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The ISS document with the four scenarios
In mid-October another document was approved that contemplates four possible scenarios for the evolution of the epidemic. It is called “Prevention and response to Covid-19: evolution of the strategy and planning in the transition phase for the autumn-winter period” and was developed by the Higher Institute of Health. The four scenarios do not ignore the 21 parameters. Scenario number 1 is the “localized transmission situation (outbreaks) substantially unchanged compared to the period July-August 2020.” So it has already been overtaken by the growth of infections in recent weeks. The second scenario identifies a “sustained transmissibility situation” with an Rt index between 1 and 1.25. Scenario number 3 identifies a “situation of sustained and generalized transmissibility with risks to the health system in the medium term”, with regional Rt values always between 1.25 and 1.5. With this scenario, “the growth in the number of cases could cause an overload of healthcare services in 2-3 months”. The fourth scenario, the worst, shows the consequences of a “situation of uncontrolled transmissibility, with regional Rt values higher than 1.5”. And the blocking scenario.
The weekly report of the Ministry of Health
In light of all this, the weekly report of the Ministry of Health provides a summary picture (analytical and synthetic) of the situation of the individual regions. For each region, the incidence of cases per 100,000 inhabitants stands out; the weekly trend (up or down) based on outbreaks and recorded cases; the “increased transmission” risk rating (moderate to high); the membership scenario (from 1 to 4); the risk rating for the impact of Covid on care services (low to moderate); the percentage probability of exceeding the critical threshold of 30% for intensive care and 40% for beds in the medical area in one month. Up to a global risk rating.
The division of the country into three risk areas
The policy then translates the scenarios and indicators into operational decisions. In the last Dpcm, for example, it was decided to use all these indicators to divide the country into three areas (red, orange and yellow), with more severe restrictions (a kind of temperate blockade) in the four red regions – Lombardy, Piedmont, Calabria, Valle D’Aosta – those where the virus circulates the most and the risk of maintaining the health system is greater. Less drastic in the two oranges, Puglia and Sicily, where the risk is rated as medium high. And mitigated measures in the yellow zones, of moderate risk.
In the latest ISS weekly report, for example, the overall risk rating was “high with high probability of progression” not only for Lombardy, Piedmont and Calabria (which later ended in the red band) but also for Puglia and Sicily. however, it is placed on an orange band. A decision on which scenario 3 instead of 4 (i.e. lower Rt index) attributed to these two Regions must have weighed. The weekly analysis of the data provided by the Regions can determine the movements of the Regions themselves from yellow to orange or red band. Regions that are already red, or already orange, should stay that way for at least two weeks.
