Policy responses for Italy - HSRM

Italy


Policy responses for Italy

1.2 Physical distancing

The Scientific and Technical Committee of the Department of Civil Protection is mapping the level of risk exposure for each type of work activity, in order to develop a protocol for safety in the workplace that will underlie the future strategy to re-open production activities.

Studies are, in fact, demonstrating that infection levels differ according to the nature of the workplace. Becchetti et al, in an attempt to explain the irregular distribution of infection rates in all Italian provinces, have shown that, among other factors (such as lockdown measures and levels of pollution) the number of small craft businesses impacts both infection and mortality rates. Small entrepreneurs are more adverse to interrupting their production compared to larger competitors as, being mostly manufacturing companies, it is more difficult for them to switch to remote working.

As a result, the Scientific and Technical Committee aims to risk-stratify the active population according to the amount of interpersonal distance between workers and clients and flag workplaces by means of a triage system: the red code (high risk) includes professionals whose activities require close contact with clients or patients, such as waiters, teachers and, of course, healthcare professionals. The yellow code (medium risk) involves clerks and employees working in factories or offices (except for those who can work remotely). Workers classified with the ‘green code’ (low risk) could be the first to be allowed back to work and include notaries, accountants and insurers. This being said, safety measures such as limiting the number of clients in the same location or using face masks can reduce the risk of infection in all three categories.

As part of the protocol to resume productive activities on April 26th, the National Institute for Insurance against Accidents at Work (INAIL) and the Scientific and Technical committee (CTS) developed a model to risk-stratify workplaces in terms of aggregation of individuals, likeliness of infection and proximity, and subsequently released  the "Technical document regarding the potential reorganization measures for the containment of SARS-CoV-2 in the workplace and prevention strategies", detailing recommendations for containment measures in the workplace to facilitate the construction of targeted management models. INAIL has also released several publications and technical documents (available at: https://www.inail.it/cs/internet/attivita/ricerca-e-tecnologia/covid-19-prodotti-di-ricerca.html) aimed at providing informative directives for the health and safety of specific categories of workers during Phase II who, due a peculiar nature of their profession, are at greater risk of exposure to the virus. These reports, some of which released in collaboration with ISS, are regularly updated and cover several sectors including public transport, catering, swimming, commerce and education.  In collaboration with the National Council of Psychologists INAIL has launched initiatives to promote the development of remote psychological support and support services.

Although data on the epidemic situation displays encouraging improvements, Italy is still far from being able to end the lockdown and reopen the country. As the Prime Minister announced on April 26, there will be small changes in terms of social distancing and isolation restrictions from May 4. These include: as far as individual travel is concerned, the possibility to visit relatives in the same region; doing physical activity in open spaces, always maintaining one meter of interpersonal distance – which extends to two meters, in case of intense physical exercise; citizens are allowed to travel to a different municipality for specific types of physical activity; lastly, individuals who have been staying far from their residence are allowed to return, even if this requires crossing over to another region, as long as they contact the Local Health Authority and go into voluntary self-isolation for 14 days.

The government is considering recruiting 60,000 volunteers to help ensuring social distancing in places where higher numbers of people are likely to gather, such as beaches, restaurants and bars, in collaboration with local authorities.
The Technical and Scientific committee is concerned with the images coming from all major Italian cities with groups of young people gathering in social activities without respecting interpersonal distance or wearing face masks. There is fear that infections might increase again and lead to selective lockdowns in the country.

On 7th August, a new Prime Ministerial Decree (DPCM) extended until 7th September 2020 the precautionary measures to contain the spread of Covid-19, with measures updated to take account of situation over the summer season. Face masks remain compulsory in closed public places, and it is still a requirement to maintain  a distance of at least 1 meter between people.

After several renewals during the summer months, on 7th September, a new Prime Ministerial Decree (DPCM) extended until 7th October 2020 the precautionary measures to contain the spread of Covid-19, with measures updated to take account of situation over the summer season. Face masks remain compulsory in closed public places, and it is still a requirement to maintain a distance of at least 1 meter between people. In the historical centre of Genoa (in the Northern region of Liguria) and in the entire region of Campania, wearing face masks became compulsory also in all public spaces from 23rd September.

