Policy responses for Italy - HSRM

Italy


Policy responses for Italy

6. Measures in other sectors

6.1 Measures in other sectors

Many MEASURES IN OTHER SECTORS beyond the immediate scope of the health system are being taken to prevent further spread of the virus. This section contains information on many of these areas, including border and travel restrictions and economic and fiscal measures, among others.

Due to significant rises in the number of cases during the month of august, the Italian Ministry of Health signed a new ordinance on 16th August 2020, to suspend all indoor and outdoor dancing activities in discotheques or locations accessible to the public.

Faced with the second wave of the pandemic, the Government (Ministerial Decree of 13th October, 2020) established that bars, restaurants, pubs, ice cream parlors and pastry shops can serve until midnight if they provide table service (the limit of six people per table was then imposed by a further Ministerial Decree of 18th October 2020) and until 21.00 if they do not. This time schedule was further restricted to 18.00 with Ministerial Decree of 18th October 2020. On-site or proximity consumption of food and beverages is not allowed after 21.00; however, there are no restrictions on home delivery and take-away services. A few days later, with Ministerial Decree of 25th October 2020, coffee shops, restaurants and ice cream parlours were obliged to shut at 18.00 but will be allowed to continue home-delivery services. Only four people will be allowed per table. There are no limitations on restaurants inside hospitals, airports and along highways.

The limit of 200 participants is in place for indoor entertainment shows and 1000 for outdoor entertainment shows when an interpersonal distance of 1-metre between seats can be ensured. Outdoor and indoor dance halls and discos are to stay closed, while fairs and congresses are still allowed. Parties are prohibited both in indoor and outdoor spaces (confirmed through Ministerial Decree of 25th October 2020) while civil or religious ceremonies, such as weddings may take place respecting safety measures. Celebrations following such ceremonies can host a maximum of 30 people. Furthermore, it is strongly recommended that people avoid private parties at home and accept a maximum of 6 guests.

Under Ministerial Decree of 25 October 2020, beauty and wellness centres, cinemas, theatres, concert halls, entertainment parks and gaming parlours will have to close.

Decree of the President of the Council of Ministers (DPCM) n. 258 of 18th October 2020 suspends local festivals and fairs, allowing only those of national and international interest.  Conferences and PA meetings can be held only remotely, unless they are in the public interest. Ministerial Decree of 25th October 2020 increases remote working within public administration, and continues to strongly encourage it in private businesses.  In addition, Ministerial Decree of 25th October 2020 strongly recommends that private meetings be hosted through virtual mediums. All public ceremonies must be carried out in compliance with current protocols, guidelines, and measures to limit the presence of the public. Those of national importance are to take place without the public. Furthermore, the Decree requests that public city streets and squares where the risk of public gatherings is high to be closed to the general public and allow in only to residents and workers.

Measures to control the spread of the virus within the community spread are being pursued to safeguard societies and economies, until vaccines and therapies become available and distributed (Alwan et al., 2020). In fact, after a week in which Regions were imposing their own further restrictions to limit transmission amid rising numbers of positive cases, Prime Minister Giuseppe Conte announced new restrictions on 25 October 2020. Movement has not been restricted, but it is recommended that people only move for work or studies, or in the case of an emergency. Although the national government has not imposed a national curfew, several Regions have. Such measures have been met with criticism by the public, leading to protests in several cities across the country.

At the beginning of November, the epidemiological trend is transitioning towards Scenario 4 and the national Rt index is 1.7 and even higher in some regions. Around 15 out of 20 Regions are expected to exceed critical ICU and medical thresholds throughout the month; thus specific attention will have to be applied once again to manage health services throughout the country. Ministerial Decree announced on 4th November 2020 details new measures that will be valid from 5th November to 3rd December 2020 and, despite the request on behalf of regions to apply nationally standardized measures, a risk-stratification framework divides the country into three areas whose restrictive measures will differ, with reference to the four ISS scenarios (please refer to Section on Governance).

The decree contains a set of national measures, which are to be complemented with the specific measures listed under each ‘risk-area’:

• At national level, leaving the house will be banned every night from 10.00 PM to 05.00 AM, unless for work, health or urgent necessities in which case a signed self-certification document must be provided to the authorities. In the remaining hours of the day, citizens are strongly recommended to avoid moving around, except for work, health and urgent necessities.

• At regional level, the three risk clusters (yellow, orange and red) will be assembled through regions’ risk coefficients, assessed weekly by the Ministry of Health, with the support of Regional Prevention Departments. The analysis will be based on a specific set of 21 indicators (including the Rt index, positive tests, hospital capacity saturation – please refer to section 1.4 Monitoring and Surveillance for further information) detailed as an attachment to the Decree. 

o Yellow regions – moderate risk  (8 plus 1 AP)
o Orange regions – medium-high risk (7 at 9th November 2020- Puglia, Sicily, Abruzzo, Liguria, Umbria, Tuscany and Basilicata)
o Red regions  - high risk (5 plus 1 AP at 9th November 2020 - Lombardy, Piedmont,  Alto Adige, Valle d’Aosta, Calabria and the autonomous province of Bolzano)

On 12th November 2020, however, the three regions of Veneto, Friuli-Venezia Giulia and Emilia Romagna have jointly decided to opt for more restrictive measures to prevent from switching to an Orange or, worse, to a Red zone in the near future. Sharing borders, having similar transmission rates and contagion trends of the virus, they have found it necessary to standardise measures by issuing shared Regional orders, primarily driven by issues of ICU personnel shortage. As stated by the governors, however, these three regions have been ‘exchanging orders’ throughout the entire pandemic, benefitting from cooperation and coordination all along. In an effort to avoid a ‘third wave’ of infections after the Christmas season, on 3rd December, the Prime Minister released a new Decree containing further restrictive measures (detailed in the following sections).  Some Heads of Regional Governments, however, have lamented that the Central Government hardly involved them in the formulation process.

On 13th January 2021 the Council of Ministers issued a new decree-law extending the state of Emergency to April 30th 2021. The decree confirmed the subdivision of the country into three differentiated risk areas (yellow, orange, red) and established a fourth, the “White area”, for those Regions that, with a low incidence of the virus, have had less than 50 cases per 100 000 inhabitants for three consecutive weeks. White Regions are not subject to the restrictive measures implemented in the riskier zones; however, activities must be carried out according to specific protocols.

The Prime Minister’s decree of 2nd March 2021 has rescheduled the reopening of theatres and cinemas in yellow areas to 27th March, with pre-assigned seats booked either online or by telephone. In compliance with the rules of interpersonal distancing, for both staff and spectators, the overall capacity cannot exceed 25% of the maximum, up to 400 spectators outdoors and 200 indoors for each room.


Productivity
According the Ministerial Decree of 4th November 2020, regions belonging to green zones will be able to able to keep restaurants, bars and cafes open till 6 PM after which takeaway and home delivery will be allowed till 10.00 PM. Orange zones and red zones will have to stay shut except for home delivery and takeaway. Furthermore, regions belonging to yellow and orange zones will be allowed to keep shops open; however shopping malls will be shut on weekends and public holidays (except for pharmacies, grocery stores, tobacconists and news-stands. Red zones will have to close all shops that do not sell essential goods (news-stands, pharmacies, supermarkets, tobacconists and laundries will stay open). Cinemas, theatres and museums will be shut in all three zones.
For the Christmas period, MD 3rd December 2020 has allowed shops to remain open until 09.00 pm from 4th December to 6th January 2021.

