Italy Wears its Covid Scars Like a Badge of Honour

Genoa, one of the Italian playgrounds of the super-rich is a city of lap dog lovers. There is no shortage of dogs, or dog turds. But there does seem to be a shortage of poop bags and it was not uncommon on my morning run along the Corso Italia this week to see a face-masked dog walker allowing his dog to leave another infectious deposit of poo, walk away and leave it steaming in the middle of the promenade.

I have just returned from Italy where the proclaimed lifting of Covid restrictions refers only to the paperwork associated with entering and leaving the country. Masks are still very much in evidence and a great deal of this is self-imposed. If not actually wearing a mask, nearly everyone has a mask around their wrist, like a talisman of which they just cannot let go. Normality will only ever be regained when the metaphorical masks are lifted from the minds of the Italian people.

My regular visits to Italy have allowed me to observe over time the reaction of the country to the emergence of the novel coronavirus COVID-19. Italy was quick off the mark in the early days of the global panic and, indeed, amongst the first to panic. I returned to the U.K. from Wuhan late in 2019 to discover I had left an epidemic behind me. While we only began hearing about the coronavirus early in 2020 it had already been making its way through the sick and vulnerable in Wuhan since at least November 2019, certainly coinciding with my five weeks in the city in November and December 2019. I had travelled on crowded trains and taxis, eaten in crowded restaurants and taught in packed lecture rooms with impunity. My initial reaction, and one which has not attenuated, was that this was just another virus, it would kill a few old folks like me and some of the more clinically vulnerable amongst us and leave the vast majority alive and unscathed. And that is exactly what happened.

I made a very quick visit to Vienna after returning from China where our train from the main station into Slovenia was cancelled because someone on the train – which came from Italy – apparently had ‘the virus’. The ultimate reaction in Vienna is well documented. A week later, in February 2020, I visited Italy where I had my temperature checked – Far East style – on arrival. By the time I returned to the U.K. at the end of that week, Italy had all but ground to a halt. The mainstream media in the U.K. were tripping over themselves to transmit gruesome scenes from hospitals and to report what seemed like alarming figures for COVID-19 (it now had a name) infections and deaths. Italy stopped all but essential health care, closed roads and restaurants and made people work from home. Essentially, devoid of any ideas of their own, the Italians followed the Chinese measures they saw taking place in Wuhan. How we in the U.K. laughed… until March 23rd 2020.

Whether deliberate or not, the scenes from Italy were really the beginning of ‘project fear’ in the U.K. If our public health officials were thinking of recommending to the Government measures akin to the lockdown in China or felt that they were not taking the prospect of a pandemic seriously then this was just the picture they needed to convince them. Indeed, they did convince them with Neil Ferguson then of SAGE claiming they never thought they would get away with it.

Nobody in the mainstream media tried to contextualise what was being reported from Italy. Pictures of busy hospitals, especially ICU units, make great TV. ICU units are normally busy. However, it adds to the drama if people are in full PPE which helps to ramp up the fear factor. But Italian hospitals are always crowded. Italy is a heavily medicalised society and one where people expect themselves and their relatives to be treated in hospital. This is exemplified by comparing Italian healthcare with U.K. healthcare. We have comparable populations in terms of size (60 million for Italy; 68.5 million for U.K.), a comparable number of hospital beds (187 thousand for Italy; 162 thousand for U.K.) and yet in Italy in 2019 there are a staggering 58.6 million annual hospital admissions compared with approximately 6 million in the U.K. Against this background, the pressure on doctors to admit patients to hospital is immense. Also, presumably, there is pressure to admit people to ICU if that is considered to be the appropriate treatment and when you have more ICU beds (3.1 per thousand people compared with 2.4 in the U.K.) you will tend to fill them.

