the stages before the confinement in Italy

During yesterday’s question time in the Chamber, Prime Minister Giuseppe Conte spoke about “scenario 3” present in a document from the Higher Institute of Health (“Prevention and response to Covid-19: evolution of strategy and planning” ) that circulates since the first of the month and is public since October 12. As we have explained, it is about the division into different levels of the emergency situation due to coronavirus. But what Conte didn’t say is that currently half of Italy is already well beyond that stage, or is already in phase 4.

Scenario 4: the stages before the blockade in Italy

In summary, scenario 3 occurs when Rt, the virus reproduction rate that measures how many people on average are infected for each infected, at the regional level is between 1.25 and 1.5. Among other things, it provides for “nightclub closure” (established with the last Dpcm) but also the closure of schools and universities (and in fact, distance education has been introduced by 75 percent in secondary school and total in universities) “. travel restrictions” and other “subprovincial restrictions” in the most affected areas. These are, in summary, the four scenarios:

• SCENARIO 1: Localized transmission situation (outbreaks) substantially unchanged compared to the period July-August 2020, with regional Rt above the threshold for limited periods (less than 1 month) and low incidence, in the case that the transmissibility does not systematically increase at the beginning of the period. fall, schools have a modest impact on transmissibility and regional health systems can track and control new outbreaks, including school outbreaks;
• SCENARIO 2: Sustained and generalized transmissibility situation but manageable by the health system in the short-medium term, with regional values ​​of Rt in a systematic and significant way between Rt = 1 and Rt = 1.25 (that is, with estimates of the interval of 95% confidence – 95% CI – of Rt between 1 and 1.25), in the event that new outbreaks, including schoolchildren, cannot be fully traced, but still largely limit the potential transmission of SARS-CoV-2 with ordinary and extraordinary containment / mitigation measures;
• SCENARIO 3: Sustained and generalized transmissibility situation with risks of maintaining the health system in the medium term, with regional values ​​of Rt in a systematic and significant way between Rt = 1.25 and Rt = 1.5 (that is, with estimates of CI 95% of Rt between 1, 25 and 1.5), and in which the transmission potential of SARS-CoV-2 can be limited only modestly with ordinary and extraordinary containment / mitigation measures. The increase in the number of cases could cause an overload of care services in 2-3 months;
• SCENARIO 4: Uncontrolled transmissibility situation with criticality in the stability of the health system in the short term, with regional values ​​of Rt systematically and significantly higher than 1.5 (that is, with 95% CI estimates of Rt higher than 1.5). Even if an epidemic of these characteristics were to lead to more aggressive mitigation and containment measures in the affected territories, such a scenario could quickly lead to a high number of cases and clear signs of overload of the healthcare services, without the possibility of tracking the situation. origin of new cases. The growth in the number of cases could lead to an overload of care services in 1-1.5 months, unless the epidemic spreads predominantly among the younger age groups, as observed in the period July-August 2020 , and managed to protect the most fragile categories (for example, the elderly). In this regard, it should be noted that it seems highly unlikely to be able to protect the most fragile categories in the presence of an epidemic characterized by these transmissibility values.

The problem, however, is that, as Il Fatto Quotidiano explains today, the average Rt is already 1.5 in the data published last week, now old because they refer to the first 14 days of October.

And there are the other conditions foreseen by the ISS: “Clusters no longer different from each other, new cases not related to known transmission chains, gradual increase in pressure for the Prevention Departments” of the ASL, which to be honest have already been overwhelmed So much so that the government requested (belatedly) Civil Protection a new call to hire personnel and reached an agreement with family doctors to entrust them with some of the swabs that the ASL cannot do.

Territorial locks, closed schools and a brake on mobility between regions

The newspaper explains that since October 14 some regions are close to or above the threshold of 2: Lombardy, Piedmont, Campania, Liguria, Umbria and Valle d’Aosta. That is, they have had a scenario of Rt above 1.5 for three weeks and this foresees territorial restrictions that local authorities, however, for reasons of consensus, do not want to implement. Then there’s the rush of intensive care: yesterday there were 1,536 hospitalized patients, it doubled every ten days, and therefore it should soon exceed the 2,300 threshold, driving hospitals crazy.

The plan for the confinement in Italy from November 9

For this reason, Giovanna Vitale explains today in RepublicConte is now evaluating a new range of restrictions: “Three options, in the sign of” gradualness and proportionality “so dear to him, to try to stop the circulation of the virus if the last Dpcm is insufficient”. The three options represent three different proposed constraints:

• The first are territorial blockades, limited to the urban centers most in crisis: at first glance it seems simple, in reality it would be a question of closing large cities such as Milan, Naples, Turin and Rome;
• the second restriction is the closure of regional borders;
• the third is the closure of all schools with the extension of distance education to all types of institutions;

If to these restrictions are added the prohibition of mobility and the closure of essential activities, a new closure is expected in Italy. Now the prime minister has two options before him: the first is to introduce them gradually in case of greater growth in the epidemic figures (yesterday the Civil Protection bulletin reported almost 25 thousand new cases and 205 deaths, the limit seems to have been set at 30 thousand to 60 thousand). This would have the advantage of being gradual and the sensational disadvantage of generating more confusion in the citizens already weakened by the three Dpcm in fifteen days. The other option is to implement all the restrictions at once after observing the growth curves of the epidemic for about ten days and discovering that there is no other way for Italy than the blockade. The second option is the most popular for now.