Martina Facchin

Overtaking China’s COVID-19 death rate by mid-March, Italy was the first European country to feel the pandemic’s full-blown effects. As the country moves into Phase 3 of reopening, there have been a total of 250,000 confirmed cases and 35,000 deaths there.

At first, both domestically and internationally, it seemed that Prime Minister Giuseppe Conte’s government was being cautious and proactive, declaring a national emergency and banning flights from China the day after the first cases were confirmed. A month later, the nation was under strict lockdown. Conte’s administration deserves praise for adopting quick and firm measures during this pandemic. However, COVID-19 has proven that decisive action needs to be executed in a timely manner, and this was not the case. The administration’s obstacles surrounding policy implementation, irreparably hindered the management of the virus.

Delaying the lockdown was the government’s first key mistake. Given Italy’s initial proactive measures, observers expected that rigid policy would quickly follow after Patient 1 in Codogno, Lombardy, was diagnosed on 7 February. Instead, the government prioritized the region’s economic growth, which accounts for 22 percent of Italy’s GDP, by implementing half-hearted measures throughout February. On 21 February a “red” zone (a quarantined territory) was declared for eleven municipalities deeply affected by the pandemic, but not the rest of Lombardy. Only after another two weeks was a regional and national lockdown announced. By following the spread of the virus rather than preventing it, the government missed a key four-week window to support hospitals, stock up on personal protective equipment (PPE), raise awareness, and slow contagion. This was a costly mistake, given that Lombardy endured a two-month lockdown and still has 94,580 confirmed cases as of 1 July, far exceeding any other region and some European countries.

The decentralized nature of the country’s regions, especially with regards to the universal healthcare system, created vastly different success rates. Some regions flattened the curve quickly, with Veneto adopting aggressive testing early and emphasizing homecare. Others, like Lombardy, found themselves with overcrowded hospitals and crematoriums. Ahead of the reopening in Phase 2, the government correctly stressed the importance of testing across the country. Regions like Veneto had 1.7 tests per capita for its population of 220,000 compared to Lombardy with 0.04 tests per capita for a population of 10 million. The central government failed to redirect and redistribute key resources in a timely manner.

Communication also proved problematic. By publishing contradicting decrees regarding COVID-19 protocol, the national government confused anxious citizens who then flocked to hospitals. On 22 January the protocol was to self-isolate if one was symptomatic; five days later only cases with recent links to China were deemed COVID suspects. The first communication campaign regarding COVID was published on 11 February and encouraged handwashing, failing to properly warn and inform citizens.

Communication and coordination between hospitals and the central government was also strained by the healthcare system’s increasing privatization. There was no government support for standardized data collection, intra-hospital knowledge sharing, or pooling of resources. Hospitals quickly became virus hotspots without PPE for workers, ventilators, or proper isolation units. When the government realized that home care was essential to preventing further contagion and protecting the collapse of the weaker healthcare system in the South, they released a decree on 9 March dictating that all regions must establish a home-care management unit per 50,000 people. By 20 March, most regions set up the homecare centers, but it was too late – cases had peaked.

With each region and its administrative bodies interpreting government decrees differently, there was no clear message. After the central government declared the “red” zone, Milan’s mayor started a hashtag #milandoesntstop and the head of the Democratic Party, shared an image of him enjoying a group aperitivo. These campaigns sent mixed signals, downplayed the virus, and undermined government actions. Only in mid-March were civic duty and social responsibility emphasized in the hopes of increasing lockdown compliance.

Italy’s fiscal response to COVID exemplifies comprehensive policy paralyzed by delayed implementation. Long-standing bureaucracy paired with a lack of liquidity has meant that the EUR 750 billion (USD 847 billion) stimulus package is struggling to reach those in need. On 17 March the #CuraItalia decree allocated EUR 10 billion (USD 11.3 billion) to supporting workers and those on Universal Basic Income. In theory, it was a good start, but in practice, not so much Immediately, Italy’s social security and pension fund (INPS) crashed, with 100 people applying per second. In addition, the INPS liquidity problem has meant that since March, employers have been paying salaries out of pocket. The Relaunch Decree on 13 May hoped to resolve this issue, dedicating EUR 55 billion (USD 62 billion) to further support workers and “fast-tracking” the INPS by removing regional bureaucracies. Well-intentioned, this reform came two months too late, leaving many struggling financially. The INPS is still waiting for its promised funds.

While Italy was the first to implement a strict lockdown outside of China, it came too late, as did the support for hospitals, emphasis on homecare, financial support, and communication to raise public awareness. The initial caution, paired with a time lag between decree announcement and real-time execution, left Italy just one step behind the virus.

Part of the COVID Comparative Project. View the complete series.