Symbol of Europe’s pandemic – Italy – keeps the virus in check

When Covid-19 struck Europe, Lombardy’s flooded hospitals and spiralling death toll provided a grim template for Italy’s neighbours. In the past weeks, however, it is offering a more upbeat, alternative path: while Spain, France and the UK are experiencing a second surge in infections after loosening lockdown restrictions, Italy has kept the disease under control.

Miles Johnson and Davide Ghiglione in Rome, John Burn-Murdoch in London

New daily cases are on the rise to 1,535 from the low hundreds in June, when restrictions started easing. But this compares with over 10,000 new cases in Spain and France. Life feels normal in most of Italy: restaurants and bars are open, people enjoy late-summer trips to the beach and children have returned to school.

Experts highlight three main reasons for Italy’s resilience.

First-mover advantage

For Fabrizio Pregliasco, a virologist at the University of Milan, “Italy is in a better situation than other countries such as the United Kingdom, Spain or France because we were among the first in the world to face the Covid hurricane.” Its health system and government have had more time to plan its post-lockdown response and the lifting of restrictions have been relaxed more gradually, allowing the government greater agility in reintroducing restrictions when needed.

Prime minister Giuseppe Conte has kept on reminding Italians to remain vigilant. Under Italy’s Covid-19 state of emergency he has the power to rule by decree, meaning his government was able to react swiftly to an uptick in new cases over the summer. By contrast, Spain’s state of alert, which granted the central government emergency powers over the regions, lapsed on June 21.

In August, Rome ordered a closure of discos and introduced a rule that face masks must be worn in all crowded places between 6pm and 6am. The measures, which were initially in place for a month, were extended for a further 30 days in early September. 

High public compliance and stricter enforcement

Public health officials cite the high public acceptance of restrictions, such as compulsory mask wearing in shops and on public transport. Visitors to bars and restaurants must write down their names and numbers, a measure largely complied with during the summer.

According to a survey conducted by Imperial College London, 84 per cent of Italians surveyed said they would be “very or quite willing” to wear a face mask advised to by their government. This compares to 76 per cent in the UK.

Those in breach of rules are punished. In late August, Italian media reported that a 29-year-old man was fined €400 for refusing to wear a mask near Rome’s Trevi fountain and telling the officers that “Covid doesn’t exist”.

On Monday alone police checked 50,602 people and 4,939 businesses, sanctioning 227 individuals and ordering the closure of three companies.

“Italians are more respectful of the measures of social distancing and against the transmission of the virus, even in the smallest commercial activity all measures are observed very scrupulously,” said Andrea Crisanti, a professor of microbiology at the university of Padua.

Individual behaviour, although hard to quantify, has played an important role, said Ferdiando Luca Lorini, director of intensive care at a hospital in Bergamo.

“We have gone from the most affected country to one of the virtuous countries in the management of the pandemic thanks to the clarity of the rules from the very beginning, and the willingness of everyone to respect them,” he said.

Effective testing and monitoring

Andrea Crisanti, professor of microbiology at the University of Padua, said the public health response has focused on not just mass testing but also effective surveillance of cases to track and trace anyone who has come into contact with an infected person.

About 2 per cent of tests give a positive result, compared with about 13 per cent of tests performed in Spain, suggesting the virus is way more widespread in the latter. 

“Once there is a positive we test all those who may have come into contact with them. The real problem of the epidemic are the cases with no symptoms, if you do not intercept these, you do not come out of it,” he said.

In August, when Sardinia, a popular holiday destinations for Italians, emerged as a hotspot for the virus — former prime minister Silvio Berlusconi and Formula One boss Flavio Briatore both contracted the virus on the island — authorities introduced drive-through testing at the port of Civitavecchia on the mainland where ferries shuttle holidaymakers to and from the island. Positive cases were isolated more quickly, preventing the outbreak in Sardinia from spreading to other regions.

While few want to tempt fate ahead of winter, there is confidence that Italy’s efforts can continue to keep the virus under control.

“If Italians, who have been very diligent so far with regard to all the measures, keep holding on then we should be able to manage the situation and get used to coexisting with the problem until a vaccine arrives,” said Mr Pregliasco.

Additional reporting by Daniel Dombey in Madrid, Adrienne Klasa in London and Victor Mallet in Paris