1/ WHO Europe team in Venice have just published a detailed account of Italy’s response to #COVID19 so far. Familiar issues inc. care homes, PPE, plus insights about pandemic response in decentralised health systems. Well worth a read –excerpts below & link at end of thread

2/At the start of the epidemic, Italy’s National Institute of Health put RO at 2.13-3.33. It went on to range between 1.5-4.0. By late March, it was at 0.3-1.5 and by early April, 0.2-0.7 (I think the current UK estimate is around 0.7 but pls correct me if wrong)

3/By late April, was estimating its total death toll to be 38k based on excess mortality data. This had been revised up by 10k – using positive tests as a metric for spread was challenging because of differences in targeting and numbers of tests carried out between regions

4/Health Ministry launched test/trace/isolate strategy early but implementation varied. Lombardy tested symptomatic cases & had test shortages (11.7 tests/1k pop). Veneto used proactive case finding, beyond guidelines (21.0/1k pop). (UK fig for 29 Apr 8.83/1k pop acc. BBC)

5/ Report says Veneto and Emilio Romagna regions have “dense public health networks” that they used for case finding and testing. But in more “hospital centric” Lombardy, systems struggled. Strengthens case for more investment in community public health in UK?

6/Lots of action to address isolation and distress – telephone hotlines for violence, family distress and lack of support to pick up shopping. Particular focus on older people – some regions were already good at this pre Covid  http://www.euro.who.int/__data/assets/pdf_file/0005/373280/healty-ageing-report-eng.pdf?ua=1

7/ also had a public mask wearing controversy – most regions enforced mask wearing in supermarkets, public transport, etc, but there have been concerns about reuse of single use masks, and about mask/glove wearing diverting attention away from important handwashing messages

8/ worked closely with primary care docs and in some regions was able to increase % of Covid patients cared for at home - eg. Veneto had 74.1% Covid patients at home by 20/3, exceeding national average.

9/ also gave doctors not normally based in the community permission to practise in the community in order to backfill for sick/quarantined GPs. This included paediatric doctors

9/ set up repurposed intermediate care facilities and ad hoc Covid hotels to house less sick patients. These provided 1-2 hours of nurse-led support per day

Oops - that should have been 10/

11/ Sadly, 153 medical doctors died from Covid related illness in Italy between 11 March and 30 April. Like the UK, Italy faced PPE challenges, with shortages of gloves, masks, respirators, goggles, face shields, gowns and aprons at different points

12/Care homes experienced excess deaths from early Feb & reported differential access to PPE. As in , the danger wasn’t immediately recognised & some took in Covid patients from overcrowded hospitals not cleared to go home. 47% of facilities reported difficulties getting tests

13/ health system is regionalised but government established a central command and control structure early on. Our national NHS structure should benefit the 4 countries in this respect. gov also set up a task force to counter Covid fake news in the press and social media

14/ is now attempting to respond to inequalities exacerbated by Covid. Campania is funding €3m to help migrants; eg. Veneto has a €2.2m basic income scheme for citizens facing catastrophic costs; Sicily has €2.5m to help domestic violence victims

15/ Inequity of digital access has been a particular problem for education. government has issued a Cura Italia Decree (urgent law) to address social and economic impact of Covid – this includes €85m to address inequalities in internet access

Ends/ The report can be read in full here – fantastic detailed and insightful work, particularly given the circumstances in which it was produced.

Thanks for reading & hope you found this thread on Italy's Covid response helpful http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/2020/an-unprecedented-challenge-italys-first-response-to-covid-19-2020