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ANALYSIS: Will Italy really be able to lift most of its Covid-19 restrictions in June?

Government officials have estimated that Italy will be in a position to lift most of its coronavirus restrictions over the next month. Is that achievable or overly optimistic? Here's what the latest health data indicates.

ANALYSIS: Will Italy really be able to lift most of its Covid-19 restrictions in June?
How likely is it that Italy will move to a white zone by next month? Photo: Den Harrson / Unsplash

Some predictions place Italy in a white zone, the lowest in its tiered system of restrictions, as early as June – but no regions are currently in this minimal-risk category.

The government is pinning its hopes on the vaccination campaign to rapidly reduce Italy’s vulnerability to Covid-19.

READ ALSO: Who is eligible for a Covid-19 vaccine in your region of Italy?

“To have the whole of Italy in white, we will have to wait until vaccinations are further along, said Pierpaolo Sileri, the undersecretary to the Health Minister, in an interview with newspaper Il Messaggero this week.

“It will happen when at least 30 million Italians have received the first dose. I expect it to happen in mid-June,” he added.

So far, only 17.3 million people in Italy have had at least the first dose of a vaccine, according to the latest figures. That’s little more than half of his target for a nationwide white zone.

Only 13 percent of the population has been fully vaccinated, placing Italy slightly behind the European average. However, the vaccination campaign is now speeding up.

Italy’s emergency commissioner Francesco Figliuolo gave the green light to offer vaccinations to the over-40s on Wednesday – just a week after instructing regions to open appointments to the over-50s.

The seven-day average daily number of vaccinations given in the country is now around 460,000 – up from almost 444,000 the week before, the latest figures show, with the country hitting its target of half a million doses in a day at the end of last month.

Although this is a step forward, Sileri’s predicted date of moving to a white zone is only a month away and currently, none of Italy meets the criteria to do so.

At the time of writing, most of the country is in a yellow or orange zone, with the tougher restrictions of orange zone rules applying to Valle d’Aosta, Sicily and Sardinia.

The classification is next up for review on Friday May 14th, with any changes coming into effect from Monday 17th.

READ ALSO: Quarantine, curfew and weddings: What rules will Italy relax next?

Provinces and towns can also make the call to go into a local red zone, separately from the surrounding region, to contain the spread of emerging coronavirus variants.

There are strict criteria for being able to pass into a white zone. In this category most restrictions are relaxed, including the 10pm curfew, with only face masks and social distancing still in place.

A region must have fewer than 50 cases per 100,000 inhabitants and an Rt number – the reproduction rate used to calculate how fast the virus is spreading – below 1 for three weeks in a row.

So which regions come close to turning white? The answer so far is none.

When Sardinia was placed into the lowest-risk category in March, it recorded an Rt of 0.67, 0.68 and 0.89 and a weekly incidence averaging around 30 cases per 100,000 inhabitants.

It subsequently lost its white classification when cases began to rise.

Although the overall figures are improving, the national picture is currently a long way from those statistics.

Each week, the Higher Health Institute (ISS) gathers the data and releases a report on the epidemiological situation in Italy. From there, the government can make a strategy on which restrictions to tighten or relax.

The latest weekly health data report, from last Friday, showed a slight rise in the national average Rt number, though overall the weekly average incidence rate of new cases continues to fall.

Italy’s national Rt number increased to 0.89, from 0.85 the week before and 0.81 before that, according to the latest health data.

How about the incidence rate? That now stands at 127 cases for every 100,000 inhabitants, down from 146 the week before, the report said – still a long way from the 50 cases per 100,000 needed to turn white.

According to official data from the Italian Ministry of Health, Valle d’Aosta has the highest incidence rate of 189 cases per 100,000 inhabitants. This is closely followed by Campania at 184 and Puglia at 170.

READ ALSO: MAP: Where in Italy are coronavirus cases falling fastest?

Regions closer to white status are Molise at 56 cases per 100,000 and Sardinia at 63.

The latest epidemiological data is encouraging, as cases and deaths are both down.

In the week of May 5-11th, new cases are now 63,409, down from 78,309 the week before, according to the latest report by the GIMBE Foundation, an independent health think tank that monitors the Covid situation in Italy.

A steady decline in new cases since the middle of March. Source: GIMBE

Nino Cartabellotta, president of the GIMBE Foundation, said: “The further drop in new weekly cases reflects the last six-week effects of an all red-orange Italy. Trends are down in all regions.”

Not only is the incidence rate and Rt used to determine a region’s colour classification, so too is how full the hospitals get. If the strain on health services becomes too great, restrictions get tightened. 

Should the level of occupancy of intensive care beds exceed 30 percent of the total (or 40 percent of hospital beds overall), a region moves into red zone. A region can be placed in yellow status if there’s less than 20 percent occupancy of intensive care beds (or 30 percent occupancy overall).

The situation in hospitals is improving as the pressure begins to ease: hospitalisations and admissions to intensive care have almost halved in a month.

READ ALSO: 

According to GIMBE, in 35 days, the number of those admitted with Covid symptoms has fallen by 49 percent. Meanwhile, the number of intensive beds occupied by Covid patients is down by 45 percent.