The Stability Law 2021 has increased by EUR 6 million the Fund for policies related to rights and equal opportunities, for the years 2021 and 2022. This measure has been taken to  contain the severe economic impact of COVID-19, with special focus on women in more vulnerable situations, and to promote autonomy and emancipation of poor women who are victims of violence.

Sporting activities
Ministerial Decree of 25th October 2020 has shut down gyms and swimming pools and provided that sports competitions, with the exception of professional, national teams will stop. Training will only be allowed for non-contact sports.
According the Prime Ministerial Decree of 4th November 2020, gyms and swimming pools will stay shut; however regions belonging to yellow and orange zones can keep outdoors sports centres open, whereas red zones will have to shut those too. In red zones, physical activity can be performed close to one’s own home. Sport can be practiced only individually and outdoors. On 14th February 2021 the Minister of Health has re-imposed the ban on amateur skiing activities, which is forecasted to last until 5th March 2021.

Travel and internal movement

According to Prime Ministerial Decree of 4th November 2020, citizens in regions belonging to yellow zones will be able to leave their house till 10.00 PM (after which the national curfew begins). Access and exit to and from orange and red zones are banned and, in addition, movement within red zones is restricted only for provable work, health and urgent needs.

For the Christmas period, Ministerial Decree 3rd December 2020 banned all travel between Regions and Autonomous Provinces – even to go to second homes - from 21st December to 6th January, inclusive. On Christmas day, Boxing day and on 1st January, people were prohibited from leaving their home town throughout the entire national territory. For New Year's Eve, the curfew lasted from 10.00 pm to 07.00 am (as opposed to 05.00 am as on ordinary days).
Of course, transport for work needs, necessities (including providing assistance to non-self-sufficient individuals) or for health reasons were allowed even during the night. Couples living apart for work reasons were allowed to reunite as returning to one’s own home has always been consented.

Furthermore, mandatory quarantine was be imposed upon access/return to Italy for:
- Italians who went abroad between 21st December and 6th January
- Tourists arriving in Italy between 21st December and 6th January
- Those who entered Italy from 7th to 15th January after staying or passing through other countries between 21st December and 6th January.

The Decree also requested amateur skiing facilities to remain closed from 4th December until 6th January and all cruise ship departures, stop overs and arrivals are suspended from 21st December to 6th January. Hotels were able to remain open, however it was not possible to organize parties and dinners on New Year's Eve. Consequently, the restaurants of the hotels closed at 06.00 pm, after which only room service was possible.

For the Christmas holidays, the 2020 Christmas Decree established for the whole of Italy to follow the rules applied to red zones on the following dates:
- From 24th -27th December 2020; and
- From 31st December to 3rd January 2021 plus 5 – 6 January 2021

During the rest of the holidays, (21 - 23 December and 28 – 30 December 2020 plus 4th January 2021) orange zones’ rules were in force. Furthermore, from 21 December 2020 to 6 January 2021 movement between regions was prohibited, except to return home. Anyone who violated such rules was fined between EUR 400-1,000.

Specifically, on red days, citizens could leave their house only for provable self-certified necessities (business, health and emergencies, including providing assistance to those who are not self-sufficient and attending funerals). Visits to grocery stores, pharmacies, tobacconists, newsstands and hairdressers were allowed. The only exception was that from 24th December 2020 to 6th January 2021, between the hours of 5am and to 10 pm, a maximum of two people were allowed to visit friends or relatives once in the same day. However, parties and gatherings were prohibited, with possible checks in homes only if there was a suspicion of a crime taking place. The recommendation was to stay at home with cohabiting people, thus limiting meetings indoors.

On orange days, there were no restrictions within municipalities on movement from 5.00 am to 22.00 pm (except on New Year's day, between 7.00 am-22.00 pm) and it was possible to travel to another municipality for (self-certified) necessities such as for work, health reasons and emergencies. The travel ban among Regions was been extended until 25 February  2021, even for Regions in the yellow zone; museums reopened in yellow Regions from Monday through Friday.

The Prime Minister’s decree of 2nd March 2021 introduced updated restriction measures confirming the division of Italy into 4 risk areas (white, yellow, orange and red) and extending the travel ban between Regions until 27th March. The decree also instituted a “permanent table” between the Ministry of Health, representatives of the regions, the Technical-Scientific Committee and the National Institute of Health, to monitor the effects of the relaxation of the measures in the white zone areas.

On March 17, 2021, the European Commission presented a proposal to create a Digital Green Certificate to facilitate the safe free movement of citizens within the EU during the COVID-19 pandemic. The Digital Green Certificate is a digital proof that a person has either been vaccinated against COVID-19, received a negative test result or recovered from COVID-19. These Certificates will be valid in all EU Member States and consist of a certificate (not a passport) stating that the owner has either been vaccinated, recovered or tested negative. It does not, therefore, constitute a certificate of immunity.

This distinction must be made with the utmost caution to ensure that citizens remain aware of the importance in still maintaining individual preventive behavior which remains essential for the control of the pandemic. In fact, while vaccination status data is easily certifiable, there are differences in the reliability of the result of a diagnostic test deriving from a molecular swab or from a rapid antigen test and in the certification of a cure.

Schools and education
Through Ministerial Decree of October 13th 2020, the Government suspended educational trips, student exchanges, guided tours and educational outings planned by school institutions, except for orientation activities and internships. Subsequently, the Decree of the President of the Council of Ministers (DPCM) n. 258 of 18th October 2020 requires secondary schools to use integrated digital teaching to complement in-person classes and to differentiate students’ entry and exit times, also considering afternoon shifts if necessary. Universities, on the other hand, are to self-manage themselves and enable distance learning tools. Ministerial Decree of 25th October 2020, however, increased distance learning to 75% for secondary schools whereas regions are also deciding the extent to which distance learning should be imposed, including increasing it to 100% and/or evaluating whether to extend it to primary education.

According the Prime Ministerial Decree of 4th November 2020, Regions belonging to yellow and orange zones will have to maintain distance learning modes for secondary schools. Kindergartens, elementary schools and middle school will be able to continue in person; however, facemasks will be compulsory. Regions in the red zones will have to resort to distance schooling even for the second and third year of middle school. For the Christmas period, MD 3rd December 2020 has established that face-to-face teaching in secondary schools will be interrupted until 7 January 2021.

Schools reopened starting on 8 January 2021 with dual-mode teaching: 50% of students are admitted to class whereas the remaining 50 % follow the lessons from home, with some differences across Italy. Despite being one of the first regions to re-open schools, Trentino Alto Adige self-proclaimed a three-week lockdown starting from 8th February 2021 due to the spread of virus mutations and increases in infection rates; thus, long distance learning methods were reactivated.

The Prime Minister’s decree of 2nd March 2021 has suspended entirely face-to-face teaching activities in schools in red regions and wherever there are at least 250 infections for every 100 000 inhabitants recorded for over 7 days, or where the regional government has taken stricter measures due to the severity of COVID-19 virus mutations.

