EXPLAINED: What is Italy’s ‘scenario 4’ and which regions are already in it?

Italian health authorities recommend tough restrictions if the coronavirus situation enters what it calls 'scenario 4'. Here's what that means - and which parts of the country have already reached that point.

EXPLAINED: What is Italy's 'scenario 4' and which regions are already in it?
A Covid-19 patient is taken from an ambulance at the San Carlo hospital in Milan on October 28th. Photo: Miguel Medina/AFP

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As the Italian government on Monday announced the latest set of restrictions aimed at stemming the spread of Covid-19, Prime Minister Giuseppe Conte said in his speech to parliament's lower house that the “epidemiological picture is in the process of transition towards scenario 4, with particular reference to some regions.”

READ ALSO: Curfew or lockdown: What will be in Italy's latest emergency decree?

But what exactly does that mean?

Here's a closer look at how Italy decides what measures to take in response to the changing coronavirus situation.

What is 'scenario 4'? 

Italy's Higher Health Institute (ISS) earlier this year set out four “risk scenarios” with guidance on appropriate measures for the government to take in each case, in plans titled 'Prevention and response to Covid-19″.

Scenario 4 is the last and most serious provided for in the ISS plan.

Health experts on Friday confirmed that the situation in Italy overall currently corresponds to that described in the less-severe scenario 3, but ministers warn that some areas are already in scenario 4.

The main difference between the two is the Rt number (the rate of transmission), as well as whether the origin of new outbreaks can be successfully traced or not.

Scenario 3 is characterized by “sustained and widespread transmissibility” of the virus with “risks of maintaining the health system in the medium term”, and Rt rates at a regional level between 1.25 and 1.5, the ISS writes.

Scenario 4 is when lockdowns at a local or national level would be considered.
Photo: AFP
Italy would enter scenario 4 if “the regional Rt numbers ​​are predominantly and significantly greater than 1.5”.
The ISS writes that such a scenario “could quickly lead to a high number of cases and clear signs of overload of welfare services, without the possibility of tracing the origin of new cases.”
If this situation is “sustained”, the official plan provides for “very aggressive measures” to be taken, including a national lockdown like that seen in spring if deemed necessary.

The Rt rate rose to 1.70 in the week between October 8 and 21, the latest ISS weekly report said, with significant regional variations.

Which regions are in scenario 4 right now?

Four regions – Calabria, Emilia Romagna, Lombardy, and Piedmont – plus the autonomous province of Bolzano are already in the phase 4 scenario, the ISS said in a report published last week.

Eleven more regions were defined as being at high risk: Abruzzo, Basilicata, Calabria, Liguria, Lombardy, Piedmont, Puglia, Sicily, Tuscany, Valle d'Aosta and Veneto.

Conte said on Monday that the number of at-risk regions would soon rise to 15.


Will these regions be placed under lockdown?
Italy's latest emergency decree, set to come into force by Wednesday, does not specifically mention lockdown measures.
However, it includes a nationwide evening curfew and tougher measures for regions with the highest transmission rates.
The way Italy will decide which regions will undergo which restrictions is to be further detailed under the forthcoming decree, as Conte announced a new three-tier system which is expected to be similar to that used in the UK.
“In the next emergency decree we will indicate three risk scenarios with increasingly restrictive measures.” Conte said on Monday.

The country is to be divided into three bands, with differing “scientific and objective” criteria approved by the Higher Institute of Health, he said.

The worst-affected regions, which he named as Lombardy, Calabria and Piedmont, would face the toughest restrictions.

Find all of The Local's latest coronavirus updates here.

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REVEALED: These are the most polluted towns in Italy

The northern cities of Milan and Turin were named Italy's 'smog capitals' in a new pollution report on Monday which urged the government to take action over poor air quality.

REVEALED: These are the most polluted towns in Italy
Photo: Pixabay

Smog and pollution are choking Italian cities year-round and many towns are exceeding limits on fine particles and other pollution, according to another report from Italian environmental watchdog Legambiente.

The Mal’aria di città (Air pollution in the city) report for 2023, unveiled on Monday, was the latest to warn about the risks to health posed by pollution in many parts of the country.

It found that 25 of 95 cities monitored had violated clean air ordinances by exceeding daily fine particle (PM10) emission limits, which are currently set at no more than 35 days a year with a daily average of over 50 micrograms per cubic metre.

Turin was ranked as the worst offender, exceeding this level on 90 days, closely followed by Milan (84), Asti (79), Modena (75), and Padua and Venice at 70.

These were followed by Cremona, Treviso, Mantua and Rovigo, all of which exceeded limits to a lesser degree.

All of the most polluted cities were in the northern Italian regions of Piedmont, Lombardy, Emilia Romagna and Veneto, with most within the north-western ‘industrial triangle’.

Some southern cities featured nearer the bottom of the ranking, with Andria (Puglia) and Ragusa (Sicily) exceeding limits on several days, as well as Rome, which overshot the permitted level for one day.

(Photo by Andreas SOLARO / AFP)

The average annual rate of PM10 emissions nationwide dropped slightly, by two percent year-on-year, the report found.

“This, however, is not enough to guarantee the health of citizens,” said Stefano Ciafani, president of Legambiente.

He pointed out that the situation looked even worse if air quality in Italian cities were measured against tighter limits under the new European Directive on air quality, in force from 2030, which lowers the PM10 threshold from 35 to 20 micrograms per cubic meter of air.

“Only 23 out of 96 cities (24 percent) would be under these limits,” Ciafani said, while 84 percent would exceed the threshold for PM2.5 and 61 percent for nitrogen dioxide (NO2).

Italy has repeatedly been reprimanded by the European Union over air quality, and has “persistently and systematically” breached EU recommended limits, the European Court of Justice ruled in 2020.

The north of Italy has long been ranked among the worst areas in Europe for polluted air according to data from the European Environment Agency.

“Air pollution is not only an environmental problem, but also a health problem of great importance,” said Ciafani. “In Europe, it’s the main cause of premature death due to environmental factors.”

“Italy has more than 52,000 deaths per year caused by PM2.5 emissions, equal to a fifth of those recorded throughout the continent,” he said.

The main causes of air pollution in Italian cities are reported to be industry, inefficient domestic heating systems, agricultural practices and, most of all, heavy traffic.

In Italy, cars continue to be by far the most-used means of transport. 65.3 percent of journeys overall are made by car, Legambiante wrote, with the emissions from some 38 million cars choking Italy’s towns and cities.

(Photo by Miguel MEDINA / AFP)

Legambiente said “drastic” measures were required to tackle the problem, including funds for more efficient heating systems in homes and public buildings and a major increase in public transport provision.

The group said Italy must “quadruple the availability of public transit, promoting integrated season tickets as done by Germany in 2022”, triple the number of electric buses, create zero-emission zones in town centres, and “create another 16,000 kilometres of cycle paths”.

It also praised local authorities choosing to bring in 30 km/h speed limits in city centres. Councils in Bologna, Turin, Milan and Cesena have all said they plan to implement these limits, following the lead of European cities including Paris and Madrid, despite fierce criticism from Italian transport minister Matteo Salvini.

Legambiente published a petition urging the government to make clean air and more livable cities a priority, saying Italy should follow Paris in attempting to create ’15-minute cities’, in which everyone lives within a quarter of an hour’s walk of vital amenities such as shops and schools and possibly also workplaces.