Law Decree of 7th October introduces the obligation to always carry facemasks, to be worn both indoors, except for private homes, and outdoors. Exceptions are made only where isolation conditions are continuously maintained. Anti-contagion protocols and guidelines established for economic, productive, administrative and social activities are reserved, thus current safety measures continue to be applied in the workplace. Children under the age of six, people with pathologies or disabilities incompatible with the use of the mask are excluded from such obligations and the use of a mask will not be mandatory during sports activities. Regions will be able to introduce even further restrictions. Such provisions have been confirmed with Ministerial Decree of October 13th which recommends using PPE in private homes in the presence of guests.

The Province of Bolzano:
On 9th June, Bolzano, the capital city of the province of South Tyrol in northern Italy, has revoked the obligation to wear face mask if the interpersonal distance of one meter is maintained, both in open and closed places, in light of the positive epidemiological trend of the past weeks. Such distance is to be respected indoors, outdoors and during sports whereas, so far, the minimum distance was 3 meters. Health facilities in which the distance between the employee and the patient is less than one meter must still deliver services wearing protective visors and the rule of one person every 10 square metres applies only in the case of enclosed areas larger than 50 square metres.
Furthermore, all passengers travelling by car must wear protective devices covering mouth and nose, however all seats in the vehicle can now be taken even if passengers do not live together. On public transport vehicles it is still mandatory to wear face-masks but they can be occupied to full capacity. Before 9th of June, in fact, buses could only allow 60% seats to be taken and cable cars only two thirds.
Hotels, B&Bs, furnished apartments and mountain huts must guarantee that each guest has 10 square meters of space available and hosts must disinfect their hands before and after reading newspapers or using board games. Stricter rules are seen in the case of "Covid Protected Areas": personnel’s  temperature is measured daily with lasers and employees are tested; guests, whose attendance history must be registered and kept for 30 days, must provide a certificate stating that they are negative which must be no more than 4 days old or, as an alternative, they can undergo rapid testing at arrival. 

Sources
- http://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=84554&fr=n
- Decree 26th April 2020 n° 108 - “Additional implementing provisions for  Law-decree N° 6 of 23rd February 2020, regarding Urgent measures to contain and manage the epidemiological emergency due to COVID-19, applicable to the entire national territory”
- http://www.quotidianosanita.it/regioni-e-asl/articolo.php?articolo_id=86066
- Decreto del presidente del consiglio dei ministri 07 agosto 2020, Ulteriori disposizioni attuative del decreto-legge 25 marzo 2020, n. 19, recante misure urgenti per fronteggiare l'emergenza epidemiologica da COVID-19, e del decreto-legge 16 maggio 2020, n. 33, recante ulteriori misure urgenti per fronteggiare l'emergenza epidemiologica da COVID-19. (20A04399) [available at: http://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=75652 ]
- Camera dei Deputati, PROVVEDIMENTO Misure sull'emergenza coronavirus (COVID-19) - Quadro generale, 7 Settembre 2020 [Available at: https://www.camera.it/temiap/documentazione/temi/pdf/1203754.pdf?_1588279335853] 
 - http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5105 
- Ministerial Decree October 13th. “Ulteriori disposizioni attuative del decreto-legge 25 marzo 2020, n. 19, convertito, con modificazioni, dalla legge 25 maggio 2020, n. 35, recante «Misure urgenti per fronteggiare l'emergenza epidemiologica da COVID-19», e del decreto-legge 16 maggio 2020, n. 33, convertito, con modificazioni, dalla legge 14 luglio 2020, n. 74, recante «Ulteriori misure urgenti per fronteggiare l'emergenza epidemiologica da COVID-19»” [Available at:
- http://www.governo.it/sites/new.governo.it/files/dPCM_13_ottobre_2020.pdf]  

Italy was the first country in Europe to adopt restrictive physical and social distancing measures. Although introduced incrementally, the nation transitioned to full lockdown in a very short period. In fact, after declaring a state of emergency on 31st January 2020, the government issued a series of “Urgent measures with regard to the containment and management of the epidemiological emergency due to COVID-19”. Legislative Decree n°6 23/02 focused on limiting further human-to-human transmission in an effort to halt the spread of COVID-19 in areas or municipalities with at least one positive case and, from 9th March, a series of Prime Ministerial Decrees (DPCMs) have extended the measures to the entire country, with new and more restrictive measures introduced almost on a daily basis.

