Analysis: Why are Covid infections in Italy rising?

People walk in central Mila wearing face masks.
Life in Italy is now almost restriction-free under the current 'green pass' rules. Photo: Miguel Medina/AFP
After months of stagnation, Covid infections are now on the rise in Italy - even though much of the population is vaccinated. What's going on and how serious is the increase?

Italy this week recorded another rise in the number of confirmed Covid-19 cases, and an increase in the number of patients with coronavirus being admitted to hospital.

Most worryingly, the trend of falling intensive care admissions had reversed in the past week – instead increasing by 12.9 percent, the independent Gimbe foundation for evidence-based medicine said in its weekly report on Thursday.

The foundation’s analysis of health ministry data showed a new rise in new infections of 16.6 percent and hospitalizations up by 14.9 percent.

READ ALSO: Italy records sharp increase in Covid patients in intensive care

Italy recorded 5,905 new infections on Thursday, November 4th – a relatively low number compared to figures seen in some European countries, though a sharp rise on Italy’s figures in recent weeks.

Italy’s health ministry on Friday reported that the Rt number, which shows the rate of transmission, has now risen above the critical threshold of 1 for the first time in months.

The number is now at  1.15 according to the latest coronavirus data monitoring report from Italy’s health ministry and the Higher Health Institute (ISS).

An Rt number above 1 indicates that the epidemic is in a phase of expansion.

Italy’s weekly number of Covid cases is shown in blue. The red line shows the test positivity rate. Graphic: Gimbe.

The rise isn’t entirely unexpected. Experts warned in July that Italy had entered the fourth wave of contagion – though the health ministry said in mid-September that numbers had so far been “contained” thanks to vaccinations and “individuals’ adherence to correct behaviour”.

But the recent increases are sparking concern that this may no longer be the case.

Infection rates are on the rise across Europe. On Thursday, WHO Europe director Hans Kluge said the “current pace of transmission across the 53 countries of the European Region is of grave concern.”

READ ALSO: Europe could see 500,000 more Covid deaths by early 2022, WHO warns

Kluge blamed the soaring caseload on “insufficient vaccination coverage” and “the relaxation of public health and social measures.”

The warning came as Germany recorded its highest number of daily Covid cases since the beginning of the pandemic, whilst France recorded over 10,000 daily cases on Wednesday for the first time since mid-September.

Italy’s recorded numbers of new cases and hospitalisations remain much lower than those seen in some other large European countries such as Germany, where a record high number of deaths and spiking infection rates have caused alarm across the continent.

Italy has the highest Covid vaccination rate in the European Union after Spain and, at the moment, some of the strictest health measures.

So why are infections and serious Covid cases now rising again in Italy?

Most hospitalisations are thought to be among those who remain unvaccinated – as Italian hospital data has shown, the vast majority of Covid patients in intensive care are unvaccinated.

“We are in a moment in which the risk of developing the serious and fatal pathology is significantly different between those who are vaccinated and those who are not”, said Franco Locatelli, head of the Italian government’s Scientific Technical Committee (CTS) which advises on health measures, at a press conference on Friday morning

He quoted Germany’s health minister, who this week described his country’s significantly worsening health situation as “a massive pandemic of the unvaccinated”.

Locatelli noted that “Italy has 9 percent more people vaccinated than Germany”, claiming that this was “a success of the organisation and sensitivity of the Italian population”.

To date, almost 45 million people or 83.3 percent of the Italian population over the age of 12 are fully vaccinated, and 1.6 million have already received booster shots, health ministry data shows.

As a share of the total population, 72 percent of people in Italy are fully vaccinated.

Italy’s Covid emergency commissioner General Francesco Figlioilo meanwhile stated on Thursday that “the growth in infections does not correspond, for now, to a proportional increase in hospitalisations” in Italy.

He said the vaccination campaign “is proving to be decisive in limiting severe forms of disease, with a positive impact on the hospital system”.

However Italy’s politicians and health experts maintain that more vaccine coverage is needed to keep the numbers down, with millions yet to receive a first dose.

To stop the curve from rising further “we need to increase first vaccinations among those who have not had it,” Locatelli said, adding that medical personnel and the elderly also needed to get their boosters to prevent immunity from waning.

READ ALSO: 

The government now set a new target of fully vaccinating 90 percent of the eligible population, and are considering making vaccination mandatory for some groups as vaccine take-up continues to slow.

