Italy’s health officials cite the high public acceptance of restrictions such as compulsory mask wearing © Guglielmo Mangiapane/Reuters

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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.

New daily cases are on the rise to 1,535 from the low hundreds in June, when restrictions started easing. But this compares with more than 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.

Chart showing that new cases in Italy are rising at a much slower pace than in peer countries

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 has been more gradual, 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.

Companies have been encouraged to extend remote working arrangements into the autumn with the government guaranteeing staff workplace insurance in their homes. Those that have reopened have strict protocols — including the wearing of face mask all day, daily body temperature scans, social distancing and free Covid-19 swabs.

Chart showing that Italy was an early adopter of widespread mask-wearing

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.

Italy’s public health response has focused on mass testing and effective track and trace surveillance © Diana Bagnoli/Getty
Rome’s Trevi fountain. Italian media said in August that a man nearby was fined €400 for refusing to wear a mask © Guglielmo Mangiapane/Reuters

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”. Businesses can be held responsible for Covid-19 infections in their premises and staff can claim damages.

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.

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Individual behaviour, although hard to quantify, has played an important role, said Ferdinando 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

Mr Crisanti said the public health response had focused not just on mass testing but 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.

Chart showing the share of Italy’s tests coming back positive remains relatively low

“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 the island of Sardinia, a popular holiday destination for Italians, emerged as a hotspot for the virus — former prime minister Silvio Berlusconi and Formula One boss Flavio Briatore both contracted the virus there — authorities introduced drive-through testing at the port of Civitavecchia, the ferries hub on the mainland. 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 Silvia Borrelli in Milan, Daniel Dombey in Madrid, Adrienne Klasa in London and Victor Mallet in Paris

Letter in response to this article:

How the virus is rewriting the Italian caricature / From Chris Crowcroft, Elstree, Hertfordshire, UK

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