsory anywhere in public and gatherings were banned in certain neighbourhoods after cases showed a spike.


Comments (2)

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Anonymous 2020/09/27 05:59
Nothing to do with loving freedom. Italy has been much more decisive and tougher in their approach to COVID-19, while Boris twiddled his thumbs, then waxed and waned on what should be done. Italy also put their citizens health first, not the economy, which should always be a governmenta priority.
Anonymous 2020/09/25 07:49
Well done, Italy. <br />Siete bravi, siete forti! Sono fiera di noi.

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