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Italy’s COVID-19 Crisis and Response

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  • January-June 2020
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    After eight weeks of lockdown, Italy has gradually started to reopen. Positive cases and death numbers have begun to decline, albeit slowly, and caution, social-distancing, patience, and perseverance will still need to guide Italians for the upcoming weeks (at least) to avoid a new wave of contagion.

    COVID-19 has indiscriminately affected the whole country (some more, some less) requiring national effort and sacrifice. With some exceptions, Italians have demonstrated a remarkable degree of endurance, solidarity, sense of duty, and responsibility. But as people start populating the streets again, uncertainty looms. As the country works towards recovery, it will have to reckon with its mistakes and shortcomings, the social, political, and economic consequences, as well as the pre-existing systemic weaknesses exacerbated by the crisis.

    How Italy Handled the Coronavirus and What Went Wrong

    Italy’s response to COVID-19 has been shaped by several elements: how authority and responsibility are divided between the Italian government and regions; the Italian civil security system headed by the National Civil Protection Department that, during states of emergency, directs and coordinates activities nationally; a set of institutions such as the national health system and the Italian law enforcement and armed forces; and Italy’s political landscape.

    The Italian government declared the state of emergency1 on 31 January 2020, one day after the World Health Organization (WHO) declared COVID-19 a Public Health Emergency of International Concern and two days after a Chinese couple visiting Italy was hospitalized for COVID-19 in Rome.2 However, it was only three weeks later that the outbreak manifested itself, initially in a way that seemed could be contained within a few towns, and then rapidly taking over Italy’s northern regions (Lombardy, Veneto, Piedmont, and Emilia-Romagna), before spreading across the rest of the country. On 21 February, the first case of COVID-19 not directly linked to China was discovered in Italy, in the region of Lombardy. In the following days and weeks, the number of positive cases grew dramatically, and with that the number of individuals needing hospitalization and intensive care, rapidly stressing health care structures in the affected areas. At the time of writing, there have been 31.610 COVID-19 deaths in the country, one of the highest figures worldwide.3

    On 21 February, the regional president of Lombardy issued the first coronavirus-related ordinance4 (in Italy, regional presidents have authority in case of health emergencies, and they are equipped with powers to issue emergency ordinances). Initially aimed at the small towns where the outbreaks occurred, the cautionary and restrictive measures were then extended to the whole region. As the situation in Lombardy and elsewhere worsened, the Italian government began issuing decrees, first establishing circumscribed red zones and then progressively implementing stricter measures nationwide: schools of all levels5 moved to online teaching on 4 March, “stay at home” orders were issued on 9 March,6 non-essential commercial activities closed on 11 March,7 and all non-essential production was halted on 21 March.8 Legally, decrees supersede regional ordinances, but regions had the power to tighten local rules if needed 9– many in fact established red zones10 in several towns that became local hotbeds.

    A 26 March governmental decree described a gradual reopening of the country in multiple phases.11 From 4 May, factories and construction sites got up and running again, take-away from bars and restaurants are now allowed, and parks have been reopened for the public.12 The next opening wave will be on 18 May and will entail the opening of stores and museums and, according to the decree, bars and restaurants will be able to fully reopen on 1 June, as well as personal care activities like hairdressers.13 While at the height of the crisis the measures implemented by the government were generally accepted by the regions, the reopening phase has seen tensions mount due to economic concerns: some regional presidents, especially in the south, have been pushing for an early reopening of commercial activities. COVID-19 was not a homogenous experience for the whole country: 70% of the total registered cases are concentrated in the aforementioned northern regions, while the south was largely spared the unmanageable figures that stressed the north’s healthcare system (which was, nationally, the best equipped to face such an emergency).14 With this in mind and data at hand, the government is evaluating whether regional differentiation can and will guide the next reopening phases. In the meantime, facemasks15 are still hard to come by; testing capabilities haven’t increased, and the national testing strategy is unclear, leaving regions to deal with local screening; and the contact-tracing app deemed crucial to restart is nowhere to be seen.16

    While the government has been responsible for the legislative aspects of crisis management, the National Civil Protection Department – still acting through the Council of Ministers, Italy’s executive organ – has directed and coordinated national efforts. The Civil Protection Department ensures joint management and coordination of emergency activities, including monitoring activities, information and data gathering.17 It works closely with different bodies as law enforcement and military forces, voluntary forces as the Italian Red Cross, as well as its own force, local administrations and authorities (from regions, provinces, and municipalities), and all entities whose participation is required to manage a given emergency.18 During the COVID-19 crisis, the Civil Protection Department (and its network of local offices) has been responsible for holding daily press conferences with updates on the national situation, collecting and publicly sharing numbers and data. It has also served as the hub for the collection and national distribution of medical supplies, its volunteers have manned regional hotlines to keep emergency lines free, it has supported the Servizio Sanitario Nazionale – Italy’s national health system – by setting up field hospitals and triage areas, and coordinating the transportation of patients in need of intensive care to available hospitals. These, however, are just some examples of the range of activities it has carried out.

