The way Italy handled its second wave is a lesson for us all

The country was one of the hardest-hit in Europe. But now, as cases spike elsewhere, Italy is keeping a handle on its second wave
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Giulio Gambino remembers that it was the images of hospitals in Bergamo back in March, with patients hooked up to ventilators and gasping for air, that got Italians to take the pandemic seriously. "I think the images coming out of Lombardy shocked people," he says. "There was a big, big fear. After that, people really accepted being locked down."

Back when Italy detected its first cases of Covid-19, Gambino, editor of Rome-based online newspaper TPI, remembers that Italians reacted similarly to many other countries – some blamed China, nobody wanted to go into lockdown and, many, even political leaders, were saying it was just the flu.

This was back at the end of January, when Italy declared a state of emergency and became the first country to block flights from China. "We can reassure all the citizens, the situation is under control," Italian prime minister Giuseppe Conte told the nation at the time. This turned out to be incorrect. By March 9, Italy had 9,172 cases and became the first country in the world to enter nationwide lockdown. In two days, it would have the second-highest number of infections outside China, with 827 Italians dead. By March 22, as factories closed, a similar number were dying every day and the country had 59,138 cases.

But now, while cases have spiked in other European countries, Italy is a picture of relative stability. The country reported just 40.4 infections per 100,000 people in the last 14 days. This is far less than Spain (325.9), France (241.8) and the UK (117.9), and even compares well with Germany (32.1), one of the nations that has best dealt with the pandemic. Italy’s death rate is low, too, at 0.4 Covid-19 deaths per 100,000 over the last 14 days, compared, for instance, to Spain’s 3.3 deaths. While the UK, France and Spain have have all had to implement local lockdowns of varying degrees, similar measures haven't been necessary in Italy at all.

Over August, the number of coronavirus infections increased steadily each week, particularly among young people, hitting more than 1,400 on a single day – as many cases as recorded in May. "At the very beginning of the summer, there was this explosion of people going out, wanting to get their lives back," says Gambino. But this possible second wave hasn’t yet come to pass. One reason for this success is that Italian residents may simply have been terrified into compliance. It was images like the ones that scared Gambino, as well the recognition that Italy still has the sixth highest death toll in the world, that have kept Italians cautious and compliant since coming out of lockdown.

Italians has been wearing their masks devoutly – back in June, according to an Imperial College London study, 84 per cent of Italians, would be willing to wear a face mask if the government advised them to; now the practise is mandatory and those who refuse to face fines of up to €3,000 (£2,700). YouGov statistics show that in Italy people tend to wear masks and face coverings as well as avoid crowded places more often than in other European countries.

Rules are also strict – waiters must wear masks and customers have always had to wear masks when inside and not eating. Masks remain mandatory outdoors in Lombardy. To tackle spread at busy nightlife spots, since August, the government has ordered that worn in all crowded places between 6pm and 6am.

Back in February, when a 38-year-old with a high temperature was allowed to return home and infect scores of Italians, including people in his local football team, and at the hospital where he was diagnosed, the Italian government was accused of incompetence. But now it should take credit – it instituted Europe’s first and longest lockdown, and Italians are generally pleased with the government’s response. In a survey from June 2020, most Italian interviewees (65 per cent) approved the government's response to the pandemic. Because of this competence, Gambino feels that the mood towards the government has been positive, which behavioural scientists say increases compliance.

Though the country is carrying out around three times less tests than the UK, Italy's testing system may also be more efficient than other countries – the country tests the entire social network of an infected person, regardless of whether they have been exposed, a great way to catch asymptomatic cases. "This strategy has clear limitations, as it cannot be sustained indefinitely, but may be one of the reasons that has limited transmission so far. Testing has recently been introduced at entry from at-risk countries too," says Ilaria Dorigatti, a lecturer at Imperial College London's School of Public Health. Rapid testing is also available at airports, train stations and schools.

But one worry is the coming winter. As is the case throughout the northern hemisphere, there is a genuine fear that the cold may push people inside and send cases soaring. "People tend to be outdoors a lot more in hotter southern European countries," says Gary McLean, a professor of molecular immunology at London Metropolitan University. "We know the virus doesn't transmit as well outside and tends to transmit very easily indoors." Still, the government has so far been proactive about monitoring the populace – according to the Financial Times, on September 28 police checked 50,602 people and 4,939 businesses – where remote work has been encouraged – sanctioning 227 individuals and ordering the closure of three companies.

But Italy is not out of the woods yet. Schools and universities reopened just a couple weeks ago, and new Covid-19 infections rose by over 2,500 on Thursday, the highest since April, though this is partly due to increased testing. But, so far, Italy has avoided a second lockdown.

Will Bedingfield is a staff writer for WIRED. He tweets from @WillBedingfield

This article was originally published by WIRED UK