Phase two: Italy considers how to move on after coronavirus peak

Nearly a month after a nationwide lockdown was implemented to prevent the spread of the virus that was ravaging through Italy’s north, there are government discussions and public debate about moving to “phase two” – a period during which citizens will have to learn to live with the virus and one which could risk another outbreak.

Italy is in the unfortunate position of being two to three weeks ahead of other European countries in fighting the coronavirus pandemic.

As the country with the most fatalities – more than 17,000 recorded coronavirus deaths, Italy’s next moves will be closely watched.

The country has been reviewing its lockdown measures every two weeks by presidential decree; the next time they will be revisited will be April 13.

While figures suggest that the measures have achieved some level of success in slowing the rate of infection, it is likely they will remain in place over the coming Easter period, usually a time for gathering and celebration.

More than 135,000 people in Italy are reported to have contracted coronavirus, according to Johns Hopkins University a number that is known to be only the “tip of the iceberg”.

The number of victims is also believed to be unreliable as it does not indicate the actual cause of death for those who tested positive, or include those who died at home or in care homes without being tested.

The government has yet to announce any dates or official measures relating to the second phase, but discussions have so far focused on reopening some factories and businesses where workers can maintain social distancing.

Easing some restrictions on citizens’ movement is also being considered.

“We are working on hypotheses for politicians to take into account,” Roberto Bernabei, who is part of the scientific-technical committee advising the government, told Al Jazeera. “Options that are credible and, as far as possible, supported by scientific analysis.”

‘Comforting data’

Early signs that Italy’s outbreak was stabilising began to appear last week.

The Italian civil protection agency said the number of new infections had begun to decrease. But the daily recorded death toll remains high, 604 on Tuesday.

“Comforting data include the number of people who are admitted to hospital, which gives us a more accurate indication of how the epidemic is evolving compared with other data,” Matteo Villa, who has been crunching statistics for the Italian Institute for International Political Studies, told Al Jazeera.

“The number of people admitted to hospital has stopped growing in nearly all regions [of Italy], despite them having started the lockdown at different stages of the epidemic,” Villa said, adding that this was a sign that the lockdown measures have worked.

Hospitals in badly hit areas that were overstretched at the height of the emergency are beginning to see a manageable caseload.

“We can breathe again,” said Michele Tempesta, head of intensive care at a hospital in Pesaro, a city in the central Italian region of Le Marche, where ICU capacity was increased from seven beds to 40 at the height of the crisis. 

During the peak, almost all of the hospital’s departments were shut except for emergency procedures, and an entire building was converted to care for COVID-19 patients.

“We currently have 25 beds in intensive care, but we remain on the alert for a second wave. We can’t go back to normal yet,” Tempesta said, “We fear what could happen when they reopen.”

Italy’s health minister Roberto Speranza said the government is looking at establishing COVID-19-only hospitals to avoid others facilitating the virus’ spread.

Living apart

In phase two, Italians will have to learn to live with the coronavirus as they return to some normality, but extra care will still be needed.

Pier Luigi Lopalco, professor of hygiene and preventive medicine at the University of Pisa, told Al Jazeera: “First of all, we will need to keep in mind the continued possibility of contagion within the community. 

“For that, we will need to continue respecting social distancing, avoiding crowded places and wear protective masks.”

But along with other European countries, Italy has been struggling to provide its medical staff with protective equipment, including masks.

Some manufacturers have offered to transform their operations to produce them, but bureaucracy is burdensome and with each person needing two masks a day for safety, demand is extremely high.

“We also need to equip the health service with an efficient monitoring method, so that as soon as there is a new suspected outbreak, the system as a whole can react immediately,” Lopalco added.

 

New solutions

While epidemiologists have long used “contact tracing” to control the spread of infectious diseases, researchers are rushing to develop apps using mobile phone data to track if a person has been in close contact with someone who is infected.

Concerns about surveillance and privacy have prompted researchers to develop apps that avoid using GPS location or other sensitive data.

An Oxford University study, for instance, bases its model on logging all users a person has been in contact with via low-energy Bluetooth technology.

Italy wants to increase its testing rate. 

It is only behind Germany in Europe in the number of tests it has carried out, but these have remained largely limited to those admitted to hospital.

Scientists are also rushing to develop antibody tests, which would allow the government to identify asymptomatic cases and therefore establish how widespread the infection really has been. These could also determine how many people may have developed some immunity.

These tests are still undergoing trials, but, according to Lopalco, are unlikely to influence decision-making at the national level.

“Other than in hardly hit areas such as Wuhan [in China] and Codogno [in Italy], where the virus saw a very high circulation, the rest of the population is unlikely to have developed antibodies, and looking for them isn’t of much use,” Lopalco argued.

It also remains unclear whether the antibodies these tests detect really shield those who have them.

“Any measure we implement going forwards should work on the assumption that the whole population remains vulnerable,” Lopalco said.