Decree-Law 44 of 1st April 2021 established that, starting from 7th April, schools located in Red Zones could reopen for students up to the first year of middle school (11 years old) without waiving any of the above  measures, unless applying more restrictive ones. In Orange regions, all pupils up to the third year of middle school (aged 12) may return to classrooms, whereas only 50% to 75% of high school students are allowed to resume in-class activities.
A study published on 26th March 26 by Lancet by Gandini et al (2021) indicates that no significant association was found in the surge of COVID-19 cases observed in Italy between October and November 2020 and the reopening of schools or between school closures and rates of Rt decline. Most likely, this is due to the fact that SARS-CoV-2 seems to affect children and adolescents less and they are less likely to transmit it, in contrast to what happens with influenza. The study shows that, the incidence of SARS-CoV-2 observed among students is lower than that in the general population and that, on the whole, contact tracing protocols are effective. In light of the lack of solid evidence that face-to-face schooling contributes significantly to the spread of the virus, this study highlights how risks of school closures (ie. serious repercussions on the health and lifestyle of children and adolescents – such as motor activity, social interaction, psychological well-being, psychopathological problems, risk of obesity, screen addiction, potential domestic abuse and learning performance - are not outweighed by benefits.


Sardinia’s plan to go COVID-free in 45 days

On 27th February 2021, Sardinia became the first region to enter the white zone after a consistent period of declining infections. Starting from 1st March, re-openings will be gradual and agreed at the local level with the Ministry of Health and the Technical-Scientific Committee. General anti-infection measures, such as the obligation to wear facemasks and maintain an interpersonal distance of at least 1 meter, will still be in force. Among the new measures, restaurants will be allowed to stay open until 11.00 PM and bars until 09.00 PM and while a curfew is still in place, it is set at 11.30 PM. People entering the country will undergo strict health checks in order to prevent spreading of infection.  For example, from 8th March 2021, rapid COVID-19 test centres will be arranged in every airport and ports: entry will be allowed only to those presenting a vaccination certificate or with a negative result released 48 hours prior to entry. The region intends to invest in a massive vaccination campaign with the aim of becoming a COVID-free island in 45 days.

Unfortunately, the region stayed ‘White’ for only three weeks until 21st March 2021. Due to rising Rt rates the island was first reclassified as an Orange Zone (Rt 1.08) and then on 12th April to Red, with an Rt index equal to 1.54, the highest in Italy (the threshold for Red zones is 1.25).


Sources
- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&id=5127
- Decreto del presidente del consiglio dei ministri 18 ottobre 2020, “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». (20A05727)”, G.U. Serie Generale , n. 258 del 18 ottobre 2020 [Available at: https://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=76753]
- Decreto del presidente del consiglio dei ministri 3 Novembre 2020  “Ulteriori misure urgenti per fronteggiare l'emergenza epidemiologica da COVID-19” GU Serie Generale n.275 del 04-11-2020 [Available at: https://www.gazzettaufficiale.it/eli/id/2020/11/04/20A06109/sg]
- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalminisero&id=5266
- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5327t
- DPCM 3rd December 2020 – [Available at: https://www.gazzettaufficiale.it/eli/gu/2020/12/03/301/sg/pdf]
- https://www.corriere.it/cronache/20_dicembre_20/decreto-natale-2020-spostamenti-multe-6b52b52a-4233-11eb-a986-08f3985f4b5a.shtml
- Law Decree 18th December n. 172, “Ulteriori disposizioni urgenti per fronteggiare i rischi sanitari connessi alla diffusione del virus COVID-19” – [Available at: https://www.gazzettaufficiale.it/eli/id/2020/12/18/20G00196/s]
- https://www.quotidianosanita.it/governo-e-parlamento/articolo.php?articolo_id=91256
- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&id=5354

- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&id=5346
- https://www.ilsole24ore.com/art/la-sardegna-entra-zona-bianca-e-studia-ingressi-sicuri-ADaekqMB

- https://www.ilsole24ore.com/art/test-rapidi-ingresso-e-controlli-massa-cosi-sardegna-zona-bianca-punta-diventare-covid-free-ADwVUnNB
- Gandini, Sara et al. A cross-sectional and prospective cohort study of the role of schools in the SARS-CoV-2 second wave in Italy, The Lancet Regional Health – Europe, March 2021, Volume 5, 100092. DOI: https://doi.org/10.1016/j.lanepe.2021.100092
- https://www.ilsole24ore.com/art/la-parabola-sardegna-passata-tre-settimane-zona-bianca-zona-rossa-ADugGfWB  
- https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/covid-19-digital-green-certificates_en
- https://carlofavaretti.wordpress.com/2021/03/29/certificato-passaporto-pass-grande-e-la-confusione-sotto-il-cielo-quindi-la-situazione-non-e-eccellente/ 


Travel
Starting from May 4, individuals will be able to visit relatives, as long as they live in the same region. See also information in the subsection below – Ending lockdown.

Schools and education
On 26th April, the Minister of Education announced that schools will not reopen before September. However, the only exception approved by the Scientific and Technical Committee (CTS), is to allow students that have to attend Baccalaureate exams to sit the tests in classrooms.

By 24th May, the government released a proposal featuring the measures that will be adopted in September by schools to allow children and students to resume lessons. In particular, school desks will have to be placed at 1 metre distance, face masks will be compulsory from primary to high school (Children from 3 to 5 will be exempted) and the use of sanitation gel will be compulsory before entering classes. Canteens will be operational but will have to follow the same rules set up for restaurants and school entrance will take place in groups accessing premises during different hours of the morning, between 8:00 and 10:00. Such proposal will be first examined by the Ministry of Education and then discussed with the unions, however the underling condition for the reopening of schools is that the infection index rate R0 must stay below 1. Once approved, guidelines will be sent to school managers who will be responsible for implementation, adapting them to the different local realities.

Economy
On 26th April the Prime Minister announced that starting from May 4th, which marks the beginning of so-called Phase II, as far as commercial and production activities are concerned, bars and restaurants will be allowed to deliver to retail and not only to customers’ homes. Manufacturers and construction sites will be able to reopen.  It has been estimated that this will imply the mobilization of 700,000 workers using public transport, imposing a significant responsibility on its organization.

It is estimated that retailers, museums, exhibitions and team sport training will be able to resume activities on May 18th, while ordinary running of bars, restaurants, barbers, hairdressers and beauty centers will have to wait for June 1st.

The National Institute of Statistics recorded a fall in industrial production of 28.4% in the month of March only, which constitutes the biggest decrease ever recorded. In March, the unemployment rate in Italy dropped to 8.4% – its lowest level for almost nine years. The government attributed this to 267,000 fewer people looking for work than in the month before, as the unemployment rate measures active job seekers.  Several Italian municipalities that receive substantial financial resources from tourism (such as Rimini, Florence, Venice, Rome, Palermo and Naples) have warned the government that they might be at risk of default if not subsidized and allowed to re-open activities and beaches for the summer season. For Florence only, the fiscal loss might reach 200 million EUR for 2020.

Since the beginning of the lockdown Italy has lost 80 billion in GDP, out of which 65 billion have been lost by self-employed workers and workers with only partial unemployment benefits. Employees, by contrast, have not lost income up to now (May 19) and have increased savings by EUR 33 billion compared to the same period in in 2019.
 
