Coronavirus: Why Italy’s trailblazing rapid tests failed to stop the second wave

Italy was the first country in Europe to bet big on rapid "antigen" coronavirus tests, and its apparent success encouraged Britain, the United States, Slovakia and others to follow suit.

Coronavirus: Why Italy's trailblazing rapid tests failed to stop the second wave
Photo: Miguel Medina/AFP

However the tests, which are roughly 80 to 90 percent accurate, have not stopped an outbreak that has rocketed from around 500 cases a day in August, when they were first rolled out, to more than 35,000 now – with the total number infections set to top one million on Wednesday.

IN GRAPHS: Track the spread of coronavirus in every region of Italy

“I believe these tests are not used properly at the moment, they are just distributed randomly to everybody,” Professor Andrea Crisanti of the University of Padua told AFP, saying the government has no overall plan.

He said their use as a measure to protect vulnerable people in care homes, for example, was “absolutely criminal” because positive cases could slip through the net.
 'No alternative'
A vaccine may well be on its way, but not in time to battle the current wave of infections in Europe and elsewhere.
Instead, policymakers are left scrambling for solutions that avoid a repeat of the economically devastating lockdown earlier this year.
Italy last week shut bars, restaurants and shops in the worst-affected areas and introduced a nationwide night curfew, but has so far stopped short of another  nationwide shutdown.
The antigen tests have become a crucial part of the italian authorities' efforts to avoid a second lockdown.
They take just minutes to produce a result and they are cheap, unlike the “gold standard” molecular PCR tests that are close to 100 percent accurate.
Photo: Alberto Pizzoli/AFP
“Having such an instrument is fundamental, you have a method to immediately understand if a patient has the virus. It is a good starting point,” says family doctor Francesco Stevanato, who has carried out roughly 50 tests from his clinic in Venice.
Rolling them out in airports, it was thought, could help protect the travel industry. With wider availability, schools and businesses could safely stay open.
Professor Sergio Abrignani of the University of Milan, who co-authored a letter with some of Italy's leading scientists in September calling for their widespread use, conceded that they were not an overall solution.
“But there are practical situations where the antigen test has no alternative,” he told AFP.
“For example, when I am boarding a train or a ship and want to reduce the risk. The molecular test takes too long to give me an answer.”
 Anyone who tests positive with an antigen test in Italy is supposed to get a PCR test to confirm the result.
But the real danger is false negatives – if the rapid tests have an accuracy level of 80 or 90 percent, infected people will return negative
'No specific strategy'
“If your objective is to screen a community to know if transmission is there, fine,” said Crisanti.
However, he said that to halt transmission, rapid tests must be complemented by the accuracy of PCR tests, along with surveillance tools and
stay-at-home orders.
The Italian health ministry told AFP there was no specific strategy in place for testing beyond boosting capacity.
And the National Institute of Health, in charge of monitoring the epidemic for the ministry, could not provide any data related to the uptake of rapid tests.
An integrated approach is frustrated by the fact health policy in Italy is largely controlled by regional officials – creating wide variations.
But Crisanti said the government should have built a broader plan to capitalise on the lower number of cases after the lockdown.
“If they had built a network for molecular (PCR) tests, if they had integrated this capability with an information tool… and if they had built
infrastructure to make the beds available where they are needed, I'm sure we would be in a completely different situation.”
By AFP's Joseph Boyle and Giuliana Ricozzi

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Q&A: What you need to know about Italy’s West Nile virus outbreak

As Italy records a surge in cases of West Nile fever, we look at what the disease is and where in the country it's spreading.

Q&A: What you need to know about Italy's West Nile virus outbreak

Mosquitos are unfortunately one downside of summer in Italy. But as well as being a nuisance, they may also pose a health risk in the country – one of the few in Europe to record cases of West Nile virus (WNV)

READ ALSO: Cases of West Nile fever surge in northern Italy

Last week Italy recorded 50 more cases of the mosquito-borne virus, bringing the total number of infections to 144 according to the latest report from Italy’s Higher Health Institute (ISS).

