How was Italy devastated by Covid-19?

Two decades of eroded national health expenditure and privatisation played a role in the country’s struggle with the virus. Now, citizens demand answers in the face of a second wave of infections.

A family that lost a loved one to a Covid-19-related illness wants to understand who is responsible for the carnage in Italy, one of the countries worst affected by the pandemic, which has killed more than 1 million people worldwide.

Over 52 000 Italians have lost their lives to Covid-19 at the time of publication. Antonio Fusco, 85, from Brusaporto, Bergamo, was among the victims. He died of heart failure just three days after testing positive. 

His son Luca and grandson Stefano do not believe the authorities did all they could to stem the spread of the virus in its early stages. They created a Facebook group called Noi denunceremo [We will denounce] on 22 March 2020. It is a space where people share stories of how they lost their loved ones. 

The group had almost 50 000 members a month into its formation. “The stories come mainly from Lombardy, but also from many other parts of Italy because it is becoming a national issue. We just tell things as they went to highlight political responsibility. We don’t attack doctors or nurses, but political decision makers,” stresses Luca Fusco. 

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Following the success of their initiative, the Fuscos turned their Facebook group into a committee to legally concretise accusations and seek justice for all victims of Covid-19 in Italy.

In early April, the Bergamo public prosecutor’s office opened an investigation with the charge of “culpable epidemic”. While the office investigates who is responsible, the charge is not yet against a particular person or institution. The family believes authorities failed to take measures that could have curbed the spread of Covid-19 in Val Seriana, an industrial valley in the province of Bergamo, the worst-hit region of Lombardy. 

Conflicting reports 

An analysis carried out by the local newspapers L’Eco di Bergamo and InTwig, using data provided by municipalities, disclosed that in March, 4 500 people died of Covid-19 in the province, more than double the official figure of 2 060 provided by local hospitals. 

To date, around 350 complaints have been brought by Fusco’s committee, while others are being examined by lawyers. The investigation is divided into three main strands: the non-imposition of the red zone in the municipalities of Nembro and Alzano Lombardo requested by the College of Health on 2 March and 5 March, the closure and reopening within a few hours of the emergency room of the Alzano Lombardo hospital and deaths in nursing homes. 

The investigators have interrogated many witnesses so far, including Prime Minister Giuseppe Conte and the World Health Organization (WHO) deputy director and national scientific technical committee member Ranieri Guerra. The latter is also allegedly involved in the mysterious disappearance from the WHO website of a report that highlights the mistakes made by Italian authorities. The report was recovered by Fusco’s committee.

3 April 2020: A priest reads from a bible as he walks near coffins holding the bodies of Covid-19 victims in a repurposed warehouse before their collection by the military in Ponte San Pietro, near Bergamo. (Photograph by Francesca Volpi/ Bloomberg)

The crime of culpable epidemic, however, is difficult to prove. This type of offence requires commissive behaviour or active agency on the part of particular people in authority. But those in charge are closing ranks. “Everyone tries to cover up and doesn’t let the truth emerge. Health authorities don’t give their personnel the chance to speak,” says Fusco. “We will act as a watchdog. We are monitoring what happens, and it is already clear that exactly the same mistakes are being made for the ongoing second wave.”

The allegations are backed by a report written and given to the Bergamo prosecutor’s office by Pier Paolo Lunelli, former head of the Joint NBC Defense School, an academy that trains military and ministerial personnel to combat biological, chemical and radiological threats.

According to Lunelli, who has drawn up several pandemic protocols for various European states during his career, Italy could have saved around 10 000 lives if anti-pandemic protocols had been respected.

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The study goes back to late 2003, when the WHO recommended all countries draw up a national pandemic plan and constantly update it. Outbreaks of avian influenza had become endemic in birds in parts of Asia. The virus had also caused serious infections in humans, and the risk of a pandemic had become more concrete and persistent. The annual report on global preparedness for health emergencies published by the Global Preparedness Monitoring Board in September 2019 states that “between 2011 and 2018, WHO tracked 1 483 epidemic events in 172 countries.”

The report partly disproves the claim that the Covid-19 pandemic came out of the blue. Italy’s pandemic plan was approved on 15 December 2006 and, according to the country’s health department website, was last updated on 15 December 2016. But The Guardian revealed that the document’s properties on Adobe Acrobat Reader show it was created in January 2006. It may not have been updated since then.