On 15th May, the government adopted a further EUR 55 billion (3.5 percent of GDP) “Relaunch” package of fiscal measures to support the country's economy, including funds for tourism, culture and agriculture sectors and additional resources for the healthcare system and families. The new decree, in fact, temporarily freezes corporate tax for all companies with an annual turnover below EUR 250 million and grants non-repayable aid of up to EUR 40,000 to small businesses. It also allows the government to intervene and recapitalize struggling companies in line with new EU state aid rules allowing public capital injections. EUR 25.6 billion are destined to extend existing unemployment benefits, more than EUR 3 billion for the health care system, EUR 1.4 billion for universities and research, and more than EUR 1 billion for the agricultural sector. Furthermore, the so-called "emergency income" of up to €800 for low-income families has been introduced. Low-income families will receive a "holiday bonus" of up to EUR 500 to boost tourism, while hotels and beach resorts will benefit from tax discounts. EUR 2 billion will aid businesses to adapt their activities to social distancing measurements. As of 18th May, the government pledged a total of EUR 75 Billion towards support of families and companies.

Following the Parliament’s approval for a further EUR 25 billion (1.6 percent of GDP) deficit deviation, on August 8th, the government adopted a new third support package. Labor and social measures (EUR 12 billion) include, among other things, additional income support for families and some workers, an extension of the short-time work program, and a suspension of social security contribution for new hires. Other key measures are extensions of the moratorium on SMEs’ debt repayment and the time to pay back tax obligations.

Social support
The public’s opinion seems to agree that, while the productive and the industry sectors are being prioritized, children wellbeing and needs are not being given much attention in the transition measures debates.
A report released by the NGO Save the Children estimates that, among the consequences of the pandemic, more than one million children in Italy are threatened by the chance of living below the absolute poverty level. Today, there are already 1.2 million children living under poverty level, which would make the total increase from the current 12% to 20% of children affected. Among other factors, the report bases its estimates on the fact 3.7 million workers who lost income over the lockdown belong to mono-income families with children and almost 50% of the families interviewed for the research stated that they have had to cut spending on groceries and food, 30% could not pay utilities bills, 26% could not pay rent and 20% could not afford essential medicines or care. According to the largest agricultural coalition, Coldiretti, another one million people will now require food assistance.
Furthermore, the number of fragile families who are recipients of State aid has doubled during the lockdown.

On 30th April, the NGO Save the Children has therefore asked the Government to provide answers on few key issues to avoid the ongoing containment measures from further exacerbating inequalities:
o How children who do not have access to technology will catch-up on education lost during lockdown;
o How families will conciliate the absence of summer activities for children with the need to resume working activities;
o How children with disabilities and special education needs will be supported;
How to sustain families that are falling below poverty level and prevent children from having to pay the consequences of the crisis.

On 22nd May, about 4 million self-employed workers and employees were estimated to have no support/state temporary benefits.
With over three million people in this form of precarious employment, ‘under the table’ jobs are common in Italy despite, of course, being illegal and play a strong role in the country's economic growth. However, with the lockdown, many have lost their jobs and are now unable to claim any help from the state.

By 23rd May, 72% of economic activities in Italy reopened, although 68% were working at loss and it is calculated that so far only 29% of customers resumed pre-Covid consumer behaviour.
On 29th May the annual report of the Italian Central Bank governor delivered on June 15 stressed that the damages could be up to 13% of the GDP and that vulnerable families will be particularly exposed, with the poorest quintile of the population being hit by the crisis twice as much as all the others.

Domestic violence
Unfortunately, isolation and quarantine have not been a synonym for 'safety' for all Italians. The country has in fact been witnessing increases in domestic violence, depression and distress. For this reason, several municipalities, regions and citizen associations have set up protection services and activated telephone hotlines, also as support to people living alone.
An article published by the Italian newspaper La Repubblica reported that from 2nd March to 5th April 2020 the Women’s Network Against Violence (D.i.Re) was contacted by 2,867 women, of whom 806 (28%) had never turned to the anti-violence centers before. Some centers had between 120 and 300 contacts. Compared to the monthly average of 2018, numbers have risen by 74.5%. Unfortunately, it appears that no centralized intervention has been programmed to deal with the situation.

Measures addressed to the elderly
In Trentino Alto Adige, the #Resta a casa, passo io (“Stay home, I’ll pass by”) was launched in mid March to assist more vulnerable individuals such as over 75-year-olds with no family, people suffering from chronic diseases or with weak immune systems. A call centre was set up to be active from 08.00 a.m. to 08.00 p.m. with a network of social workers, volunteers and psychologists who provided emotional support, helped with grocery shopping or purchasing pharmaceuticals.  By mid May, the service had processed over 4,000 requests, of which 37% were related to requests for information, 27% for grocery shopping, 21% for pharmaceuticals and about 12% were related to emotional support. On 16th of May, the accessibility to such service was then restricted from 09.00 a.m. to 12 p.m. and from 2-5 p.m.

Frail patients

The psychological consequences deriving from the emergency situation have had a greater impact on children with cancer. Several initiatives have been launched to support families whose children have cancer, both economically and in terms of mental health services. For example, in 2020, the Italian Onlus foundation “Soleterre” strengthened its intervention for poor families, guaranteeing economic support for all expenses related to care: Soleterre covered expenses such as drugs, diagnostic tests, transport to the hospital, room and board at cancer centers, Covid-19 tests - for a total value of € 209,123 in 2020 (an increase by + 46% of the amount dedicated in € 143,090 in 2019.

Sources
- WHO regional office for Europe - An unprecedented challlenge, Italy’s first response to COVID-19. World Health Organization 2020
- https://www.ufficiostampa.provincia.tn.it/Comunicati/Resta-a-casa-passo-io
- https://www.ansa.it/trentino/notizie/2020/05/14/coronavirus-call-center-patin-2-mesi-oltre-4.000-richieste_2017c7b1-925d-4f76-9450-facf9e29966d.html
- https://www.orizzontescuola.it/rientro-a-settembre-un-metro-di-distanza-tra-i-banchi-obbligo-di-mascherina-anticipazioni-rapporto-tecnico-domani-presentato-al-ministero-dellistruzione/
- https://www.lastampa.it/economia/2020/06/10/news/il-governatore-della-banca-d-italia-visco-con-il-ritorno-dei-contagi-il-pil-a-13-1.38951807?refresh_ce
- Extract n. 82 of the meeting held at the Civil Protection Department on May 28th, 2020 – “ TECHNICAL DOCUMENT ON THE HYPOTHESIS OF REMODULATION OF CONTAINING MEASURES IN THE SCHOOL SECTOR” [Available at: https://www.miur.gov.it/documents/20182/2467413/DOCUMENTO+TECNICO+SULL%E2%80%99IPOTESI+DI+RIMODULAZIONE+DELLE+MISURE+CONTENITIVE+NEL+SETTORE+SCOLASTICO.pdf/8d3ca845-d7a7-d691-ec78-1c1ac5e5da53?t=1590689741359]
- https://www.inail.it/cs/internet/attivita/ricerca-e-tecnologia/covid-19-prodotti-di-ricerca.html
- National Health Institute, Report 58/2020 “Operational indications for the management of cases and outbreaks of SARS-CoV-2 in schools and childhood education services”. 28th August 2020. [Available at: https://www.iss.it/documents/20126/0/Rapporto+ISS+COVID+58_2020+Rev.pdf/29a228fe-4b3d-c5d7-cd6a-7a86d141d440?t=1598976654944]
- Prime Ministerial Decree  7th September 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”. (20A04814) (GU Serie Generale n.222 del 07-09-2020) [Available at: https://www.gazzettaufficiale.it/eli/id/2020/09/07/20A04814/sg]
- https://www.imf.org/en/Topics/imf-and-covid19/Policy-Responses-to-COVID-19
- Senato della Repubblica e Camera dei Deputati. Principali iniziative dell'Unione europea per fronteggiare l'impatto economico-sociale della pandemia COVID-19. 21 Settembre 2020 [Available at: http://documenti.camera.it/leg18/dossier/pdf/AT039.pdf?_1601306858343] 
- https://www.sanita24.ilsole24ore.com/art/europa-e-mondo/2021-02-15/giornata-contro-cancro-infantile-primo-report-impatto-pandemia-102217.php?uuid=ADs0y3JB


