Dereliction of duty: How Italy bungled the pandemic

Something went wrong in the way Italy handled the pandemic in the early days of the outbreak of the novel coronavirus, exactly one year ago. Was it due to unpreparedness or negligence?

With over 2.6 million cases and more than 91,000 deaths, authorities in Italy – the first country in Europe to face the Covid-19 emergency and one of the hardest hit – are investigating whether its response was adequate and timely. 

Already last August, a report by the former army general Pier Paolo Lunelli, an expert on pandemic plans, claimed that Italy could have saved 10,000 lives hadn’t the country had “an old and inadequate plan”.

Authorities in the northern city of Bergamo, in the region of Lombardy and epicentre of the first outbreak, are investigating whether the (outdated) pandemic plan was even activated in time when the World Health Organization (WHO) first launched the alert in January last year.

In a new 130-page report that has become part of the proceedings together with a complaint filed by a group of victims’ relatives, Lunelli writes that Italy “has neglected or, worse, ignored [the epidemic] until it was too late.” 

Investigations by the Public Prosecutor’s Office in Bergamo are under way into criminal negligence by national and local authorities, to verify the correlations between the outdated plan and the high number of deaths, as well as the failure to enforce a red zone in Val Seriana in the early days of the outbreak.

An obsolete plan

It all started on May 13 2020, when the independent report ‘An Unprecedented Challenge: Italy’s First Response to Covid-19’ was published on the WHO website and promptly removed, as reported by The Guardian in August.

The report examined what happened in Italy in the early days of the outbreak in order to help other countries to better cope with the health emergency. In labelling Italy’s response as “improvised, chaotic and creative,” the report stated that the national pandemic plan had not been updated since 2006, failing to comply with the latest WHO and European Centre for Disease Prevention and Control (ECDC) guidelines issued in 2017.

Francesco Zambon, a scientist at the WHO’s office in Venice and the coordinator of the report, allegedly came under pressure from Ranieri Guerra, WHO’s Deputy Director for Strategic Initiatives and among the scientists currently on the Italian government’s Covid-19 taskforce. Zambon was reportedly pressured to edit the report and remove the part where it claimed Italy’s pandemic plan – officially dated to 2016 – was not updated but was a “copy-pasted” plan from 2006, in the aftermath of the SARS epidemic in Asia.

Zambon reached out to WHO General Director, Tedros Adhanom Ghebreyesus, warning of a “catastrophic damage in terms of independence” as he felt the organisation was conspiring with Italy to hide the incriminated report that had upset Italy’s Health Minister.

“The aim of the report was to prevent other countries from running into the same disaster we faced in Lombardy,” Vittorio Agnoletto, a doctor and activist, explained to TRT World.

Angoletto is the host of “37.2”, a radio broadcast on health issues and author of the book ‘Senza Respiro’ (which translates to “breathless”) on the health catastrophe unleashed in Northern Italy during the first wave.

“According to The Guardian, Guerra was the director general of health prevention at the Italian Ministry of Health since 2014 and head of the office in charge of updating the pandemic plan," Agnoletto said.

Guerra claims the plan was updated.

TRT World reached out to Zambon, who declined to respond as the WHO has stopped him from giving further interviews, and even tried to prevent him from testifying at the hearings of the prosecutors in Bergamo.

“When I got Guerra’s email about the plan, I thought I had made a mistake and that he was in good faith,” Zambon explained in an interview to AGI at the end of December. “Later on, after my team had ascertained that in fact the plan had not been updated and discovered Guerra’s conflict of interest – who at the time worked for the ministry and was in charge of the updates – anger and disbelief took over.”

Those emails and documents now lay on the prosecutor's desk.

A wasted window of opportunity

On January 5, 2020 the WHO issued an alert to all countries regarding a pneumonia of unknown aetiology in China, recommending national authorities to enforce public health measures on influenza surveillance.

It was only 17 days later that the Italian government set up a dedicated taskforce to address the issue. Another five days later, a meeting was called at the Ministry of Health, where Giuseppe Ippolito, director of the National Institute for Infectious Diseases Spallanzani, a flagship in Italy’s national health system, unambiguously advised – as written in the taskforce’s reports obtained by the investigative primetime TV programme ‘Report’ – to “refer to methodologies of the pandemic plan that Italy is equipped with and to adapt them to the guidelines just issues by the WHO.”

Roberto Speranza, Italy’s Health Minister, was among the five people in the high-level meeting. As per the report, no reply came from the authorities following this communication. In the following days, no decision was taken; the pandemic plan – not updated since 2006 – had not been implemented.

Another meeting was convened on February 15, 2020 by Francesco Maraglino, senior executive at the Ministry of Health. The topic of the meeting, also attended by Speranza, was the update and implementation of the pandemic plan according to the Covid-19 emergency. But again, no decision was taken.

The first registered cases of Covid-19 in Italy were detected on January 30, 2020, when two tourists from China were found positive for the virus in Rome. The first case of the disease was officially reported in Codogno, Lombardy, on February 21. Until mid-February, authorities seem to have underestimated the danger.

On February 5, the Bruno Kessler Foundation, a non-profit public interest think-tank, presented a possible scenario based on mathematical models predicting 70,000 deaths in one year. The secret report had been transmitted to the Istituto Superiore di Sanita (ISS), the leading technical-scientific body of the national health service, and Speranza officially received it on February 12. Only then did Italian authorities start to take seriously the risk of an epidemic.

But it was only on February 20 that the Covid-19 taskforce met to discuss the plan. The gap between January 5 and February 20, 46 days, was a period that prosecutors in Bergamo deemed as too long for Speranza to be persuaded of the pandemic’s gravity and precious time where the number of deaths and spread of virus could have probably been contained.

“We are interested to know if the pandemic plan that was in force in January 2020 was applied and, if so, which plan was it” said Antonio Chiappani, the prosecutor in Bergamo. The same prosecutor interrogated Speranza during a hearing on January 28.

“Those days were a ‘window of opportunity’ – as defined by the WHO – or the time that elapses from the discovery of the virus in China until the virus incubated in the West. The first region to be hit was Lombardy. The window of opportunity is the period in which all health officials should have taken appropriate actions to fight the virus, something that has not been done,” explains Agnoletto.

“Failing to do so has affected everyone, especially in Lombardy, where we have recorded 260 Covid-deaths every 100,000 people. But it affected all of Italy, to the extent that when the virus was identified there were no PPEs, no tests, no reagents, and no devices for intensive care units. The window of opportunity had been wasted.”

Speranza’s approach to the pandemic is contained in a book titled ‘Why We Will Heal’ written in the summer of 2020. The book, which claimed Italy won the fight against pandemic, was expected to be out in Italian bookstores at the end of October but was withdrawn as the narrative clashed with the imminent surge of infections and deaths of the second wave.

The Dutch philosopher of the 1600s Baruch Spinoza said that “fear” and “hope” are two different passions stemming from the same phenomenology – the first through a negative approach and the latter through a positive one. Both delegate the resolution or worsening of the problem to external factors out of their domain.

Perhaps this is what the prosecutors in Bergamo are trying to ascertain: If Speranza (which means “hope” in Italian) did everything that was in his power to reduce the spread of the pandemic in Italy – or if he had waited, hopeful for a positive evolution of the events.