What’s also alarming is that Nino Cartabellotta, president of the Gimbe Health Foundation, said that the organisation takes daily screenshots of Covid-19 statistics when they are released because they “disappear” the following day in websites of certain institutions. 

Why Italy was hardest hit 

Italy finds itself in this position because of decisions made in the 1990s, when the country started gradually cutting health spending and privatising the health system. According to data published in 2017 by the Council of Ministers, the ratio of health expenditure to wealth produced in the country would have lowered to 6.3% in 2020. That means 0.2% less than the threshold indicated by the WHO to guarantee access to quality care.

Despite one of the highest death tolls in the world and accusations of misconduct, Italy is not at all ready to deal with the second wave, which is now further exposing the shortcomings of the country’s health system. 

In late October, Italy counted 6 628 intensive care unit (ICU) beds, which translates to 10.6 beds per 100 000 people. The government’s safety threshold says that number should be 14. These gaps stress health facilities and contribute to unnecessary deaths – for instance, in the Cardarelli hospital in Naples, a man died in the bathroom.

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The lack of personnel, in particular trained nurses who can work in the ICU, has been another weak point in the Italian health system. Last-minute recruits, although much needed, come with their own problems. 

“It takes three to six months, and at least a month of coaching, to be autonomous in an ICU,” says Maurizio Mercuri, co-director of the nursing degree at the University of Ancona. “The most serious problems were system issues. Health professionals responded well, and had also to cope with the acquisition of highly advanced skills in a critical phase. You can’t restore in a short time what you’ve lost over the years, and political responsibilities are extremely evident.” 

The fact that Minister of Health Roberto Speranza was ready to publish a book in October titled Why We Will Heal: From the Hardest Days to a New Idea of Health, as if the crisis is over, speaks volumes. The publication was halted because of the worsening situation.

Paralysing uncertainty 

“Previously, there was confusion about the use of personal protective equipment, which was scarce at first, and therefore we didn’t know if we were protected,” recalls Gaia Guardabassi, an ICU nurse at the Rimini hospital in the Emilia-Romagna region. “We didn’t know how to fight the virus. Then, working eight hours in a row with overalls and a mask with only the eyes uncovered is exhausting, especially when you have to assist several patients.”

The lack of personnel strongly affected the contact tracing system. As of 16 October, according to Il Sole 24 Ore, there were only 9 241 contact tracers in Italy, far below the threshold of one per 10 000 inhabitants set up by the government. The contact tracing app Immuni, launched in June, still has several bugs and health professionals responsible for the tracking chain revealed that they were never informed how it works.

According to a comparative study carried out in seven European countries, including Italy, by non-profit research organisation More In Common, most Italians believe in the importance of seizing the opportunity given by Covid-19 to bring about important social changes. But two-thirds of them think those changes won’t happen. This resignation is caused by the growing distrust of authorities – 51% of interviewees are convinced the government is hiding information on the pandemic. Luca Fusco is among these. 

“Italians must be aware that voting matters a lot and before going to vote they should think about who they vote for. We put these people who made mistakes there.”

The pandemic has had a devastating effect on the country’s mental health. “The health of Italians is seriously compromised,” claims Angela Quaquero, the president of the order of psychologists of Sardinia and a member of the national council of psychologists. “But the demand for psychological support now appears secondary to the one for economic certainties and efficiency of health services. People want to know whether they have contracted the virus. They want to be tested. Psychological support is needed, but the request is unspoken, and I’m afraid that when people come back to express it, the situation will be even more serious.”

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A recent study that looked at a sample of 20 720 participants found that levels of anxiety, depression and symptoms related to stress increased tremendously during the lockdown. At the International Conference on Issues Related to Suicide, held on the World Day for Suicide Prevention (10 September), it was reported that since March there has also been an increase in suicides and suicide attempts. “People cannot feel hope. There is fear of loneliness, closure and poverty,” says Quaquero. 

The Italian College of Health warns that investing in nationwide mental health services and programmes, which have suffered from limited funding for years, is now more important than ever, because “the demand for psychosocial interventions is likely to increase significantly in the coming months and years” and “the economic impact of the pandemic may hinder progress towards social inclusion and mental wellbeing.

“We have trained psychologists, we know how to work online and in emergencies. We just need to improve the psychology services in the public national health system, and to make them available to all citizens. We are risking depression, emotional isolation, and therefore more suicides. And, after all, the economy also gets affected since people who are ill work worse and produce less.

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