    COVID-19 has tested Italy’s regionally based national health system, highlighting its weaknesses – including personnel shortage,19 the general decline in the number of hospital beds during the past decade,20 and the lack of coordination between the regional governments and the local medical nodes, namely family doctors, local clinics and nursing homes.21 To front the emergency, retired doctors were called back, young graduates were speedily habilitated as doctors and nurses, and makeshift hospitals were set up. But these weaknesses also meant that those doctors on the frontlines, the ones who had the first contact with positive patients – family doctors – were initially left without direction or the protection to carry out their work due to a nationwide shortage of supplies.22 Additionally, nursing homes – hosting the most vulnerable section of Italy’s society (over 70% of COVID-19 victims were over 70 years old)23 – became hotbeds of contagion.24 Over 200 doctors (family and hospital doctors), nurses, pharmacists, and care-workers have lost their lives in the fight against COVID-19, and investigations are shedding light on nursing home deaths.25

    Italian law enforcement forces have also been playing an active role during the emergency: from manning checkpoints around the red zones, patrolling cities and enforcing the measures contained in the decrees, to engaging in spontaneous acts in service of the population. The Italian military has also been crucial in repatriating citizens from China, making its medical personnel, hospitals, and structures available to support the national health care system, supporting public safety activities and offering logistical support as the transfer of patients and equipment nationwide.26

    In a country where fractious politics has been a constant feature for decades, the government was able to muster general support from political opponents for the sake of national unity at the height of the crisis but was not immune to criticism. As the health emergency gives way to what will likely be Italy’s next economic crisis, criticism is evolving into threats of new elections from opponents, and from within the fragile coalition government. The government has been accused of initially underestimating the threat and for its slow adoption of more restrictive measures. It has also been under pressure for the delivery of the promised social and economic safety nets27 and during its negotiations with the European Union and was criticized for mismanaging communication efforts throughout the crisis. 28

    Because Italy was the first European country to experience an overwhelming outbreak, the Italian government was faced with making decisions entailing short-term and long-term consequences, especially economic ones, requiring both caution and proportionality: an example was the decision to halt non-essential and non-strategic production which was taken on 22 March, four weeks after the first measures were implemented in Lombardy and three weeks after the whole country was subject to “stay at home” orders.29 Given Italy’s weak pre-coronavirus economic situation, such decisions were not easy ones to take.

    In addition to the economic consequences of Italy’s industrial and commercial pause, there have been social repercussions as unemployment grows, business-owners incur debts, families plunge into poverty and pre-existing inequalities only grow deeper, especially for those whose livelihoods depend on the shadow economy, which has been forced to halt as well. In the meantime, the promised social safety nets for Italian workers and businesses have been slow to arrive, often tied down by bureaucracy, and have, so far, not been enough30 (in March, the government had approved a decree allocating 25 billion euros to face the emergency31 ).

    Finally, while the Italian government has strived to adopt a transparent approach and to enhance communication to inform the public, the result has sometimes been a little different: the daily briefing on national trends led by the Department of Civil Protection has been crucial in helping Italians understand the extent of the crisis, and Prime Minister Giuseppe Conte, who has received credit for his performance during the crisis, increasing his approval ratings, personally owned the government’s decisions, talking to Italians and announcing the introduction of new measures on streamed social media press conferences.32 However, these press conferences have sometimes been streamed late at night, somewhat undermining the intended collective reach; unofficial statements of ideas for measures33 have been shared publicly, unnecessarily stirring reactions; and, ultimately, Italy’s systemic use of officialese has often made the hyper-bureaucratic decrees hard to decipher, leaving Italians with more questions than answers.

    What Lies Ahead?

    Many sacrifices were made, from staying indoors on beautiful spring days or not seeing a loved one for an extended period of time, to the long hours worked by doctors and nurses to guarantee care. Much has been lost too, from jobs and livelihoods to the lives of fellow citizens.

    Italians are now eager to get moving despite the many uncertainties lying ahead and the looming economic crisis. Patience and caution will still be needed because the road back to normal will likely be long and socially, economically, and politically bumpy. In the meantime, the government has approved the text of a law decree,34 which has been nicknamed rilancio – comeback, mirroring the country’s mood, and it will come into force once it is officially published on the Gazzetta Ufficiale della Repubblica Italiana. The decree – a de facto recovery plan – was supposed to be introduced in April, but given the magnitude of the plan, worth 55 billion euros, lengthy negotiations stalled its deliberation within the Council of Ministers. With over 250 articles, the decree is aimed at laying the foundations for Italy’s recovery with temporary measures and introducing changes that may help address some of the pre-existing systemic weaknesses.

    Measures will include fiscal discounts, grants, and emergency income and allowances to support businesses, workers, families, and hard-hit sectors such as tourism.35 Significant investments will be made to empower the national health system, building on the lessons learned to attain readiness for future health emergencies: local health networks will be strengthened to enhance assistance, prevention and monitoring, intensive care hospital beds will increase from 5,179 to 11,109, and additional personnel will be hired.36 The school system will also receive funds to prepare its infrastructure to safely welcome back students and invest in digitalization. The decree also aims to reduce irregular, off-the-books employment for domestic workers and seasonal agricultural laborers (this is an important measure that will hopefully have an impact on the illegal, criminal practice of caporalato). Finally, acknowledging the hurdles posed by hyper-bureaucratization that have hindered initial payments, the decree aims to simplify and streamline some bureaucratic processes and procedures, to ensure timely disbursement of the much-needed benefits and liquidity.

    The decree and its measures will not be the panacea to Italy’s post-COVID-19 situation, but it definitely is a first, important step. Some measures will bring temporary relief, some might bring about long-term changes, and additional measures will be needed. The opposition forces have already voiced37 criticism, and it will be up to them to improve the decree in Parliament through amendments, which the Prime Minister has openly invited them to do.

    As they say, in every crisis there are opportunities, and the challenge will be seizing them through hard work, patience and, most importantly, political unity and political will.

    Disclaimer: The piece was submitted on May 16, and the situation may have evolved since then.

    Chiara De Cuia is a terrorism and security analyst living in Rome and the deputy director of NextGen 5.0. She holds a master’s degree in Security Studies from Georgetown University’s School of Foreign Service.