COVID-19 pandemic in Italy
The COVID-19 pandemic in Italy was part of the COVID-19 pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The virus was first confirmed to have spread to Italy on 31 January 2020, when two Chinese tourists in Rome tested positive for the virus. One week later an Italian man repatriated to Italy from the city of Wuhan, China, was hospitalized and confirmed as the third case in Italy. Clusters of cases were later detected in Lombardy and Veneto on 21 February, with the first deaths on 22 February. By the beginning of March, there had been confirmed cases in all regions of Italy.
On 31 January, the Italian government suspended all flights to and from China and declared a state of emergency. In February, eleven municipalities in northern Italy were identified as the centres of the two main Italian clusters and placed under quarantine. The majority of positive cases in other regions traced back to these two clusters. On 8 March 2020, Prime Minister Giuseppe Conte expanded the quarantine to all of Lombardy and 14 other northern provinces, and on the following day to all of Italy, placing more than 60 million people in lockdown. On 11 March 2020, Conte prohibited nearly all commercial activity except for supermarkets and pharmacies. On 21 March, the Italian government closed all non-essential businesses and industries, and restricted movement of people. In May, many restrictions were gradually eased, and on 3 June, freedom of movement across regions and other European countries was restored. In October, Italy was hit by the second wave of the pandemic, which brought the government to introduce further restrictions on movement and social life, which were gradually eased in mid-2021.
By 18 January, Italy had tested about 48 million people. Due to the limited number of tests performed, the real number of infected people in Italy, as in other countries, is estimated to be higher than the official count. In May 2020, the Italian National Institute of Statistics (Istat) estimated 11,000 more deaths for COVID-19 in Italy than the confirmed ones. This estimation was later confirmed in October 2020 by a second Istat report. In March 2021, Istat published a new report in which it detected an excess mortality of 100,526 deaths in 2020, compared to the average of the previous five years. Moreover, 2020 became the year with the highest number of deaths since 1945, when Italy was fighting in World War II on its soil.
During the peak of the pandemic, Italy's number of active cases was one of the highest in the world. As of 17 March 2023, Italy has 141,988 active cases. Overall, there have been 26,969,918 confirmed cases and 198,523 deaths (a rate of 3,329.8555 deaths per million population), while there have been 25,320,467 recoveries or dismissals.
As of 4 February 2023, a total of 150,178,254 vaccine doses have been administered.
On 31 December 2019, the Health Commission of Wuhan, Hubei, China, informed the WHO about a cluster of acute pneumonia cases with unknown origin in its province. On 9 January 2020, the Chinese Center for Disease Control and Prevention (CCDC) reported the identification of a novel coronavirus (later identified as the SARS-CoV-2) as the cause. In late January 2020, following the developments of COVID-19 outbreak in mainland China, on 3 February, Italy set up enhanced screening measures, including thermal cameras and medical staff at airports.
The pandemic outbreak heightened the pressure on the Italian healthcare system.
Lombardy authorities adopted a specific policy advising that care home residents aged over 75 with frailty and with COVID-19 be cared for within care homes, which generally meant no supplemental oxygen. A Milan care home's management fired 5 workers who reported they hid cases of infected workers, even barring them from using PPE to avoid scaring residents.
On 9 March, Alessia Bonari, a nurse from Grosseto who worked at a hospital in Milan, posted on Instagram stating that she was physically strained from being overworked and was scared to work after treating over 10,000 patients who have tested positive. Bonari and her co-workers had been extremely exhausted due to the pressures of work, and according to her, health caretakers had been working in uncomfortable conditions. The post, which reached global notoriety, contained a photo of her bruised face from wearing unfit masks and hazmat goggles, and stated that "the protective devices are bad." She concluded her post persuading others "to be selfless, to stay at home and thus protect those who are most fragile."
On 17 March, undersecretary at the Ministry of Health Sandra Zampa announced the purchase of many new ventilators as well as the importing of one and a half million masks from South Africa.
