Italy Enters Phase 2 of the COVID-19 Response – What Does this Mean for Social Determinants of Health?

All of Italy has been on lock-down for at least four weeks, with some northern regions experiencing more than seven weeks of disrupted school and work conditions. There are signs that this has helped to slow the COVID-19 infection rate, though deaths continued to climb. While this feels like a light at the end of a tunnel, it is not clear yet when and how we will emerge from all this. The government closed schools and the vast majority of businesses until April 14. Only a few days ago did some businesses begin to reopen, with lockdown measures alleviated, despite some anxiety by business owners. Social distancing and containment measures will remain in place until early May. Multiple measures in the enormous “Cure Italy” bill, including earning supplements and unemployment benefits for all workers, even the self-employed, special funds for businesses, babysitting vouchers and parental leave for those with young children, tax, loan and mortgage delays, a freeze on firings and emergency nutrition funds for citizens, will be in place until August. But what then?

Working in a research center in northern Italy, socio-economic data on COVID-19 infections and deaths have been nearly impossible to come by. Education level is an optional variable in medical records, thus often missing. Linkages with databases housing socio-economic data at the individual level are possible but laborious, both bureaucratically and logistically. Hospital staff and administration understandably have bigger fish to fry right now, so one can only speculate about the dynamics of COVID-19 infection, related lock-down measures, and socio-economic factors here in Italy.  Inequality had been increasing in Italy since the 2008 financial crisis, and the current economic situation points to an even greater recession, which may further exacerbate the differences between the haves and have-nots. While my small northern town has remained calm, with fully stocked grocery stores and obediently empty streets, different stories are emerging from the south, where livelihoods are more precarious. Grocery stores need armed guards and Facebook groups are inciting civil disobedience and disorder, while organized crime aims to profit from the situation. It is anyone’s guess how long a lock-down can be sustained in these conditions, but with the World Health Organization (WHO) indicating a vaccine is still 12 to 18 months away, it is clear that new strategies are needed in the short to medium term to address the health and socioeconomic impacts of COVID-19 infection in Italy.

A large field of study has established clear links between economic inequality and health, with social determinants like poverty, housing status, labor status and education impacting everything from general mortality to the severity of pandemic H1N1 infection. In Italy, we can draw on this research, collecting essential data to inform analyses of social determinants of COVID-19 infection and disease severity, as well as the effect of nationwide lock-down and eventual return to economic and social activities on the socio-economic status and health of the population.

It is promising that the Italian government has been looking ahead, proposing a task force for restarting the economy. Ex-Prime Minister and leader of the new Viva Italia party, Matteo Renzi, has outlined ten steps for reopening businesses and schools, prioritizing both health and economic well-being. There are many important and reasonable ideas here, including reorganization of industry to protect workers and allow production to start up again, widespread testing to identify who has immunity and can safely return to work and school, elimination of red tape for economic support to individuals and businesses, further reinforcement of the health system, and rapid return of an operational Parliament. Adding a special focus on the most vulnerable members of society will be important to ensure they don’t fall between the cracks.

I will try to keep homeschooling, carrying around an auto-declaration every time I leave the house to prove I am following lock-down protocol, and putting on gloves and a mask before entering the supermarket for as long as necessary. We have adjusted to a new normal of empty streets, keeping our distance, police stopping people to check whether they can really be outside and street cleaners in our parking lots and the most rural of roads. The challenge ahead will be adjusting to yet another new normal, hesitantly coming out of complete lock-down to a future that doesn’t look quite the same as before. With careful planning and thoughtful attention to the interconnected nature of these parallel health and economic crises, there is hope that we can emerge with more information and the will to change our society for the better. 

Dr. Rebecca Lundin is a social epidemiologist working in pediatric infectious disease research. She is  interested in the interaction of policy, the built environment, social structures or phenomena and health inequalities. Check out her blog

Photo by Lopez Robin on Unsplash

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