ENDING LOCKDOWN
Although the virus is still circulating and the state of emergency remains, on the night between 16th and 17th May, the Italian Prime Minister and the Minister of Health signed the new Law Decree n° 126, after an agreement with the Regions. This new decree increasingly lifts lockdown measures and constitutes a central reference for regional protocols to be issued, with the aim of ensuring that rules are certain and homogeneous throughout the country. This decision derives from a calculated risk, in the knowledge that the contagion curve may rise again but that he had little choice. The country’s circumstances could not wait until a vaccine against the virus is developed because of the damage to the economic and social structure. On 23rd September, Prime Minister Giuseppe Conte repeated that it is unlikely the Government will impose another general lockdown, however it might be necessary to impose targeted lockdowns. As stated by the ECDC, it appears that by the last week of September, Italy, and its healthcare system, have managed to return to a low COVID-19 risk. The Council of Ministers approved the extension of the state of emergency to 31st January 2021, together with the assignment of powers to the government to adopt all measures aimed at containing the spread of SARS-CoV-2. The new Decree Law, also extends measures contained in the Decree of the President of the Council of Ministers (Dpcm) of 7th September 2020 to 15th October 2020.

Starting from 18th May, several commercial activities (such as bars, restaurants, pubs and hairdressers for example) are allowed to reopen. The reopening of cinemas, theaters and other activities still suspended will follow. The timeline announced by the Prime Minister establishes that by the 25th May, sport clubs and swimming pools will reopen and on 15th of June, theatres and cinemas, with limitations in numbers of seats. It is up to Regions and mayors to adapt those guidelines to their local realities.   The government will monitor the evolution of the infection and will intervene should numbers rise beyond the boundaries set in agreement with the Minister of Health and the scientific committee.

Among the sectors that have suffered the most, the creative industries will be the last to reopen as shows in cinemas and theaters will resume on June 15th. In addition to the interpersonal distance of 1 metre, there will be a maximum limit of 200 people for indoor screening and one thousand for outdoor screening.

Since 15th June, arcades, betting rooms, bingo halls, wellness centers, spas, cultural centers and social centers are allowed to reopen, on the condition that Regions and autonomous Provinces guarantee that an activation of such activities occurs taking the epidemiological curve into consideration. Summer centres will also re-open and host children from 0 to 3 years of age, which will notably facilitate circumstances for working parents who cannot work from home. Contrarily, all activities that take place in dance halls, clubs or similar settings -whether outdoors or indoors - are still suspended. As for public fairs, conferences and congresses, were authorised to resume activities on July 14th.

Sports and physical activity
From 25th June, contact sports could be practiced in those Regions and Autonomous Provinces which, in agreement with the Ministry of Health and the Delegated Authority on sports, have previously checked the compatibility of the aforementioned activities with the epidemiological curve of each territory. By October, however (Ministerial Decree of October 13th), the Government has halted training and competitions for of all amateur sports involving close contact.

Furthermore, through Prime Ministerial Decree (DPCM) of 7th August 2020 small sized sports events will be allowed to have a maximum of 1000 spectators for outdoor stadiums and 200 spectators for indoor facilities, from the beginning of September. Ministerial Decree of October 13th maintained such measures adding the obligation to measure body temperature at points of access.

Further changes were implemented with Decree of the President of the Council of Ministers (DPCM) n. 258 of 18th October. In fact, only individual and team sport competitions of national or regional significance are still allowed, with the same audience restrictions. Regions and autonomous provinces may derogate from these restrictions in relation to their own epidemiological situation, if approved by the Minister of Health. Training sessions are allowed solely behind closed doors.

Travelling to and through the country:
Starting from 18th May, individuals were allowed to travel within their region without any restrictions and without having to self-certify their reasons.  EU citizens could enter Italy without obligation of quarantine. Those entering Italy for work reasons and staying for no more than 120 hours (5 days) are not obliged to undergo quarantine; however. They must have a registered office, or secondary office, in Italy.

Following Law Decree n° 33 (issued on 16th May), all regional borders were reopened at midnight of 3rd June; thus Italians were allowed to freely move throughout the entire country and abroad.
At a national level, railway stations will mandatorily measure the body temperature of all passengers on long-distance trains and access will be denied if it exceeds 37.5 °C. Trains will be equipped with on-board catering services but staff will serve food and drinks in sealed and single-dose packaging, wearing masks and gloves. Trenitalia, the primary train operator in Italy, has increased the frequency of its service and now provides daily 80 high-speed trains, 48 Intercity trains connecting major and minor cities and 4653 regional tracks. Italo, the second train operator has also added new destinations (Bolzano, Trento, Rovereto, Rovigo and Verona) and the main Italian airports (24 in total) are now fully operational. From abroad, access is consented to 26 Schengen countries and the UK, without mandatory quarantine.

The decision to reopen, though, alerted governors of southern regions, concerned about potential spreads of the infection and has been the subject to several controversies even among policy makers in norther regions who would have preferred to delay the reopening. Puglia has requested that each traveler report all movements, visited places and people encountered in the 30 days previous to the date of entry in the region. In Sicily, tourists’ origin and localization must be traceable and the existence of any suspicious cases in one’s family verified. Lazio has established that body temperature will be measured on those accessing by car, by placing controls at the border of the regions. Those with a body temperature over 37.5 °C will be subject to a nasopharyngeal swab with domiciliary confinement while awaiting for the result, and may be reported to Health Authorities. Sardinia has chosen to keep transport limited until 12th June.

On 14th July 2020, an order signed jointly by the Ministry of Health, of Foreign Affairs, of the Interior and of Transportation banned access to travellers arriving from (or who, in the 14 days prior to arrival, have transited through) 13 countries considered more at risk: Armenia, Bahrein, Bangladesh, Brazil, Bosnia and Herzegovina, Chile, Kuwait, Northern Macedonia, Moldova, Oman, Panama, Peru and the Dominican Republic. Furthermore, it has also banned direct and indirect flights to and from these countries. On 16th July 2020 the MoH added to this list also Kosovo, Montenegro and Serbia, while from 13th August 2020 it included Colombia.