Late in 2021, I was able to return to Italy as I was then considered fully vaccinated and this visit was reported in the Daily Sceptic passim. However, I had to postpone an April visit to May as I am no longer considered fully vaccinated. To enter Italy now if you are unvaccinated or cannot prove recovery from Covid you need a negative lateral flow test within 48 hours prior to entering Italy. I duly crossed the Humber Bridge from Hull to Humberside airport one morning to have the test and then travelled to Heathrow. Two cancelled and rescheduled BA flights later I arrived in Italy to breeze in without ever being asked to produce the test certificate. Masks were enforced on the flight to Milan but not reinforced in Club Class once the curtain was drawn behind us.

Masks remain mandatory on public transport and the driver of the bus from Milano Linate airport to Milano Centrale station gave me that horrid gesture with the cupped hand over the mouth and nose indicating I needed to wear a mask on the bus. I complied politely but as soon as his back was turned, I removed it. I noted another passenger studying me carefully and expected a confrontation. Instead, he removed his. Small victories. I even removed my mask on the train on the way to Genoa as I saw another passenger had removed his. Nobody challenged me. The travel regulations specify FFP2 grade masks, but people were wearing a range of face coverings, and nobody was challenged.

There was trouble when I went to Mass that evening. I got ‘the gesture’ from one of the pass keepers about my maskless face. He did not speak English, so he got someone who did. I told him it was not compulsory, and he went away. I found out later that, in fact, it was compulsory as this was considered a public gathering. While we were few, I was not the only maskless person at Mass, but I was the only one challenged.

Face masks are not required at places of work, except in hospitals which also require the ‘Super Green Pass’ for entry. Nevertheless, the University of Genoa where I was working is insisting that staff and students wear face masks at all times. I did not comply, and nobody complained but I was astonished at the level of compliance – essentially 100% – among colleagues and students. Not a single colleague had ever challenged the Covid narrative, and one claimed to have absolutely no idea what had been taking place in Australia and New Zealand. Disappointingly, he seemed impressed rather than horrified. Trying to elicit views on the pandemic measures was like trying to draw teeth, which is the perfect analogy. People literally winced at the news that face masks were not effective or that there was no evidence for the efficacy of the whole range of non-pharmacological interventions. Faith in the vaccines, their efficacy and safety, is absolute.

It is obvious that a combination of Covid catastrophising and the pandemic measures have hit the Italian psyche hard. They are very willing, almost enthusiastic at playing up how badly they think Italy was hit by Covid and to play down any suggestion that the reaction was disproportionate and probably unnecessary. Covid-related conversations inevitably start: “In Italy…” rather than on the nature of the virus or the need for any of the restrictions. Whatever the Italian Government has told them, they accept. There is no reference to other countries, so I did not even bother to point out how well Sweden had coped.

Italy seems to have lived in a coronavirus bubble of its own making for the past two years. This seems like an incredible achievement, given the availability of both mainstream and social media. Of course, there have been significant protests against the restrictions but, in keeping with all of the above, these have been effectively played down and nobody I spoke to was aware of their scale. Trying to move people on to that territory simply elicited a sentence that started: “In Genoa…”. Of course, I was moving in entirely the wrong circles among academics and postgraduate nurses to expect anything else.

In addition to BA cancelling my return flight and not rescheduling it, leaving Italy proved more problematic than entering. At the departure gate I was told to wear a mask before boarding the bus to the plane. I duly fished out my disposable surgical mask to be shouted at by the member of staff: “No, no. No this one; must be FFP2.” I had purchased some in expectation, so I put one on and soon realised how lightly we had got off in the U.K. Wearing an FFP2 is like wearing an S10 respirator without the filter. Laboured breathing and light-headedness from re-breathing carbon dioxide set in within minutes. The cabin crew were all wearing FFP2s when we boarded. As soon as boarding was complete and Italian officialdom had departed, they all changed them for disposable surgical ones. There was a half-hearted announcement about face masks but the word ‘mandatory’ was not included. My mask was off immediately. Relatively happy days!

Dr. Roger Watson is Academic Dean of Nursing at Southwest Medical University, China. He has a PhD in biochemistry.

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