An announced catastrophe
After the three-month lockdown from March to May 2020, Italian national and regional government has done little to prepare adequately for the second wave. This has led to a deepening of the health and social crisis: According to experts, the virus is almost impossible to control, the intensive care units in hospitals are overloaded and healthcare workers are reaching their limits.
"With this level of new infections, the number of tests carried out no longer makes sense. It made sense to do 400,000 tests a day to break the chain of infection. But now the virus has got out of control and we will not be out of the woods until late 2021, early 2022." This is how Andrea Crisanti, virologist and lecturer in microbiology at the University of Padua, described the state of the pandemic in Italy to La Repubblica on 15 November 2020. Italy’s daily coronavirus figures confirm this position: after a rather quiet summer, infections began to rise again from mid-September and on 16 October the daily number of new cases exceeded 10,000, reaching a peak of 40,902 just a month later (13 November 2020). The number of deaths has also seen a slow but steady increase, reaching 853 on 24 November.
Far more worrying than these figures, however, are the accounts from the frontline that have appeared in the international press in recent weeks. In the hospital of Rivoli near Turin, patients suspected of being infected were left alone for days in the emergency room on field stretchers. The incident prompted the union of nurses Nursind to make an official statement condemning the handling of the pandemic : "We are seeing Covid patients left on the floor, wards and corridors left uncleaned, reconstruction works lying unfinished, and a severe shortage of healthcare workers. We have no words to describe the gravity of the situation here in Piemonte."
Yet the situation in the south of the country is possibly even more tragic, as the example of Calabria shows. Since 2010, the Calabrian health care system has been under provisional control due to mismanagement and infiltration by the Mafia. At the beginning of 2019, Saverio Cotticelli, a former general of the carabinieri, was appointed to lead the special commission. However, on 6 November 2020 he expressed his surprise at being tasked with drawing up a plan to combat the spread of the virus. "I have to draw up an operational Covid plan? I didn't know that", he told to Italian state TV RaiTre on live camera. In fact, no one in the regional government had taken on this responsibility and today the southern Italian region is experiencing a catastrophic situation. As a result, Cotticelli was forced to resign from his post.
Calabria and Piemonte are exemplary of a systematic mismanagement laid bare by the coronavirus crisis. So where does Italy stand today, eight months after the outbreak of the pandemic, in terms of health and social policy?
After a decline in the number of new cases and fatalities in May and June, and consistently lower numbers throughout the summer, a steady increase from mid-September onwards became cause for concern. With the trauma of the first wave still fresh, images of lines of military trucks removing coffins from the Lombardy city of Bergamo loom large in the nation’s collective memory. Although the number of new infections rose sharply at the beginning of the second wave, the number of deaths was initially low, due to a significant increase in testing meaning the disease could be detected in its early stages or in the absence of symptoms. However, over the following few months the situation deteriorated once more, with daily death tolls returning to spring levels.
Bringing the course of the disease under control requires adequate hospital capacity. Following the first wave the Italian government made a commitment to expanding the number of intensive care beds. However, policy implementation in Italy is the responsibility of the regions making the jump from words to action a more complicated manoeuvre. According to the data analysis carried out by IlSole24Ore, by mid-October only two (Veneto and Valle d'Aosta) out of the 21 regions had reached the target set. In most regions, including those severely affected such as Lombardy, Piemonte and Campania, only 10% of the target number of extra beds had been reached. According to the Agency of Regional Health Services, hospitals reached the "critical limit" of 30% intensive care occupation by Covid cases as early as mid-October, and by mid-November in 17 regions, this passed more than 40%.
Moreover, according to the health organisation Gimbe, Italy's testing and tracing system was no longer fir for purpose. For over 80% of the people testing positive the authorities were unable to trace the point of infection. Indeed, it is difficult to even find statistics on track and trace, the only records kept are those on transmissions in the workplace kept by the National Institute for Occupational Accidents Insurance Inail. This data shoes that around 10% of all infections occur at workplaces, and a third of all work-related deaths over 2020 were Covid cases with figures only rising. So while regional and national government were well aware they were facing a potential disaster with the second wave, they nevertheless did little to prepare Italy’s healthcare system for the hit.
Yet the unpreparedness was not for want of spending. In the larger regions in particular, such as Lombardy, Campania and Tuscany, investment in healthcare has certainly risen since the outbreak of the pandemic. However, investigations carried out by the national anti-corruption agency Anac show striking regional differences in where the money ends up. While in the Veneto region much of the money was spent on Covid tests, in the Campania region it was used mainly for individual PPE. In the first four months of the year, 204 million euros were "invested" in Campania, no less than 1,279 public tender procedures were launched. Campania is also one of the regions with the highest per capita expenditure for each Covid patient with 76,308 Euros. In this context, the public prosecutor's office of Naples is today conducting various investigations into illegitimate financing of privates by the region.
Private profits against collective health
The second wave of the Covid-19 pandemic is thus laying bare the contradictions underlying the healthcare policy Italy has pursued in recent decades. Years of austerity has meant reductions in the number of beds in public intensive care units and in healthcare staff, leading the health system to become dangerously overstretched in a crisis situation. These developments are now being exploited to drive forward the restructuring and privatisation of the health care system.
