In the weeks when all of Italy was ordered indoors – no soccer games, no cafes or bars, no church services – the country made slow progress in containing its severe outbreak of the corona virus.
There are signs of hope: even as the number of cases increases, the infection rate slows under the nationwide ban. However, Italy remains liable for errors made prior to its entry into force.
More than 124,000 people in Italy have tested positive for Covid-19, the disease caused by the new coronavirus, since the outbreak began. The country that has recorded more than 15,000 deaths now has the highest number of coronavirus deaths in the world – and it is still increasing.
Some scientists say that Italian officials have acted decisively to stop the virus early, and have underestimated its risk and rate of spread. "We found that the virus was late here," said Roberto Burioni, one of Italy's leading virologists. "It was already spreading."
Any decision to relax now and relax movement restrictions warned the health authorities of a new wave of infections. "We have not yet peaked and have not yet peaked," said Silvio Brusaferro, head of the Italian national health institute, at a recent press conference.
The number of new coronavirus cases in Italy seems to be decreasing …
… but it takes longer for the number of new deaths fall.
Source: Italian Ministry of Civil Protection
Given the continuing seriousness of the crisis, Italy extended its hold until at least mid-April, with most government and health authorities recommending that the measures be kept in force even longer.
"If we started to relax the measures, all of our efforts so far would have been in vain," said Prime Minister Giuseppe Conte at a press conference on Wednesday. “We would pay a very high price. We ask everyone to continue to respect the measures. "
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This message may be difficult to hear for the 60 million who have spent the last month in their homes and whose patience is waning. However, public health experts stress that Italy's safe release from the block requires not only greater security, that the spread of the infection has slowed significantly, but also assurance that the country can prevent another immediate outbreak.
"A robust test, trace and quarantine system must be in place before you can unlock these measures," said Thomas Hale, a professor of public policy at Oxford University, who has followed government responses to the corona virus worldwide. "In Japan we saw a country that thought it was in control, but may now need to be seriously banned."
Fortunately, Italy has some evidence that "flattening the curve" of new infections is possible within its own borders. Northern provinces such as Lodi and Padua, which responded to the outbreak faster than their neighbors, are already seeing a steady decline in new infections. They provide clues as to how the whole country can emerge from its closure.
Locked and waiting
By March 8, the government had instructed most regions in northern Italy to close schools and ban sporting events and large gatherings. A curfew closed at 6 p.m.
The nationwide ban that came into effect on March 10 continued and prohibited all nonessential movements and required permission to travel for work, health, or “other necessities” such as groceries. Police checkpoints have been set up across the country, and those who have been stopped have to fill out official forms explaining their movements.
These extreme measures seem to have worked: people stopped moving.
The locks have been reduced how far people have traveled compared to trips before the outbreak.
After a partial ban on February 23, residents of Lodi Province only traveled 30 percent as far as before.
The national blocking It started on March 10th and stopped the trip for most people in Italy.
Italians cut their trip by more than 50 percent after the blockade was extended to cover most of northern Italy.
After a partial ban on February 23, residents of Lodi Province only traveled 30 percent as far as before.
Italians cut their trip by more than 50 percent after the blockade was extended to cover most of northern Italy.
The national blocking It started on March 10th and stopped the trip for most people in Italy.
The national blocking It started on March 10th and stopped the trip for most people in Italy.
After a partial ban on February 23, residents of Lodi Province only traveled 30 percent as far as before.
Italians cut their trip by more than 50 percent after the blockade was extended to cover most of northern Italy.
After a partial ban on February 23, residents of Lodi Province only traveled 30 percent as far as before.
Italians cut their trip by more than 50 percent after the blockade was extended to cover most of northern Italy.
The national blocking It started on March 10th and stopped the trip for most people in Italy.
After a partial ban on February 23, residents of Lodi Province only traveled 30 percent as far as before.
Italians cut their trip by more than 50 percent after the blockade was extended to cover most of northern Italy.
The national blocking It started on March 10th and stopped the trip for most people in Italy.
