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Commentary: How Italy – once overwhelmed by infections – is living with endemic COVID-19

Having learnt a harsh lesson in the first crushing wave, the country has put in place measures that allow its people and economy to go about normal living, says an observer.

Commentary: How Italy – once overwhelmed by infections – is living with endemic COVID-19
A man wearing a respiratory mask shops under the arcades of Piazza Vittorio Emanuele II in the Esquillino district of Rome. Tiziana FABI/AFP

ORLANDO, Florida: Italy was the first Western democratic country that faced the COVID-19 crisis.

In early 2020, as parts of the country were being overwhelmed with coronavirus cases, some media outlets argued that the Italian government had taken too long to impose restrictive measures to fight the spread of the coronavirus.

But Italy has learned several lessons since its first national lockdown last March, and now – a year and a half after that first crushing wave of COVID-19 cases – the country has put in place measures that in some cases are more stringent than in other countries, including the United States.

With these new protocols in place – notably, a health certificate to show vaccination status for certain activities – daily life is moving toward what many people call a new normal.

Despite some opposition, Italians support these measures, even when they come with a degree of discomfort or extra steps.


As of Aug 6, the government requires individuals to present the “Green Pass” – Italy’s extension of the European Union Digital COVID Certificate – to attend large events, dine indoors, access gyms and more.

The Green Pass is essentially a vaccine passport: A document, either digital or printed, that confirms its holder has tested negative for the virus in the last 48 hours, been fully vaccinated or recovered from a case of COVID-19.

According to a survey conducted by SWG Research, more than 50 per cent of Italians supports the Green Pass to regulate activities other than traveling. Business owners welcomed the Green Pass as a tool to avoid more restrictive measures – if not even another lockdown in the fall.

With the more contagious delta variant of the coronavirus spreading rapidly, the Italian government is urging more people to get vaccinated, and requiring use of the Green Pass seems to be motivating more people to get the shots.

As soon as Prime Minister Mario Draghi announced the Green Pass requirements on Jul 22, several regions registered record bookings for vaccine appointments, including Abbruzzo, Lazio, Lombardia, Piemonte and Toscana.


The general Italian public considers the Pfizer-BioNTech and Moderna vaccines the most effective against the delta variant of the four vaccines approved by the European Medicines Agency.

So in the recent surge of vaccination appointments, most people registered to receive the Pfizer or Moderna shots, as in the case of the Marche region.

As of Aug 4, Italy’s national vaccination rates were higher than those of the United States, with 53 per cent of eligible people fully vaccinated, compared to 50 per cent in the US and 64 per cent having received first shots, versus 58 per cent in the US.

Italian COVID-19 Emergency Commissioner, General Francesco Paolo Figliuolo, has set a goal of 80 per cent of eligible persons vaccinated by the end of September. According to Giovanni Rezza, the Health Ministry’s Director of Prevention, that would allow the country to get back to “pseudo-normality” within the first months of 2022.


With low percentages of both intensive care and non-critical hospital beds occupied by COVID-19 patients – 3 per cent and 4 per cent respectively as of Aug 4 – as well as widely available vaccines, the Italian Ministry of Health has revised how it uses its colour system to set regional public health mandates based on an area’s pandemic situation.

A medical staff member administers a dose of the Pfizer-Biotech vaccine to an over eighty-year-old, in the Santa Maria della Pieta hospital in Rome, Monday, Feb. 8, 2021. (AP Photo/Alessandra Tarantino)

For over a year, colours were assigned – white, yellow, orange or red, in order of emergency level – based on the region’s number of COVID-19 cases. But as of the Prime Minister’s executive order of Jul 22, the colours are now assigned weekly based on both infection rates and hospitalisation rates per 100,000 residents.

A region moves into the red zone when the weekly infection rate rises above 150 per 100,000, combined with an intensive care occupancy rate of 30 per cent and an overall hospitalisation rate of 40 per cent.

Regional governors strongly support these latest changes in the colour system because they account for not only the total number of infections and hospitalisations, but also the overall severity of the pandemic in the region.


In addition to the Green Pass, several requirements remain in place, such as mask wearing and social distancing when indoors, and social distancing even when outdoors. When it is not possible to maintain social distancing outdoors, then masks must be worn.

The only exceptions to the mask mandate are for children under the age of six, as well as for people with disabilities and their caregivers when wearing a mask would prevent communication or care.

Italy’s seaside destinations, popular with both Italians and tourists, are open this summer – with beach resorts, restaurants and bars observing social distancing and mask mandates as needed or required by the government.

Indoor dining is resuming in Italy, particularly given the reopening of the country to tourists. But during my recent visit, I’ve observed that many people still prefer to eat outdoors – which is actually the typical choice of Italians during the summer, pandemic or no pandemic.

Outdoor mask mandates are now limited to situations where social distancing is not possible, such as during sport events or in line when entering museums. I’ve noticed, however, that many people are choosing to wear masks on the streets as well as indoors, even when not mandated.

The tourism industry has eagerly welcomed the government’s reopening of the country to foreign visitors.

Travellers entering Italy from some countries, including the United States, are now required to show an official proof of vaccination – such as the EU Digital Certificate or a US Centers for Disease Control and Prevention vaccination card – a negative COVID-19 test or a certificate of recovery from COVID-19 signed by a health care provider.

(Are on-off curbs on dining in Singapore prompting F&B operators to rethink staying in the business? Find out from Ya Kun Kaya Toast's Jesher Loi and chef-owner Anthony Yeoh on CNA's Heart of the Matter podcast.)


Offices are still offering employees the option to work remotely, especially at-risk employees. Where employees who are not in an at-risk category are going back to work, they usually have alternate shifts so fewer people are in the office at the same time.

Several companies, including international firms with offices in Italy, are taking steps to ensure compliance with the latest pandemic laws. For example, Ferrari, which closed its main factory in Maranello three days before the first national lockdown was imposed, has established a small internal task force to ensure the company follows the government’s rules and recommendations.

The school year officially starts on Sep 13, but the government has not yet issued official policies for school reopenings, and it remains unclear what measures will be in place during the school year.

Factors that could affect this include the pace of vaccination among children and youth aged 12 to 19 years, and how well schools will be able to maintain social distancing – six feet between students and teachers, and three feet between students – as some schools may not have enough space in their classrooms.

But the system of showing proof of vaccination is being implemented in education as well: Starting in September, teachers, school staff and students at universities will need to show a Green Pass or get tested regularly.

Sara Belligoni is a PhD Candidate in Security Studies at the University of Central Florida. This commentary first appeared in The Conversation.

Source: CNA/cr