To deal with the numbers of COVID-19 patients, intensive care units were expanded, and new hospitals were created, especially in Lombardy. In Emilia-Romagna, professor Marco Ranieri developed a method to double the efficiency of ventilators in ICUs. The lack of a single protocol for hospitals was considered to be a problem.
Due to hospitals overcrowding with coronavirus patients, thousands of cancer patients experienced difficulties in getting access to treatment and transplants, with their lives put at even higher risk. Dozens of cancer hospital sections were indeed either dedicated to host coronavirus wards, or closed after personnel got infected. According to a study, cancer patients represented 17% of coronavirus fatalities in Italy.
In March 2020, oncologist Luigi Cavanna of the hospital of Piacenza was one of the first physicians in Italy to focus on house calls, realising that too many critically ill COVID-19 patients were arriving at his hospitals and that some of them could have been treated earlier at home before a possible escalation of the symptoms.
A letter published on the NEJM Catalyst Innovations in Care Delivery claimed that one of the reasons for the high death count in the area of Bergamo was hospital contamination. Progressively, different hospitals became dedicated to COVID-19 patients only, and more rigid separations were set up between hospital sections and triage structures. In some regions, hotels were used to host healthcare workers or patients, and in Liguria a ship was adapted to host people in quarantine. On 1 April, the first Italian drive-through testing facilities opened in Alessandria and in north-western Tuscany.
At least ten different clinical trials were ongoing in Italian hospitals at the beginning of April. The supercomputer of ENEA in Portici was used to run advanced simulations related to other possible drugs. Some of the treatments employed for COVID-19 patients involved the administration of antiviral drugs. Remdesivir was tested with promising initial results in Naples. Despite doubts from the scientific community, Avigan (favipiravir) was also included in testing protocols by Italian Medicines Agency (AIFA) even though it was not authorised in Europe. Similarly to France, hydroxychloroquine (the less toxic version of the malaria drug chloroquine) was also tested: in Lazio, its use was reported by the second week of April on a significant fraction of the roughly a thousand COVID-19 patients confined at home. Later prohibited by AIFA, the use of hydroxychloroquine was approved again in December by the Council of State upon request of some general practitioners.
Plasma treatment already tried in China (transfer of antibodies from recovered COVID-19 patients to sick people) was tested at the hospital of Pavia (and later in Mantua) under the supervision of professor Cesare Perotti; the first two donors involved in the research programme were a married couple, both doctors and among the first COVID-19 patients reported in the province. The final results published in May showed a reduction in mortality. In the beginning of April, based on the results of autopsies showing the presence of micro-thrombosis in the lungs of COVID-19 patients, doctors in Tuscany and other areas of northern Italy started to use heparin to reduce the risk of blood clotting; the news was originally circulating on social media from internal chats of healthcare workers and considered a hoax by virologist Roberto Burioni, but protocols including low-molecular-weight heparin were formally submitted as a treatment proposal to AIFA. A programme involving 14 research centres was approved on 13 April.
The workforce of the healthcare system underwent massive reorganisation. Pediatricians were assigned to adult patients and as a result, their insurance coverage had to be adapted. Retired professionals were asked to go back to work to fill the vacancies, despite the high risk for their age group. At the peak of the pandemics volunteers from the rest of the country were sent to hospitals in critical areas of northern and central Italy.
Healthcare workers were also affected by coronavirus infections, with a higher percentage of the infected healthcare workers being women because of their predominance among nurses. This resulted in death in a considerable number of cases, especially amongst general practitioners. By the end of March, more than 60 doctors in Italy had died with COVID-19, and the figure increased to 80 by 4 April and later 145 by 22 April. Healthcare personnel were also subject to high levels of stress, and the risk of professional burn-out was considered high, particularly across nurses and in more affected areas. Two suicides, one of a nurse in Jesolo and one of a nurse in Monza, were assumed to be related to psychological pressure.