As the month of August unfolded, both at national level and at regional level, rules regarding quarantine and isolation for travellers continue to be heterogeneous and are updated regularly as the pandemic evolves. For example, a Covid-19 test (through swabs) have become mandatory for those entering from countries such as Malta, Spain, Croatia, Greece and, since 22nd September, some regions of France (Paris and other ‘red areas’). By 7th October, Belgium, the Netherlands and the UK were added. Those travelling to Sardinia must be able to show a negative test result belonging to the 48 hours previous to arrival. Every traveller to Sardinia must also register online 48 hours before departure.

For those who, in the fourteen days prior to their arrival in the country have stayed or transited through Romania and Bulgaria, quarantine is compulsory and must last two weeks.
More specifically, on 12th August 2020, the Ministry of Health issued an ordinance establishing that all travellers arriving in Italy after visiting Greece, Croatia, Spain or Malta must be tested for Covid-19 through a swab unless, at their arrival in the country, they provide a molecular or antigenic test with a negative result conducted no longer than 72 hours before entering Italy. Travelers can choose between a so-called ‘rapid swab’ upon arrival in Italy’s major airports or to be tested elsewhere at their destination within 48 hours after arrival. In the region of Lazio, a total of 20 drive-ins for molecular swabs have been set up around the capital city of Rome whereas in the city’s two main airports and at the port of Civitavecchia, rapid swab tests are available and are able to provide a response in 30 minutes. Similarly, tests have been made available in two airports in Milan (North, Lombardy) - Malpensa and Linate - and in the airport in Bologna (North, Emilia Romagna). Naples (South, Campania), has organized for travellers to be tested at the Cotugno Hospital; in the region of Liguria (North) the governor has opposed making swabs compulsory, despite increases in the number of infected people returning from Sardinia to the port of Genova. In Turin (North, Piedmont) travellers can be tested at the Amedeo di Savoia Hospital. Access to the country from non-EU or non-Schengen countries is allowed only for proven work/academic reasons of absolute urgency, health reasons or for those returning to their own home.

The Prime Ministerial Decree (DPCM) of 7th August 2020 also allowed cruise services to depart starting from 15th August and to organize trade fairs and conferences from  1st September as long as interpersonal distance of at least 1 meter can be maintained.

Schools and education
Shutting down schools has indeed been among the most complex and painful measures for the country; however, the policy was essential to contain the pandemic. The CTS and the National Institute for Insurance against Accidents at Work (INAIL), consider schools to be in the medium-low integrated level of risk and a medium-high risk of aggregation. 

Preparing for the academic year 2020- 2021, INAIL has prepared a set of guidelines reported in the “Technical document on the hypothesis of reorganization of containing measures in the education sector”, based on the epidemiological and scientific knowledge available on 25th May 2020, detailing system, organizational, prevention and protection measures to make sure that the new school year starts safely in Autumn. The indications, released on 28th May, are of a general nature in order to provide flexibility to individual premises to contextualize them to their specific situation.  To elaborate such guidelines, INAIL first conducted an estimation of the number of schools in each region and in the entire country, and then measured the volume of transportation  - about 30 million people transit  daily to reach their academic institution or workplace, with a large share represented by students – and the analysis takes into account organizational and prevention measures undertaken in other European countries to manage the re-opening of schools. First of all, the basic conditions for students and all staff to be allowed to access their schools are an absence of respiratory symptoms or body temperature above 37.5 °C in the current and previous three days; not having been in quarantine or home isolation in the previous 14 days; not having been in contact with Covid-positive people in the previous 14 days. In addition the guidelines state that:

• Schools will not be obliged to measure individuals’ body temperature at entrance, thus responsibility is entirely on students, parents and tutors.
• The focus is on the optimization of spaces and on student mobility, especially on working days in large metropolitan areas, in morning and afternoon peak hours. Thus, schools in large urban centers are asked to consider starting classes at different times to reduce the load on public transport between 7:00 am and 8:30 am.
• In relation to the number of pupils and staff, it will be essential that each school considers the possibility of changing class schedules or to reduce the amount of hours spent inside, paying particular attention to the risk of overcrowding, especially outside classrooms. Distance learning can continue to be pursued as complementary/integrated form of lesson delivery rather than a substitution of in-school classes.  The physical presence of parents at schools - or their delegates - should be minimized unless strictly necessary.
• Classroom layouts will have to be revised, possibly repositioning desks, chairs and blackboards to safeguard an interpersonal distance of at least 1 meter.
• Common areas, recreation areas and corridors must be connected through specific pathways signalled by signposting, whereas recreation and Physical Education classes should be carried out outdoors as much as possible. In the first period of the new academic year, team games and sports are not recommended, while individual physical activities that consent distancing are to be promoted.
• School facilities must also be equipped with windows to ensure a regular and sufficient exchange of air and natural ventilation.
• Headmasters must ensure that, prior to school reopening, structures have been thoroughly cleaned by the school staff following instructions provided by the ISS has through the Ministry of Health Circular "Indications for the implementation of measures to contain the contagion from SARS-CoV-2 through sanitization procedures of non-sanitary structures ( surfaces, interiors) and clothing "
• Appropriate procedures will have to be detailed for the isolation of anyone who manifests respiratory symptoms and fever.
• Masks and sanitizing products must be available for students and staff, at several locations within the school building and, in particular, at each classroom entrance. Pupils will, in fact, be required to continuously wear surgical masks unless they have forms of disability that compromise their safe use.
• Even for all non-teaching staff, in the common areas, the same spacing rules of at least 1 meter must be guaranteed, also wearing a surgical mask.

Ministerial Decree of 7th September formally confirmed the reopening of schools on 14th September (although in 5 regions the openings will be delayed until after the September 20-21 elections). All schools should be re-opened by October 1st; however, by September 23rd there have already been cases of schools closing for a limited number of days following students testing positive.

While classes are meant to take place in person, there are still many organizational issues that are yet to be solved, such as a shortage of single-person desks and teachers needed for socially distanced lessons, thus the issue of has been generating much national debate. Currently, the obligation is to fully comply with the guidelines published by the National Health Institute (ISS) and developed in accordance with the Ministry of Health, Ministry of Education, INAIL, Bruno Kessler Foundation, Veneto Region and Emilia-Romagna Region. The report, "Operational indications for the management of cases and outbreaks of SARS-CoV-2 in schools and childhood education services” provides recommendations to guarantee that schools reopen in the safest conditions with structured plans that ensure continuity.  The document illustrates the planned national response strategy and explains correct behaviour to be followed and precaution measures to be taken when a pupil or an operator reveals suspected or positive cases, both in school and at home. In such cases, action will be required from: the child’s parents, his/her paediatrician or GP, the Department of Prevention of the competent Local Health Authority and each school’s designated contact, intended as an adequately trained employee that is in charge of recording contacts between pupils and staff of different classes, making sure that children have their temperature measured every day by their parents and report any absences due to health reasons that may be linked to Covid-19.

Children who start manifesting symptoms at school must be isolated in a dedicated area with the assistance of a staff member protected by PPE. Parents must immediately take their child home and contact a pediatrician or GP, who, after evaluating the situation, will decide if it is necessary to contact the Prevention Department (PD) for a swab. In positive cases, the Department of Prevention will then perform all the necessary investigations for contact tracing and evaluate whether to impose quarantine on classmates, teachers and other close contacts.