This marked a 53-percent increase in cases against the previous week, while ten people have died so far.

As the number of infections continues to rise, here are the answers to the most pressing questions about the disease and the outbreak in Italy.

What is it?

The West Nile Virus (WNV) is a single-stranded RNA virus that can cause West Nile fever in humans.

It’s a member of the Flavivirus family together with other endemic viruses such as the Zika and Dengue viruses.

The virus was first identified in 1937 in Uganda’s West Nile district but has since spread to many other parts of the world, to the point that it is now considered indigenous to Africa, the Middle East, Asia and Australia. 

Carried by birds, West Nile virus is transmitted to humans by mosquitoes.

The West Nile virus is primarily transmitted by mosquitoes of the Culex species, which infect humans and other mammals through their bite, according to Italy’s health ministry.

There is no evidence that human-to-human transmission is possible.

Where are cases being reported in Italy?

Infections have been largely concentrated in the north of the country, especially in the Veneto region, where six people have now died of the disease. Other deaths were recorded in Lombardy, Piedmont and Emilia-Romagna.

The city of Padua, which is located in Veneto’s mainland, around 35 kilometres away from the Adriatic coast, is currently regarded as the hotspot of the virus. 

It isn’t yet clear why Veneto has been the worst-hit region so far, but experts fear that its marshy lowlands might be the perfect breeding ground for disease-carrying mosquitoes. 

A mosquito of the Culex species viewed under a microscope.

Mosquitoes of the Culex species, a specimen of which is pictured above, are responsible for transmitting the West Nile Virus to humans and other mammals. Photo by Jon CHERRY Getty Images / AFP

How severe is the outbreak in Italy?

West Nile virus is not new to Italy. However, this summer has brought the highest number of cases recorded yet.

National infection levels remain relatively low but the country has by far the largest number of cases in Europe.

According to the most recent report from the European Centre for Disease Prevention and Control (ECDC), dated August 3rd, 94 out of 120 recorded cases were in Italy.

Greece had 23 reported cases. Romania and Slovakia had two and one respectively. 

Italy is the only European country that has reported fatalities.

What are the symptoms?

According to the Italian Higher Health Institute (ISS), around 80 percent of infected people show no symptoms whatsoever.

In symptomatic cases, however, symptoms generally resemble those of a common flu and include fever, headaches, nausea and diarrhoea. 

The infection is usually only dangerous for people with weakened immune systems such as the elderly, and the most severe symptoms occur in fewer than one percent of infected people.

In healthy people, the virus is unlikely to cause more than a headache or sore throat, and symptoms generally last only a few days.

According to the data currently available, around one in 150 infected people can show symptoms as serious as partial vision loss, convulsions and paralysis. 

In very rare cases (around 0.1 percent, or one in 1000) the disease can cause brain infections (encephalitis or meningitis) which may eventually be fatal.

Brazilian biologists handle mosquito larvae.

There is currently no vaccine against West Nile disease, though several are being tested. Photo by Apu GOMES / AFP

Is there a cure?

There is no vaccine against West Nile fever. “Currently vaccines are being studied, but for the moment prevention consists mainly in reducing exposure to mosquito bites,” the ISS states.

There is also no specific treatment for the disease caused by the virus.

Patients showing the more serious symptoms are usually admitted to hospital and treated with IV fluids and assisted ventilation.

What should you do to protect yourself?

Seeing as there is currently no vaccine against the virus, the best way to protect oneself is by reducing exposure to mosquitoes as much as possible.

Italian health authorities have listed a number of official recommendations to help residents avoid mosquito bites. These include: 

  • Use repellent
  • Wear long-sleeved shirts and long trousers when being outdoors and especially during ​​mosquitoes’ peak activity times, i.e. sunrise and sunset
  • Use mosquito nets on your windows or sleep in rooms with air-conditioning and keep the windows closed
  • Make sure there are no pools of stagnant water around your house

See more information about West Nile virus in Italy on the health ministry’s website.