The emergency was an occasion to test or develop new protocols based on digital technologies. With the aim of reducing consumption of protective equipment, robots were introduced in hospitals in Varese, and remote diagnostics were introduced to monitor home care patients in Lodi. To facilitate home calls from patients, Istituto Italiano di Tecnologia in Genoa (IIT) and Istituto di robotica e macchine intelligenti (I-RIM) designed a robot for video calls that could be assembled by hospital personnel and that was tested at the end of April in Pisa, Massa-Carrara and Induno Olona.
The pandemic provoked large economic damage to the Italian economy. The sectors of tourism, accommodation and food services were among the hardest hit by foreign countries' limitations to travel to Italy, and by the nationwide lockdown imposed by the government on 8 March. By April, finance minister Roberto Gualtieri predicted a 6% GDP decline for 2020.
On 12 March, the Italian stock market was among the worst hit during Black Thursday, when the FTSE MIB index lost 17% of its value in one day.
Multiple factories, like Fiat Chrysler, halted production in some of their plants. On 21 March, the government issued the shutdown of all non-essential businesses, industries, and economic activities.
The Economist predicts a 7% GDP decline for Italy in 2020. Economist Alberto Bisin forecast that Italy's debt-to-GDP ratio would rise from 130% to 180% by the end of the year, due to borrowing and losses. Multiple economists believe that Italy will struggle to pay back its debt.
Although the virus has hit northern Italy hardest, economically deprived areas of southern Italy are suffering the most from the lockdown. Many residents of those areas work in the grey economy and are therefore not eligible for unemployment benefits. In some places the Italian mafia was reported to be delivering groceries to needy residents. Prosecutors warned that the mafia was not acting out of altruism and was instead seeking control over residents.
Some Italian small and medium-sized enterprises partially or totally converted their production to supply personal protective equipment at a local scale. Many of these items could not be approved for hospital use, but they were considered useful to supply demand for the general population.
In Veneto, Grafica Veneta – the printing company of the Harry Potter books in Italian – started to mass-produce protective masks. In Piedmont, Ci.Ti.Elle, a company from Castiglione Torinese specialising in textiles for hotels, put its twelve employers to assembling surgical masks for the regional Protezione Civile, and the hospitals of San Maurizio Canavese, Alessandria and Chivasso, with the support the Filmar company from Caselle for the elastics.[306] In Lombardy Cifra, a manufacturer from Verano Brianza specialising in sportswear, also converted its production line. In the textile district of the province of Prato, the Machattie company started production of polypropylene masks in March, and the Dreoni company in Vaiano switched its production from car upholstery to protective masks with certified standard, with the help of the local population (its owner later died of COVID-19).
Companies producing alcoholic beverages also underwent reconversion to produce alcohol-based hand sanitiser. In Piedmont this occurred in Canelli at the Ramazzotti factory (part of the Pernod Ricard group) and in Chieri at the Martini plant.
Isinnova, a local engineering startup from Brescia, provided emergency solutions to local hospitals to compensate the shortages of spare parts for the machines. Firstly, they produced venturi valves for respirators using 3D printers, and later (in collaboration with Decathlon) they adapted a snorkelling mask into a non-invasive ventilator. Using 3D-printer technology as well, Elmec Informatica started to produce for the hospital of Busto Arsizio, sterilisable protective masks in thermoplastic polyurethanes that could adapt to Continuous positive airway pressure (CPAP) antiviral filters. The Italian National Mint and Printing House used the plastic film applied to identity cards to produce face shields.
On 25 March, Italy, together with Belgium, France, Greece, Ireland, Luxembourg, Portugal, Slovenia, and Spain, sent a joint letter to the Council of the EU, calling for the issuing of a new common debt instrument, nicknamed in the media as "eurobond" or "corona bond", to help funding the measures taken against the COVID-19 pandemic and the expected economic downturn to follow. In subsequent conference calls between the leaders of the EU member states, the proposal saw the opposition of the Netherlands and Germany.
On 9 April, after two meetings of the Eurogroup, the ministers of Finances of the Eurozone countries agreed to €500 billion aid, including the possibility of using the ESM, but without common debt instruments.
