Domain 5: Service delivery 35

Background: the response to the COVID-19 Pandemic in Italy

In Italy, the epidemic has been experienced in two waves. The first exploded on February 21, 2020 with the identification of ‘case 1’ in Codogno, and was almost immediately contained with the increasingly restrictive measures that led the country to lock down between March 9 and May 3 2020. This wave predominantly involved the north of the country where the levels of incidence and prevalence were higher than in other parts. In contrast, during the second wave (October–December 2020), the incidence and prevalence, although on average more significant in the northern regions, rose throughout the country. At this juncture, the lack of restrictions on the movement of people soon made it impossible to track cases, leading to an explosion of infections up to the peak of new daily positives in November 2020. The Italian NHS reacted rapidly to the spread of COVID-19. In a few days, hospitals increased their number of ICU and non-ICU beds, and new personnel were hired. The regional system, albeit with some differences (discussed later), put in place different organisational solutions to handle increased hospitalisations.

Whereas in the first wave, regions reacted predominantly by increasing bed numbers, between the first and second waves, the health system utilised the resources available to strengthen the network of services. Another substantial challenge has been the care and management of patients who do not require hospitalisation, with the regions committed to finding adequate solutions, also on the basis of the pre-existing organisational model. Regarding diagnostics, in the first phase of the pandemic, the reduced availability of nasopharyngeal swabs led to significant regional variations in diagnostic and tracking capacity. The initial test centralisation strategy adopted by some regions was soon abandoned in light of more inclusive approaches adopted by other regions. Due to the large number of people affected by COVID-19 during the second wave, it was almost impossible to perform contact tracing.

The system has made a strong effort to counteract the pandemic, but this has had wider implications: the Italian NHS had to stop most elective care during the first phase of the emergency and, for some regions, in November and December 2020. However, there are positives to be drawn, for example the response to the crisis has given a strong impetus to the diffusion of telemedicine, particularly for cancer and chronic patients.

Cross-Cutting Themes

Alongside our analysis across the five key domains, we have also identified a number of cross-cutting themes. These are long-standing, interrelated and unresolved factors that have influenced the system’s ability to respond to the pandemic:

§ Relationship between central government and regional/local government: the pandemic has exacerbated tensions between central and regional/local governments. For some aspects of the response, regions have been slow to implement the organisational solutions made available at the central level. Regions have independently provided vital medical devices and have given different guidelines for swabbing methods. Even in aspects not directly related to health management, the lack of coordination has often led to regional variation with standards imposed at the central level.

Ultimately, COVID-19 has worsened the existing regional differences in the organisation of healthcare services. Regions with efficient systems and well-organised territorial assistance were more ready to face the pandemic’s challenges. Stronger and clearer mechanisms for cooperation should be a priority for future preparedness.

§ Regional differences: COVID-19 has worsened the existing regional differences in the organisation and provision of healthcare service. These differences, which entail inequalities in terms of access and quality of care and life expectancy, have inevitably affected the management of health emergencies such as COVID-19, with those regions with efficient systems and well-organised