Only in three regions has there been a worsening of hospital occupancy due to Covid – in Calabria, Lombardy and Tuscany.

“The easing of the pressure on hospitals depends both on the lower circulation of the virus and on the initial effects of the high vaccination coverage among the over-80s,” said Renata Gili from GIMBE.

Of the more than 4.4 million in this age bracket, 3,403,495 (77 percent) are fully vaccinated with two doses and 576,609 (13 percent) have received only the first dose.

Source: GIMBE

Cartabellotta said that regions could speed up the vaccination campaign by now offering shots to the over-40s.

However, the percentage of over-60s not yet vaccinated is still so high that the campaign is lagging overall – and made worse by unknown numbers of people refusing the AstraZeneca shot.

Sergio Abrignani, an immunologist on the Scientific Technical Committee (CTS) that advises the Italian government, told the Corriere Della Sera newspaper: “The strategy of gradual re-opening has been rewarding and from June the trend will be very similar to that of England with about ten deaths per day.”

Italy is still a long way from that goal, with 262 deaths registered on Wednesday alone. That’s up from the day before with 251 and 198 the day before that.

However, the numbers are moving in the right direction overall, as GIMBE figures show that there were 1,544 deaths in the past week versus 1,826 from the week before.

Source: GIMBE

Abrignani is hopeful that the country will have made strides by the end of the month. “Everything suggests that, surprises excluded, by the end of May the population of over 60s will be immunised, vaccinations are going ahead at a good pace,” he said.

“It means that we will have secured 97 percent of the people who would risk dying of Covid if they were infected. The number of fatalities will drop dramatically,” he predicted.

READ ALSO: Italy to begin vaccinating over-40s

Sileri of the Health Ministry urged: “This summer we will have to do everything we can to convince even the youngest to get vaccinated. If the circulation continues, there is a risk that new variants will emerge, even in Italy. Even the youngest people must be vaccinated.”

The GIMBE president also calls for promotion of the vaccine rollout using “persuasion strategies”.

“Considering that the vaccination campaign is entering a phase that depends on the adherence of the population, it’s necessary to integrate voluntary booking with an active call system, involving family doctors in a systematic and widespread way,” Cartabellotta said.

For now, the predictions are likely to change week by week according to the latest health data. Officials can’t yet say for sure whether the latest easing of restrictions has had a negative impact or not.

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MONKEYPOX

Semen ‘a vehicle’ for monkeypox infection, say Italian health experts

Researchers in Italy who were first to identify the presence of monkeypox in semen are broadening their testing, saying early results suggest sperm can transmit infection.

Semen 'a vehicle' for monkeypox infection, say Italian health experts

A team at Rome’s Spallanzani Hospital, which specialises in infectious diseases, revealed in a study published on June 2nd that the virus DNA was detected in semen of three out of four men diagnosed with monkeypox.

They have since expanded their work, according to director Francesco Vaia, who said researchers have found the presence of monkeypox in the sperm of 14 infected men out of 16 studied.

READ ALSO: EXPLAINED: How is Italy dealing with rising monkeypox cases?

“This finding tells us that the presence of the virus in sperm is not a rare or random occurrence,” Vaia told AFP in an interview.

He added: “The infection can be transmitted during sexual intercourse by direct contact with skin lesions, but our study shows that semen can also be a vehicle for infection.”

Researchers at Spallanzani identified Italy’s first cases of monkeypox, found in two men who had recently returned from the Canary Islands.

The latest results reported by Vaia have not yet been published or subject to peer review.

Since early May, a surge of monkeypox cases has been detected outside of the West and Central African countries where the disease has long been endemic. Most of the new cases have been in Western Europe.

More than 3,400 confirmed cases and one death have now been reported to the World Health Organisation from more than 50 countries this year.

The vast majority of cases so far have been observed in men who have sex with men, of young age, chiefly in urban areas, in “clustered social and sexual networks”, according to the WHO.

It is investigating cases of semen testing positive for monkeypox, but has maintained the virus is primarily spread through close contact.

Meg Doherty, director of the WHO’s global HIV, hepatitis and sexually-transmitted infection programmes, said last week: “We are not calling this a sexually-transmitted infection.”

Could antivirals curb the spread of monkeypox?

Spallanzani researchers are now trying to ascertain how long the virus is present in sperm after the onset of symptoms.

In one patient, virus DNA was detected three weeks after symptoms first appeared, even after lesions had disappeared – a phenomenon Vaia said had been seen in the past in viral infections such as Zika.

That could indicate that the risk of transmission of monkeypox could be lowered by the use of condoms in the weeks after recovery, he said.

The Spallanzani team is also looking at vaginal secretions to study the presence of the virus.

A significant finding from the first study was that when the virus was cultured in the lab, it was “present in semen as a live, infectious virus efficient in reproducing itself”, Vaia told AFP.

Vaia cautioned that there remained many unanswered questions on monkeypox, including whether antiviral therapies could shorten the time in which people with the virus could infect others.

Another is whether the smallpox vaccine could protect people from the monkeypox virus.

“To study this we will analyse people who were vaccinated 40 years ago before human smallpox was declared to have disappeared,” Vaia said.

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