The virus was first confirmed to have spread to Italy on 31 January 2020, when two Chinese tourists in Rome tested positive for the virus. One week later an Italian man repatriated to Italy from the city of Wuhan, China, was hospitalized and confirmed as the third case in Italy. Clusters of cases were later detected in Lombardy and Veneto on 21 February, with the first deaths on 22 February. By the beginning of March, there had been confirmed cases in all regions of Italy.
On 31 January, the Italian government suspended all flights to and from China and declared a state of emergency. In February, eleven municipalities in northern Italy were identified as the centres of the two main Italian clusters and placed under quarantine. The majority of positive cases in other regions traced back to these two clusters. On 8 March 2020, Prime Minister Giuseppe Conte expanded the quarantine to all of Lombardy and 14 other northern provinces, and on the following day to all of Italy, placing more than 60 million people in lockdown. On 11 March 2020, Conte prohibited nearly all commercial activity except for supermarkets and pharmacies. On 21 March, the Italian government closed all non-essential businesses and industries, and restricted movement of people. In May, many restrictions were gradually eased, and on 3 June, freedom of movement across regions and other European countries was restored. In October, Italy was hit by the second wave of the pandemic, which brought the government to introduce further restrictions on movement and social life, which were gradually eased in mid-2021.
By 18 January, Italy had tested about 48 million people. Due to the limited number of tests performed, the real number of infected people in Italy, as in other countries, is estimated to be higher than the official count. In May 2020, the Italian National Institute of Statistics (Istat) estimated 11,000 more deaths for COVID-19 in Italy than the confirmed ones. This estimation was later confirmed in October 2020 by a second Istat report. In March 2021, Istat published a new report in which it detected an excess mortality of 100,526 deaths in 2020, compared to the average of the previous five years. Moreover, 2020 became the year with the highest number of deaths since 1945, when Italy was fighting in World War II on its soil.
During the peak of the pandemic, Italy's number of active cases was one of the highest in the world. As of 17 March 2023, Italy has 141,988 active cases. Overall, there have been 26,969,918 confirmed cases and 198,523 deaths (a rate of 3,329.8555 deaths per million population), while there have been 25,320,467 recoveries or dismissals.
As of 4 February 2023, a total of 150,178,254 vaccine doses have been administered.
On 31 December 2019, the Health Commission of Wuhan, Hubei, China, informed the WHO about a cluster of acute pneumonia cases with unknown origin in its province. On 9 January 2020, the Chinese Center for Disease Control and Prevention (CCDC) reported the identification of a novel coronavirus (later identified as the SARS-CoV-2) as the cause. In late January 2020, following the developments of COVID-19 outbreak in mainland China, on 3 February, Italy set up enhanced screening measures, including thermal cameras and medical staff at airports.
The pandemic outbreak heightened the pressure on the Italian healthcare system.
Lombardy authorities adopted a specific policy advising that care home residents aged over 75 with frailty and with COVID-19 be cared for within care homes, which generally meant no supplemental oxygen. A Milan care home's management fired 5 workers who reported they hid cases of infected workers, even barring them from using PPE to avoid scaring residents.
On 9 March, Alessia Bonari, a nurse from Grosseto who worked at a hospital in Milan, posted on Instagram stating that she was physically strained from being overworked and was scared to work after treating over 10,000 patients who have tested positive. Bonari and her co-workers had been extremely exhausted due to the pressures of work, and according to her, health caretakers had been working in uncomfortable conditions. The post, which reached global notoriety, contained a photo of her bruised face from wearing unfit masks and hazmat goggles, and stated that "the protective devices are bad." She concluded her post persuading others "to be selfless, to stay at home and thus protect those who are most fragile."
On 17 March, undersecretary at the Ministry of Health Sandra Zampa announced the purchase of many new ventilators as well as the importing of one and a half million masks from South Africa.