Note: To calculate the reduction in travel expenses, the researchers drew a circle around all the points that people visited in each period. The reductions in each province reflect the change in the average distance traveled per person.· ·Source: Data compiled for the New York Times based on an article by Pepe et al.
Researchers who looked at anonymized smartphone data found that Italians stayed much closer to home after the locks were imposed. In the week after the national ban, they traveled an average of 20 percent as far as before. (The middle person traveled even less: just a tenth of their usual distance.)
At this point, however, the virus had enough time to spread. And almost a month after the national ban, Italy still added around 2,500 new cases a day.
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Scientists say trajectory is expected. Because the virus has an incubation period of up to two weeks, new cases reflect infections that may have occurred days or weeks earlier. This means that even the strictest locks will not give instant results.
"This is the frustrating thing," said Dr. Burioni. “You have to wait 15 days to see if there is an effect. In the meantime, all you have to do is hold your breath. "
Lombardy, the northern region where the outbreak was first discovered, is most affected: the region accounts for around 40 percent of the country's confirmed cases and more than 50 percent of deaths. Lombardy may also be the first area in Italy to see the positive effects of the closure.
Local bans seem to have slowed the spread of the virus even in Lombardy. Provinces that previously restricted mobility were able to lower the infection rate earlier.
The growth in new cases of coronavirus per capita varies between the provinces of Lombardy.
Note: Government official case dates begin on February 24, although there were cases prior to that date. Source: Italian Ministry of Civil Protection.
Lodi, the province south of Milan where the first cases occurred, closed several cities on February 24th. The neighboring provinces of Bergamo and Milan did not restrict the movement until the national government blocked most of them north two weeks later.
Lodi managed to smooth out his curve, while in some other provinces of Lombardy more cases per day occurred until the end of March. Giovanni Sebastiani, mathematician at the Italian National Research Council, said that Lodi's experience had shown "that if the closures had occurred earlier, we would likely have reduced the spread of the epidemic."
Unlock
Countries around the world will be watching Italy to see if it eases restrictions later this month and what happens when and when.
Mr. Brusaferro, head of the country's health department, told reporters that Italy is in an enviable position of being the first in the West: first to see a serious outbreak, first to block its citizens, and first to decide what comes next.
"We have to avoid any action that causes the curve to rise again," he said at a press conference on Tuesday. "There are no studies or literature on this. We examine scenarios that have never been taken up by countries that resemble Italy. Other nations see us as a pilot program. "
According to public health experts, there is no ideal time frame for blocking. The growing international consensus is that an area that continues to see a slowdown in case growth – ideally close to zero new cases a day – can ease the restrictions. Italy could start reopening schools or businesses in certain regions or loosening the rules for social distance.
The other important consideration is how well Italy can continue testing people for the virus and tracking their contacts to prevent a second outbreak.
In South Korea, widespread tests have enabled health authorities to identify infections early and to quarantine sick people, even in people who showed no symptoms. Public health officials then tracked down anyone an infected person may have had contact with, slowly eliminating the spread of the virus.
In Italy, the Veneto region, an area with around five million inhabitants in the north, is already well ahead in tests. The regional government there plans to achieve 20,000 tests a day this month.
Veneto leads Italy in the number of Tests per capita.
Source: Italian Ministry of Civil Protection
However, given the limited availability of tests and the capacity of sampling laboratories, it is difficult to scale up the tests. Next up is the more difficult part: tracking the contacts of those who tested positive for the virus and asking those who are in contact with an infected person to isolate themselves and get tested.
Rosalind Eggo, an infectious disease modeler at the London School of Hygiene and Tropical Medicine, estimates that public health officials would need to find between 20 and 100 contacts for each infected person, depending on the activity of a person, before they test positive. Efforts are being made to achieve greater digital contact tracking, but these are still being developed.
It is currently safest for Italy to maintain the lock – even longer than absolutely necessary – to ensure that the virus does not spread.
"When we relax, is it better if we relax at schools, at work, or with social interactions?" Asked Dr. Eggo. "Which of these interventions can we relax? It's a really big question we're trying to answer. We have never been in this situation. It is unprecedented. "