“I believe that 90 percent is a quota that would allow us an endemic management of the pandemic,” Andrea Costa, a junior health minister, said in an interview on Italian television on Tuesday.

“By now there is an awareness that we can no longer talk about herd immunity,” he added, “because even a vaccinated person can contract the virus, but it is much milder.”

The effectiveness of vaccines in preventing serious illness is reflected in the current situation in intensive care units in Italy, where data shows the vast majority of patients are unvaccinated.

There is however a recorded increase in vaccination ‘breakthrough’ cases, because immunity decreases over time.

Health authorities are now recommending a booster shot to all risk groups and those over 60, as well as healthcare workers and care home staff. However, the take-up of third doses has so far been limited.

Italian authorities are now pushing for faster administration of third doses as well as first vaccinations as the curve rises sharply in parts of Europe, saying large-scale vaccination is the best way to contain a new rise in cases in Italy over winter.

Italy’s intensive care units are seeing an increasing number of Covid-19 patients. Photo: Andreas SOLARO/AFP

In Europe and beyond, factors scientists believe are contributing to the rise in cases include the prevalance of the more infectious Delta variant, colder weather, and an increase in gatherings and travel.

“All over the world the circulation of the virus is increasing for three reasons,” said Walter Ricciardi, a professor of hygiene and preventative medicine and a health advisor to the Italian government, in an interview on news channel Sky TG24.

“The cold weather, that leads to being in enclosed and more crowded places; the lack of vaccination coverage of important percentages of the population – this is not the case in Italy, but for example, we see this in countries such as Bulgaria and Romania, where coverage has barely reached 30 percent.”

“The last reason is the partial reduction of vaccination protection for people vaccinated over six months ago,” he said.

“With this extremely contagious variant, they begin to get infected. If we add to this the fact that we move more, we use masks less and we are less attentive to social distancing because we are all tired, we can understand how these elements together raise the epidemic curve.”

Last winter, socialising indoors was found to be a major driver of contagions in Italy with most transmissions said to be between friends and family members and a large percentage of outbreaks traced to parties and gatherings at private homes.

READ ALSO: Where do you now need to show a Covid green pass in Italy?

For this reason, socialising – including visiting family – was heavily restricted over the Christmas and New Year holidays in Italy last winter.

While there’s no data as yet which shows this is happening again – and the weather has only recently turned colder in Italy – Locatelli warned again on Friday that “gatherings and participation in parties must be avoided.”

Under Italy’s green pass scheme, entry to indoor bars and restaurants and many other covered venues is restricted to those who can show a health certificate. 

But some places such as shopping centres and supermarkets are under no obligation to check green passes or limit crowds, and enforcement of mask-wearing rules varies.

For now, it looks unlikely that Italy will bring back the tight restrictions enforced last winter, when the entire country was declared a ‘red zone’ over Christmas meaning business closures and tight travel restrictions.

“The situation this Christmas does not worry [the government], but we are obviously keeping an eye on the numbers,” junior Health Minister Pierpaolo Sileri told Rai News 24 on Friday.

“The present situation of vaccinations, the use of the green pass and diagnostics will keep the situation very much under control”.


Member comments

  1. Spot on Mary. Show me someone who is following the masking and social distancing rules to a T and I’ll show you someone who is on the verge of a mental breakdown. That’s why we constantly see our “leaders” who are pushing these protocols being caught violating them. Nobody can follow them for more than a short time without going crazy.

  2. The fact that some people ignorant or lazy with regard to proper mask discipline is not an indication that using masks to limit infection is not a valid health measure. That’s the equivalent of saying that we shouldn’t bother using condoms for safe sex because sometimes they break, slip, or are put on improperly. If you want to gamble with your health and life, please do it somewhere where it doesn’t invoke risk for the rest of us. And if you are concerned about someone not using their mask properly, tell them and then distance yourself.

  3. To see the stupidity of the mask use is really sad. Can we just do away with this charade? I see servers in restaurants constantly touching their faces as they fiddle with their masks. Then they touch the plates and glasses. If they had no masks, they would not be touching their faces so much. And many wear the masks on their chins or below their noses. It is all dangerous theatre–dangerous for mental health; dangerous for creating a situation of face-touching that would not otherwise exist.

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