Students with disabilities
As it is not always possible to guarantee the proper interpersonal distance when assisting students with certified disabilities, staff may be provided with additional PPE such as nitrile gloves and eye protection glasses. Each preventive and protective measure will have to take into account the specific situation of the disabled child.

Specific guidelines for kindergartens
In kindergarten, physical distancing will be more difficult and will require additional resources to reduce the number of pupils simultaneously present in classrooms or to regularly clean surfaces. Kindergarten pupils, and children under 6 in general, will not have to wear a mask, and staff may be allowed to use additional PPE (e.g. nitrile gloves and eye protection glasses) in addition to the usual surgical mask.
 
 The recommendations also suggest resorting to information campaigns both within schools and through webinars for students and their families. For example "Five Rules" for a safe return to school are to be passed on to children and youngsters:
 
1. If you have symptoms of acute respiratory infections (fever, cough, cold), talk to your parents immediately and DO NOT come to school.
2. When in school, wear a mask, even if made of cloth, to protect your nose and mouth.
3. Follow teachers’ instructions and follow the instructions in posters/signs.
4. Always keep an interpersonal distance of 1 meter, avoid gatherings and physical contact with schoolmates.
5. Wash your hands frequently and use appropriate hand sanitizers to keep them clean; avoid touching your face and mask.

Economy
The EU deal for “Next Generation EU”, commonly known as the Recovery Fund deal, assigns a total of EUR 208 Billion to Italy, divided between subsidies and loans, making the country the biggest beneficiary among member states. On 15th September, Italy released its first resource allocation guidelines that will shape the National Recovery and Resilience Plan for accessing the Recovery Fund, to be finalized by April 2021. In general, the plan aims at a modernization of the country’s services by improving bureaucratic flows, reducing times necessary for the administration of justice and increase public sector investments (education, R&I and public infrastructure).

More specifically, the government’s guidelines are currently before Parliament and its main objectives include:
• Doubling the average growth rate of the Italian economy (0.8% in the last decade, according to governmental data), bringing it at least to EU average (1.6%, according to governmental data);
• Increasing public investments to from 2.2% (Eurostat 2019) to at least 3% of GDP;
• Raising the value of research and development investments above EU average of 2.1% compared to the current 1.3% in Italy (governmental data).

The National Plan has been divided into six main areas of intervention ("Missions"), each containing its own set of project clusters linked to support and reform policies.
The six missions are:
1. Digitalization, innovation and competitiveness of the production system;
2. Green revolution and ecological transition;
3. Infrastructure for mobility;
4. Education, training, research and culture;
5. Social, gender and territorial equity;
6. Health

Separately, the European Commission has approved the mobilization of more than EUR 660 million from the Cohesion Fund, to be put towards the operative programs of Lombardy and Sicily. More specifically, Lombardy will allocate EUR 193 million to strengthening its health services and EUR 10 million of working capital to SMEs. Sicily has chosen to put 4.3 million towards supporting the health sector, EUR 320 million towards its SMEs, EUR 75 million in the tourism sector whereas the remaining EUR 60 million will aid the modernization of schools and higher education institutions.

Prime Minister Conte has announced that further economic support will be given to sectors in difficulty.  On 27th October 2020, the Cabinet approved new economic support measures amounting to over EUR 5 billion through the ‘Ristori decree’. Measures include:
• EUR 1.6 billion to finance an additional 6 weeks’ furlough payments.
• A maximum of 4 months’ tax relief for employers who have had to interrupt or reduce their business.
• Tax credit on commercial rent for October, November and December for businesses with revenues of over EUR 5 million.
• EUR 1,000 indemnity for autonomous and intermittent workers in the entertainment and tourism sectors.
• EUR 1 billion for selected sectors:
- EUR 400 million for holiday agency and tour operators
- EUR 100 million for the publishing and conference sectors
- EUR 100 million for the hospitality sector
- EUR 400 million for export and international fairs
• Two months of emergency salary payments.
• Establishment of an EUR 50 million fund to support amateur sport clubs and associations.
• Establishment of an EUR 100 million fund to support the agriculture and fishery sectors.
• EUR 30 million to supply 2m rapid tests to family doctors (please refer to section 1.5 Testing) for further information.

Memorial Day for Covid-19 victims
The Italian Parliament has set 18th March as the Memorial Day for the Covid-19 victims. This date was chosen as it registered the largest number of deaths nationally and the entire country was shaken by the dreadful image of a parade of military trucks filled with coffins that carried corpses away from the overcrowded cemetery of Bergamo to be cremated in surrounding regions. Schools, institutions and local authorities are invited to host informative and awareness raising initiatives and events, to keep informing and sensitizing citizens of all ages and commemorating the deceased.

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”
- https://www.ilfattoquotidiano.it/2020/04/27/coronavirus-azzolina-scuole-chiuse-un-dolore-ma-aprirle-rischia-di-vanificare-gli-sforzi-ma-abbiamo-ok-per-maturita-in-classe/5783051/
- https://www.ilsole24ore.com/art/fase-2-inail-iss-riaperture-700000-lavoratori-mezzi-pubblici-ecco-10-regole-rispettare-ADX4GzM
- https://www.repubblica.it/cronaca/2020/04/14/news/emergenza_coronavirus_aumentano_le_violenze_sulle_donne-254026268/
- WHO regional office for Europe - An unprecedented challenge, Italy’s first response to COVID-19. World Health Organization 2020
- Law Decree n. 126 of 17th May 2020, available at http://www.quotidianosanita.it/allegati/allegato6252186.pdf
- https://www.corriere.it/cronache/cards/coronavirus-piu-treni-aeroporti-operativi-cosi-l-italia-ritorna-viaggiare/comincia-fase-tre_principale.shtml
- http://www.governo.it/it/articolo/coronavirus-il-presidente-conte-firma-il-dpcm-11-giugno-2020/14741
- https://www.corriere.it/cronache/20_luglio_09/coronavirus-italia-vieta-ingresso-13-paesi-rischio-a27adfaa-c1ff-11ea-9a71-56106a53bf80.shtml?refresh_ce-cp
- https://www.tgcom24.mediaset.it/politica/vittime-del-covid-fissata-al-18-marzo-la-giornata-della-memoria-mozione-approvata-allunanimit-dalla-camera_21049251-202002a.shtml
- http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5018 
- Ministero della Salute, Ordinanza 12 agosto 2020 – “Ulteriori misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19.” Available at: http://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=75696 
- https://www.ilsole24ore.com/art/tamponi-e-quarantena-manuale-il-rientro-sicuro-vacanze-ADFNF0k 
http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=5026 
- Ministry of Education, Circular 20th August 2020 “Operational indications for the management of cases and outbreaks of SARS-CoV-2 in schools and childhood education services” [Available at: http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=75894&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=5024 
- Ministero della Salute, Ordinanza 16 agosto 2020 “Ulteriori misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19. (20A04564)” [available at: http://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=75709] 
- DPCM 7 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 ]
- ORDINANZA 21 settembre 2020  Ulteriori misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19. (20A05139) (GU Serie Generale n.234 del 21-09-2020) [available at: https://www.gazzettaufficiale.it/eli/id/2020/09/21/20A05139/sg]http://www.regioni.it/news/2020/09/21/ue-riassegna-660-mln-a-italia-su-fondi-coesione-contro-crisi-covid-618800/
- 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]  





Borders and mobility
The Minister of Health released initial mandatory isolation directives on 21st February; however, in the week between 23rd February and 1st March, 50 000 people were confined and EUR 3.6 billion allocated to support the economy.  At that stage, as the dramatic outbreak was still confined to some areas in the north, the country was risk-stratified as follows:

• A Red Zone, including the most affected towns in Lombardy and Vò in Veneto, in which containment measures were the most restrictive including banning entry and exit to and from such areas, the interruption of educational activities, the cancellation of public events and the suspension of commercial activities.
• The Yellow Zone (the rest of Lombardy and Veneto plus Emilia-Romagna) underwent less restrictive measures; schools were closed, and religious and sports events were allowed only behind closed doors. However, social sites could function if they guaranteed the 1m safety distance between clients or visitors.
• The rest of Italy had to set up preventive measures in schools and Public Administration offices. Public sites were requested to adopt extraordinary sanitation measures. Those returning from China or from the Red Zone after the 14th February were requested to alert Local Health Units.