To deal with the numbers of COVID-19 patients, intensive care units were expanded, and new hospitals were created, especially in Lombardy. In Emilia-Romagna, professor Marco Ranieri developed a method to double the efficiency of ventilators in ICUs. The lack of a single protocol for hospitals was considered to be a problem.
Due to hospitals overcrowding with coronavirus patients, thousands of cancer patients experienced difficulties in getting access to treatment and transplants, with their lives put at even higher risk. Dozens of cancer hospital sections were indeed either dedicated to host coronavirus wards, or closed after personnel got infected. According to a study, cancer patients represented 17% of coronavirus fatalities in Italy.
In March 2020, oncologist Luigi Cavanna of the hospital of Piacenza was one of the first physicians in Italy to focus on house calls, realising that too many critically ill COVID-19 patients were arriving at his hospitals and that some of them could have been treated earlier at home before a possible escalation of the symptoms.
A letter published on the NEJM Catalyst Innovations in Care Delivery claimed that one of the reasons for the high death count in the area of Bergamo was hospital contamination. Progressively, different hospitals became dedicated to COVID-19 patients only, and more rigid separations were set up between hospital sections and triage structures. In some regions, hotels were used to host healthcare workers or patients, and in Liguria a ship was adapted to host people in quarantine. On 1 April, the first Italian drive-through testing facilities opened in Alessandria and in north-western Tuscany.
At least ten different clinical trials were ongoing in Italian hospitals at the beginning of April. The supercomputer of ENEA in Portici was used to run advanced simulations related to other possible drugs. Some of the treatments employed for COVID-19 patients involved the administration of antiviral drugs. Remdesivir was tested with promising initial results in Naples. Despite doubts from the scientific community, Avigan (favipiravir) was also included in testing protocols by Italian Medicines Agency (AIFA) even though it was not authorised in Europe. Similarly to France, hydroxychloroquine (the less toxic version of the malaria drug chloroquine) was also tested: in Lazio, its use was reported by the second week of April on a significant fraction of the roughly a thousand COVID-19 patients confined at home. Later prohibited by AIFA, the use of hydroxychloroquine was approved again in December by the Council of State upon request of some general practitioners.
Plasma treatment already tried in China (transfer of antibodies from recovered COVID-19 patients to sick people) was tested at the hospital of Pavia (and later in Mantua) under the supervision of professor Cesare Perotti; the first two donors involved in the research programme were a married couple, both doctors and among the first COVID-19 patients reported in the province. The final results published in May showed a reduction in mortality. In the beginning of April, based on the results of autopsies showing the presence of micro-thrombosis in the lungs of COVID-19 patients, doctors in Tuscany and other areas of northern Italy started to use heparin to reduce the risk of blood clotting; the news was originally circulating on social media from internal chats of healthcare workers and considered a hoax by virologist Roberto Burioni, but protocols including low-molecular-weight heparin were formally submitted as a treatment proposal to AIFA. A programme involving 14 research centres was approved on 13 April.
The workforce of the healthcare system underwent massive reorganisation. Pediatricians were assigned to adult patients and as a result, their insurance coverage had to be adapted. Retired professionals were asked to go back to work to fill the vacancies, despite the high risk for their age group. At the peak of the pandemics volunteers from the rest of the country were sent to hospitals in critical areas of northern and central Italy.
Healthcare workers were also affected by coronavirus infections, with a higher percentage of the infected healthcare workers being women because of their predominance among nurses. This resulted in death in a considerable number of cases, especially amongst general practitioners. By the end of March, more than 60 doctors in Italy had died with COVID-19, and the figure increased to 80 by 4 April and later 145 by 22 April. Healthcare personnel were also subject to high levels of stress, and the risk of professional burn-out was considered high, particularly across nurses and in more affected areas. Two suicides, one of a nurse in Jesolo and one of a nurse in Monza, were assumed to be related to psychological pressure.
