EXPLAINED: How has Italy changed the way it decides regional Covid-19 rules?

As it continues to reopen the country, the Italian government has changed the way it assesses the risk level in each region – and therefore which rules apply. Here’s how the new criteria work.

EXPLAINED: How has Italy changed the way it decides regional Covid-19 rules?
A beach bar on the Sicilian island of Lampedusa declares itself "Covid free". Photo: Alberto Pizzoli/AFP

Italy’s tier system that divides regions into risk zones has now been in place for six months, and until this week it depended on a complex assessment of more than 20 separate factors carried out every seven days.

Waiting for the national health institute’s analysis of the data every Friday has become a familiar routine for residents anxious to learn where they can travel, eat, shop and study for at least the next week.

READ ALSO: Indoor dining and later curfew: Italy’s new timetable for easing Covid-19 restrictions

While the idea was to get a comprehensive idea of the risk in each region by studying everything from how well contact tracing was working to how many hospital beds were occupied, regional authorities complained that the calculation was so complicated it made it difficult to foresee which zone their region might fall into, and therefore plan ahead – or contest the decision.

As infections surged again in the spring, the government introduced a red flag that would automatically send regions into lockdown: if new cases hit more than 250 per 100,000 inhabitants, regions would be declared high-risk “red zones” under maximum restrictions regardless of any other data.

The other key factor Italy based its calculations on was the Rt number, which indicates how many people each patient will transmit the coronavirus to on average, and therefore gives a sense how quickly infection is spreading. An Rt over 1 made it likely a region would become a moderate-risk orange zone, while over 1.25 indicated it would go red.

Below 1, meanwhile, increased a region’s chances of being classified a lower-risk yellow zone or even the lowest risk zone of all, white.

MAP: Which zone is your region in under Italy’s coronavirus rules?

With health data improving in recent weeks and Italy preparing to reopen the country by summer, regional authorities were once again pushing the Health Ministry to change the way it decided the risk zones.

In particular, they wanted to give less weight to the Rt number – which reflects infections of any severity, including ones without symptoms – and focus instead on how many serious cases were recorded.

The government agreed, and in its latest emergency decree of May 18th it simplified the way regional risk zones are classified to place more emphasis on the number of Covid-19 patients in hospital and intensive care.

Now the classification is based on just two main factors: incidence rate (the number of new cases per 100,000 inhabitants over the past week) and occupancy of hospital beds.

In detail, the criteria are as follows:

  • White zone: 50 cases per 100,000 inhabitants for three consecutive weeks.
  • Yellow zone: either a) 50-149 cases per 100,000 inhabitants; or b) 150-249 cases per 100,000 inhabitants and hospital bed occupancy of 30 percent or less, or intensive care occupancy of 20 percent or less.
  • Orange zone: 150-249 cases per 100,000 inhabitants and none of the other conditions that would make it either a yellow or red zone.
  • Red zone: either a) 250 cases or more per 100,000 inhabitants; or b) 150-249 cases per 100,000 inhabitants and hospital bed occupancy of 40 percent or more, or intensive care occupancy of 30 percent or more.

The new system makes it easier for regions to meet the “yellow” criteria, by offsetting a higher number of cases against the strain on hospitals.

The health institute will nonetheless continue to monitor all of the risk factors it previously considered until at least June 16th, the new decree states. When the two assessments produce different results for the same region, the government will go with whichever is lowest – even if it means choosing the old, complex assessment over the new one.

In other words, if a region is orange by the new system and yellow by the old (or vice versa), it will be declared yellow.

Sunbathing in Milan, in one of Italy’s Covid-19 yellow zones. Photo: Miguel MEDINA/AFP

But the Health Ministry says it will operate an early-warning system based on data that might suggest a region is about to see a rapid spike – including the Rt number and forecasts of hospital occupancy rates. The new decree allows for yellow zones that show enough of these worrying signs to be declared orange regardless of the usual criteria.

That’s an outcome all regions will be dreading as Italy releases the brakes on travel and invites tourism, both domestic and international, to resume. With most of the country now under the lightest restrictions in months, an abrupt return to lockdown would be disastrous for newly reopened businesses. 

MAP: Which parts of Italy will be Covid-19 ‘white zones’ in June?

The government has already announced that six regions will have almost all their restrictions lifted next month: Friuli-Venezia Giulia, Molise and Sardinia, which become white zones on June 1st, and Abruzzo, Liguria and Veneto which follow a week later.

The first three already have a weekly incidence rate of new cases per 100,000 inhabitants in the low 40s, while the others have rates in the 60s, per the health institute’s latest report for the week to May 13th.

Overall Italy’s incidence rate is 96 cases per 100,000 inhabitants, nearly double the threshold required for white zones but comfortably within the new yellow zone range.

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Reader Question: What are Italy’s Covid quarantine rules for travellers?

Italy's quarantine rules have changed so many times over the past couple of years, it can be hard to keep track. Here's the latest information on when and how visitors need to self-isolate.

Reader Question: What are Italy's Covid quarantine rules for travellers?

Question: “One of your recent articles says you can exit quarantine by testing negative for the coronavirus. But you can also exit quarantine by obtaining a Letter of Recovery from Covid-19… true?”

Unfortunately, official proof of having recovered from Covid-19 won’t get you out of the requirement to self-isolate if you test positive for Covid while visiting Italy – though it can shorten your quarantine period.

Anyone who tests positive in Italy is required to immediately self-isolate for a minimum of seven days: that’s if the person in question is fully vaccinated and boosted, or has completed their primary vaccination cycle or recovered from Covid less than 120 days ago.

That period is extended to 10 days for those who aren’t fully vaccinated and boosted, or those who recovered from Covid or completed their primary vaccination cycle more than 120 days ago.

READ ALSO: Travel in Italy and Covid rules this summer: what to expect

In either case, the infected person must have been symptomless for at least three days in order to exit quarantine (with the exception of symptoms relating to a lost sense of taste or smell, which can persist for some time after the infection is over).

The patient must also test negative for the virus via either a molecular (PCR) or rapid antigen test on the final day of the quarantine in order to be allowed out.

Quarantined people who keep testing positive for the virus can be kept in self-isolation for a maximum of 21 days, at which point they will be automatically released.

Italy does not currently require visitors from any country to test negative in order to enter its borders, as long as they are fully boosted or were recently vaccinated/ have recently recovered from Covid.

READ ALSO: How tourists and visitors can get a coronavirus test in Italy

Some countries (including the US), however, do require people travelling from Italy to test negative before their departure – which means visitors at the tail end of their journey could be hit with the unpleasant surprise of finding out they need to quarantine for another week in Italy instead of heading home as planned.

It’s because of this rule that a number of The Local’s readers told us they wouldn’t be coming on holiday to Italy this summer, and intend to postpone for another year.

If you are planning on visiting Italy from a country that requires you to test negative for Covid prior to re-entry, it’s a good idea to consider what you would do and where you would go in the unlikely event you unexpectedly test positive.

Please note that The Local cannot advise on specific cases. For more information about how the rules may apply to you, see the Italian Health Ministry’s website or consult the Italian embassy in your country.

You can keep up with the latest updates via our homepage or Italian travel news section.