On 9th March, Prime Ministerial Decree (DPCM) #Iamstayingathome extended all containment measures to the entire country as Prime Minister Giuseppe Conte announced that all of Italy was to be considered a “Red Zone”, meaning that the entire country was on lockdown and people had to limit travel except for work or medical reasons.  In the following days, all commercial activities not providing necessity goods, such as groceries and pharmaceuticals, were suspended; public parks, gardens and playgrounds were closed. In hindsight, this selective approach of “following” the virus might have facilitated the spread of the infection; after publicly announcing the lock-down of northern Italy, a massive exodus to southern Italy was set off, undoubtedly spreading the virus to regions where it had not yet arrived.

On 28th March, the Ministry of Infrastructure and Transport (http://www.mit.gov.it ) released a new ordinance co-signed by the Ministry of Health, according to which each person entering the national territory via air, sea, train or land must hand in a declaration detailing the motives for travel, a full address where surveillance and isolation will take place, the means of transport that will be used to reach the destination and a telephone contact. Carriers verify the documentation and measure body temperature of passengers and allow boarding only if the temperature is below 37.7 degrees. They are also requested to guarantee the maintenance of 1 metre distance between passengers and provide personal protective equipment. These rules do not apply to freight transport.

Economy
The #CureItaly decree (“CuraItalia”), issued on 17th March, approved a EUR 25 billion emergency package (as of April 2) in support of the healthcare system, employment, workers and families. The decree suspended obligations to pay taxes and contributions owed in the month of March and April (EUR 6.4 billion were allocated for this purpose from the emergency package), independently from annual revenue, for all businesses working in the sectors believed to be the most affected, such as:
• Tourism and hospitality
• The spa industry
• Transport
• Restaurant and catering
• Culture
• Sport
• Education
• Amusement Parks
• Events
• Arcades and betting

 Furthermore, it guarantees premiums for all workers who are obligated to stay in services directly involved in the emergency.  In addition, specific funds have been allocated to sanitize workplaces of the Police Force, the Armed Forces, the Department of Corrections, the Fire Department, the Prefectural Administration and the Civil Administration. Furthermore, the decree has facilitated leave for parents with dependent children for the months of March and April and set aside a EUR 600 bonus for families with children under 12 years old, increasing the amount to EUR 1,000 for healthcare professionals involved in the emergency.

Previous measures had already enhanced modalities for remote working and extended social safety net measures to all individuals whose working activities had already been suspended, such as lay-off compensation funds or wage subsidies.
The psychosocial and economic impact of this crisis is enormous and much of the Italian economy relies on family-owned small or medium enterprises, which will now have to be helped by resorting to the banking system and the Central Guarantee Fund.

On 30th March, Ministry of Labour and Social Policies, trade unions and the Italian Banking Association (ABI) banking sector association signed an agreement to enable banks to transfer unemployment subsidies directly to entitled workers’ bank accounts for nine weeks. The amount is guaranteed by the State and the Italian National Pension Fund will then refund banks. This strategy allows the rapid payment of subsidies to millions of workers on behalf of the government, in an attempt to avoid potential social turmoil caused by families not being able to address basic needs, including food and rent. Indeed, experts have warned that criminal organizations, present and active especially in the South of the country, will take advantage of the rapid poverty increase and will exploit their large financial means to recruit new people to work for them. In Sicily, the Mayor of Palermo, Leoluca Orlando, has asked to organize a so-called “survival income” for the poorest citizens, also owing to the fear of acts of violence promoted by criminal gangs.

On 6th April 2020, the Italian Government approved a new decree to provide immediate access to funds for small, medium and large enterprises, with the aim of supporting firms, entrepreneurs and workers to get back on track. This major manoeuvre has secured loans for EUR 400 Billion, meaning that since the beginning of the crisis, the State has mobilized a total credit of 750 Billion, almost half of its GDP. EUR 200 Billion are destined to the internal market and other EUR 200 Billion are for the exports market. Funds will be provided by ordinary financial bodies, however the State will act as guarantor for such loans. 


School and education
After EUR 85 Million were set aside to manage remote schooling, on 6th April, the Council of Ministers addressed issues concerning the end of the academic year 2019/20 by releasing the “School Decree”. Should classes restart regularly by May 18th, the “Esame di Maturità”, Italy’s equivalent of the International Baccalaureate, will undergo some minor simplifications concerning the written tests, whereas Middle School finals will be simplified by reducing the number of exams. Should students not return to school before the end of this academic year, the Esame di Maturità will be simplified and reduced to one single videoconference oral examination, whereas Middle School final exams will be cancelled entirely. Furthermore, all other students from the other school years will be admitted to their next year automatically.
Sources

- https://www.fiscoetasse.com/approfondimenti/13623-covid-19-sospensione-tasse-e-contributi-per-i-settori-pi-colpiti.html 
- https://www.repubblica.it/politica/2020/03/01/news/coronavirus_misure_governo-249980561/
- https://www.bloomberg.com/opinion/articles/2020-03-02/coronavirus-italy-shows-how-to-tackle-the-epidemic-s-impacthttps://hbr.org/2020/03/lessons-from-italys-response-to-coronavirushttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30110-8/fulltext 
- https://www.ilsole24ore.com/art/app-anticontagio-e-test-rapidi-piano-sanitario-ministro-speranza-ADmf0JI 
- Boccia S, Ricciardi W, Ioannidis JPA. What Other Countries Can Learn From Italy During the COVID-19 Pandemic, Viewpoint. JAMA Internal Medicine. 2020; 32:1-2. Published Online: April 7, 2020. doi:10.1001/jamainternmed.2020.1447
- http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4412 
- http://www.mef.gov.it/en/inevidenza/Protect-health-support-the-economy-preserve-employment-levels-and-incomes-00001/
- https://www.theitaliantimes.it/italia/abi-cos-e-cosa-indica-vuol-dire-nascita-storia-significato-presidente_090420/https://www.repubblica.it/cronaca/2020/03/23/news/la_mafia_del_virus_dalla_droga_alla_sanita_la_pandemia_aiuta_l_economia_criminale-252023708/
- https://www.vaticannews.va/it/chiesa/news/2020-04/intervista-don-ciotti-mafie-coronavirus.html
- http://www.mef.gov.it/inevidenza/Gualtieri-Un-bazooka-di-liquidita/