The emergency was an occasion to test or develop new protocols based on digital technologies. With the aim of reducing consumption of protective equipment, robots were introduced in hospitals in Varese, and remote diagnostics were introduced to monitor home care patients in Lodi. To facilitate home calls from patients, Istituto Italiano di Tecnologia in Genoa (IIT) and Istituto di robotica e macchine intelligenti (I-RIM) designed a robot for video calls that could be assembled by hospital personnel and that was tested at the end of April in Pisa, Massa-Carrara and Induno Olona.
The pandemic provoked large economic damage to the Italian economy. The sectors of tourism, accommodation and food services were among the hardest hit by foreign countries' limitations to travel to Italy, and by the nationwide lockdown imposed by the government on 8 March. By April, finance minister Roberto Gualtieri predicted a 6% GDP decline for 2020.
On 12 March, the Italian stock market was among the worst hit during Black Thursday, when the FTSE MIB index lost 17% of its value in one day.
Multiple factories, like Fiat Chrysler, halted production in some of their plants. On 21 March, the government issued the shutdown of all non-essential businesses, industries, and economic activities.
The Economist predicts a 7% GDP decline for Italy in 2020. Economist Alberto Bisin forecast that Italy's debt-to-GDP ratio would rise from 130% to 180% by the end of the year, due to borrowing and losses. Multiple economists believe that Italy will struggle to pay back its debt.
Although the virus has hit northern Italy hardest, economically deprived areas of southern Italy are suffering the most from the lockdown. Many residents of those areas work in the grey economy and are therefore not eligible for unemployment benefits. In some places the Italian mafia was reported to be delivering groceries to needy residents. Prosecutors warned that the mafia was not acting out of altruism and was instead seeking control over residents.
Some Italian small and medium-sized enterprises partially or totally converted their production to supply personal protective equipment at a local scale. Many of these items could not be approved for hospital use, but they were considered useful to supply demand for the general population.
In Veneto, Grafica Veneta – the printing company of the Harry Potter books in Italian – started to mass-produce protective masks. In Piedmont, Ci.Ti.Elle, a company from Castiglione Torinese specialising in textiles for hotels, put its twelve employers to assembling surgical masks for the regional Protezione Civile, and the hospitals of San Maurizio Canavese, Alessandria and Chivasso, with the support the Filmar company from Caselle for the elastics.[306] In Lombardy Cifra, a manufacturer from Verano Brianza specialising in sportswear, also converted its production line. In the textile district of the province of Prato, the Machattie company started production of polypropylene masks in March, and the Dreoni company in Vaiano switched its production from car upholstery to protective masks with certified standard, with the help of the local population (its owner later died of COVID-19).
Companies producing alcoholic beverages also underwent reconversion to produce alcohol-based hand sanitiser. In Piedmont this occurred in Canelli at the Ramazzotti factory (part of the Pernod Ricard group) and in Chieri at the Martini plant.
Isinnova, a local engineering startup from Brescia, provided emergency solutions to local hospitals to compensate the shortages of spare parts for the machines. Firstly, they produced venturi valves for respirators using 3D printers, and later (in collaboration with Decathlon) they adapted a snorkelling mask into a non-invasive ventilator. Using 3D-printer technology as well, Elmec Informatica started to produce for the hospital of Busto Arsizio, sterilisable protective masks in thermoplastic polyurethanes that could adapt to Continuous positive airway pressure (CPAP) antiviral filters. The Italian National Mint and Printing House used the plastic film applied to identity cards to produce face shields.
On 25 March, Italy, together with Belgium, France, Greece, Ireland, Luxembourg, Portugal, Slovenia, and Spain, sent a joint letter to the Council of the EU, calling for the issuing of a new common debt instrument, nicknamed in the media as "eurobond" or "corona bond", to help funding the measures taken against the COVID-19 pandemic and the expected economic downturn to follow. In subsequent conference calls between the leaders of the EU member states, the proposal saw the opposition of the Netherlands and Germany.
On 9 April, after two meetings of the Eurogroup, the ministers of Finances of the Eurozone countries agreed to €500 billion aid, including the possibility of using the ESM, but without common debt instruments.
31-35, F