First wave of social distancing measures:
Government decrees released from 9th to 22nd March have:

• Banned any movement to, from and within municipalities except for proven working requirements, situations of necessity and health reasons. Citizens must carry a signed self-declaration explaining the reason for their movement or risk criminal charges
• Recommended to those presenting symptoms of respiratory infections and a body temperature above 37.5°C to stay at home
• Prohibited any form of mobility for those in quarantine or who have tested positive to the virus
• Closed all schools (kindergartens, primary and secondary schools) and universities, requiring educational activities to take place solely through online teaching
• Suspended all forms of gatherings, including sport competitions and cultural, recreational, religious or trade-fair events
• Suggested salaried workers resort to days of paid leave or to work remotely
• Discontinued civil and religious ceremonies, including funerals
• Suspended public tenders except those evaluating candidates through digital mediums. Healthcare and Civil Protection professionals constitute the only exception; however, the examination must take place in conditions that guarantee a safe distance between people
• Allowed bars and restaurants to stay open from 6.00 a.m. to 6 p.m. if managers can guarantee the required safety distance of at least one metre between clients
• Suspended ordinary leave permits for personnel whose activities are requested by regional crisis units
• Shut down all fitness and wellness centres, excluding services recognized as Essential Levels of Assistance (LEAs) i.e. listed in the health benefits package
• Suspended all driving license tests and lessons



Second wave of measures:
A further decree on 22nd March addressed non-essential businesses (e.g. working from home, closure of premises, restrictions of working hours, etc.) and increased restrictions by suspending the production of all industrial and commercial activities, unless they can be undertaken through remote working. Thus, all bars and restaurants, as well as most stores are currently shut. Pharmacies, drug stores and grocery stores are excluded; however, they must guarantee safety distance between customers. Those businesses directly involved in the correct functioning of these essential services and of public utility services are also exempt and are allowed to function as normal, making employees working remotely when possible. The production, transport and marketing of pharmaceuticals, healthcare technology, medical devices and groceries or activities considered necessary for dealing with the emergency are, in fact, still permitted. Similarly, the restrictions are not applied to the aerospace and defence sectors, together with other activities that are strategically relevant for the national economy. Of course, all personnel must abide by infection containment protocols designed for the workplace (“Shared Protocol regarding the regulation of measures for the contrast to and containment of the spread of Covid-19 in the workplace”- 14th March 2020).

On 31st March, the Ministry of Health also released a circular banning the possibility to go jogging. However, it is still possible to practice physical activity in proximity of one’s own home.


Sources

Council of Ministers’ Resolution, 31st January 2020  - “Declaration of a state of emergency due to health risk linked to the insurgence of pathologies deriving from transmissible viral agents” www.gazzettaufficiale.it/eli/id/2020/02/01/20A00737/sg  

Decree Law n° 6, 23 February 2020 - “Urgent measures to contain and manage the epidemiological emergency due to COVID-19”. https://www.gazzettaufficiale.it/eli/id/2020/02/23/20G00020/sg  

http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioFaqNuovoCoronavirus.jsp?lingua=italiano&id=228#11 

Shared protocol for the regulation of measures to contrast and contain the diffusion of COVID-19 virus in the workplace, 14th March 2020. http://www.governo.it/sites/new.governo.it/files/protocollo_condiviso_20200314.pdf  

https://www.repubblica.it/cronaca/2020/03/11/news/coronavirus_dpcm_11_marzo_2020_negozi_chiusi-251007567/  

https://www.ilsole24ore.com/art/coronavirus-italia-veneto-quasi-11mila-contagi-6-nuove-vittime-AD1FiBI   

http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=73785&parte=1%20&serie=null 

http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4544

Becchetti et al. Understanding the Heterogeneity of Adverse COVID19 Outcomes: the Role of Poor Quality of Air and Lockdown Decisions. Covid-19 Review n 30 – 14th April 2020.

Bocci M. Rischio alto per i dentisti, basso per i notai. L’indice di pericolo dei lavoratori. La Repubblica. Covid-19 Review n° 28 – 12th April 2020, Banchieri, Vannucci.