This push for privatisation hits community medicine particularly hard. With the emergency decree introduced on 9 March, the government instructed the regions to set up a special medical unit per 50,000 inhabitants to treat Covid patients or people with symptoms in the community to support GPs. However, the so-called Usca (Unità Speciali di Continuità Assistenziale) in many cases failed to materialise. As a result, private clinics were able to exploit this void, charging citizens for services that should have been offered for free by the public system. In the region of Lombardy, for example, a complete lack of community care meant sick people were forced to resort to private clinics paying as much as 75 euros for a test and 450 euros for a visit to a specialist. As such, low-income and poverty-stricken people are being de facto excluded from the public health system.
Private clinics are therefore able to benefit from a systematic underfunding of public hospitals. And this is not only true for community care. Regional governments have also used the exponential increase in the number of Covid cases and the lack of places in intensive therapy to fill the pockets of the private hospitals. The Campania Region is currently pays private hospitals 1,000 euros for each intensive care bed it and 360 euros for each sub-intensive care bed kept unoccupied as a back-up for when public hospitals fill up, an advance payment for a service that may never be provided and an – expenditure that could have been invested in the expansion of the public facilities.
This is not simply a matter of a lack of intervention by the state when the pandemic breaks out. The current health policy difficulties are an expression of the structural weakness of the national health system, which existed before the pandemic and is the result of previous political decisions: austerity, neo-liberal restructuring and privatisation of public services.
Health care workers at their limits
Those who pay the price of neoliberal policies are patients and staff. A shortage of ICU beds and of ambulances means Covid patients are dying for lack of care, while non-Covid patients are having their treatment postponed and risk complications or even fatality as a result. Lastly, anyone being admitted to hospital as an emergency risks contracting Covid-19 due to poor safety measures. If patients are suffering from a deterioration in service, it is the health care workers who have to shoulder the burden of managing the crisis.
For all the ostentatious gestures of gratitude for the “heroes” on the frontline, the reality is they have been completely abandoned to their fate. To date, more than 200 doctors have died of the virus. In a statement issued on 18 November, the unions expressed fierce criticism of the handling of the pandemic: "More than 20,000 health workers have been infected by the virus, including general practitioners, who are often forced to work without any protective equipment. There is a shortage of staff in the health facilities, and those who work are forced to work double shifts. Despite these dramatic conditions, we have not seen any structural investment to general practice and community medicine. The specialised teams intended to provide care at home for Coronavirus patients in many cases were never activated and there is still no prospect of permanent recruitment of nursing, emergency and ambulance staff."
Moreover, in some regions, healthcare workers even face disciplinary measures and dismissal if they speak publicly about working conditions and the conditions in health facilities. This is the case in Campania, where at the beginning of October, after the publication of shocking images from the Codugno immunology centre and from the largest hospital, Cardarelli, the regional Covid crisis unit imposed a gagging order on healthcare workers and prohibited journalists from reporting close to facilities.
With tensions rising, it was only a matter of time before the health care workers decided to protest. In mid-November, doctors and nurses protested in healthcare facilities across the country, crossing their arms to draw attention to the crisis. A national day of protest has been announced by the major trade unions for 9 December.
Beyond the health crisis
While the national health system is collapsing, the central government is still attempting to play off social issues, the economy and the health crisis against each other. As a result of the first lockdown, Italian GDP fell 12.4% in the second quarter of 2020. Under pressure from the business association Confindustria, the government is reluctant to impose a second general lockdown. Furthermore, protests began to break out in mid-October against coronavirus closures calling for more financial support for workers, the middle classes and small businesses. Indeed, the second time around the general public is less willingness to accept restrictive measures. The first lockdown saw a significant rise in mental health problems and domestic abuse (suicide, domestic violence, feminicides, sale of psychotropic drugs, depression and anxiety, etc.), a social crisis that is now beginning to bubble over into a generalised desperation and anger.
The inability of politicians to master this balancing act is particularly apparent when it comes to the question of reopening the schools. During the summer, the Italian Education Minister Lucia Azzolina had relied exclusively on what she termed a "renewal of the infrastructure", distributing millions to private suppliers to pay for new school desks and anti-Covid material via public tenders. However, far more important problems were left unsolved: about 200,000 teachers throughout Italy continued to work on temporary contracts, were forced to work in precarious conditions at different schools and thus became carriers of the virus. No investments were made in public or school transport and overcrowded buses and trains became virus danger zones, putting commuters and students at grave risk.
Predictably, shortly after the schools reopened in mid-September, they were closed again in October as the rise in infections forced a transfer to distance learning. Currently, around half of the 8.4 million students are forced to follow lessons from home. For children from disadvantaged backgrounds or living in poorer regions, the effect on their learning is serious. Indeed, many simply cannot continue to follow their lessons. Yet this is a situation that could have been avoided; the potential for schools to be transformed into test and trace centres while guaranteeing the right to education has been missed.
Instead of creating a context that would minimise the health and social consequences of the coronavirus crisis – closure of non-essential economic activities, expansion of public health, education and transport, financial support for workers who’ve lost their jobs – the current measures are only exacerbating the situation.
About the author
Maurizio Coppola works as a freelance journalist, translator and interpreter and maintains the telegram channel @ItalienNews with current news in German about Italy. He lives and works in Naples.