How Italy squandered an opportunity to control its COVID-19 cases and doomed itself to an open-close cycle

The Costa Smeralda, the beach resort on the northeast coast of Sardinia where millionaires dance under the stars in open-air nightclubs, was pretty much back in full swing at the peak of the season, in mid-August. The pandemic had faded, and Italians were rewarding themselves for having endured the world’s longest lockdown.

But physical distancing got sloppy, and by the end of August Sardinia was a COVID-19 hot spot. Former Italian prime minister Silvio Berlusconi, who owns a mansion on the island, and his buddy Flavio Briatore, the former Formula 1 racing team boss whose Billionaire nightclub is one of the Costa Smeralda’s most famous party destinations, were infected and sent to hospital.

What happened in Sardinia didn’t stay in Sardinia. When the thousands of holidaymakers left for the Italian mainland, few were tested for the virus. Friends of mine who returned by ferry to Livorno, on the Tuscan coast, on Aug. 23 were not offered tests when they landed. Testing centres at the ports were not operating until early September, by which time is was too late. One of the main causes of the new Italian outbreak can be traced to Sardinia.

The case is just one example of how Italy, the original European epicentre of the pandemic, squandered the opportunity to keep its COVID-19 cases under control. New infections have climbed tenfold since the start of October and are hitting 25,000 or more a day. The ICUs are filling up again, and the death count is rising. On Monday, there were 233 new deaths, taking the total to 39,059 – the second-highest in Europe, after the U.K., and the sixth-highest globally.

By Monday, the Italian government was on the verge of announcing new restrictions that may fall just short of a full national lockdown. “Despite our efforts … the evolution of the pandemic in the last few days is very worrying,” Prime Minister Giuseppe Conte told parliament. “We must intervene with more stringent measures.”

The new restrictions are likely to include travel bans between the hardest-hit regions, an evening curfew, the closure of high schools and museums, the shuttering of shopping malls on weekends and running public transport at no more than 50-per-cent capacity to ensure adequate physical distancing.

Last month, the government ordered the use of masks outside the house and shut bars, cafés and restaurants by 6 p.m. Still, the number of cases galloped ahead. The estimated national reproduction rate – the R factor – is 1.7, meaning one person infects on average 1.7 others, leading to exponential increases. In the early part of the pandemic, only Northern Italy was hit hard and the R factor fell to 0.8 by late April, meaning the pandemic was losing momentum fast. By June, Italy’s daily case increase had fallen into the low double digits.

In an interview Monday, Andrea Crisanti, the prominent University of Padua microbiologist who highlighted the dangers of asymptomatic transmission in March, said the government had utterly failed to build on its success in the spring, when the severe Italian lockdown had almost snuffed out community transmission. “I think the situation we have arrived at today demonstrates the fact that we have arrived completely unprepared for this moment,” he said.

He said the government and the health authorities failed to open enough molecular test labs (molecular tests are more accurate than the 30-minute swab tests); failed to integrate the results of those tests into a national system that could map the spread of the infection in real time; and failed to ensure that COVID-19 testing centres were easily available to anyone, anywhere.

In essence, Prof. Crisanti is saying the health authorities had no mechanism to break the transmission chain short of a total lockdown, dooming Italy and other countries such as France, Spain and the U.K., where caseloads are also exploding, to a cycle of economically and psychologically punishing closings and reopenings. He thinks Italy could see yet another lockdown in early 2021 unless it gets its act together. At a minimum, he says, the country needs to be doing 400,000 tests a day, more than double the current level.

Italy and other European countries hurtling back into lockdown found themselves in the middle of a war between businesses such as restaurants, which wanted no or few restrictions, and hospital authorities, which wanted a lot. Tight lockdowns meant killing businesses; no lockdowns meant killing the vulnerable, especially those over 60.

In Italy, the business side won the first round. The country was largely open in the summer and stayed that way through September and October, even as the case count soared. Some politicians were simply deluded; they apparently thought the pandemic was over and had no stomach for new restrictions.

There is a middle ground. Countries such as Taiwan, Vietnam and South Korea have managed to break the open-close cycle through mass testing and tracing, rigorous mask use, the rapid isolation of local hot spots, clear messaging to the public and the closure of borders when needed. Taiwan last reported a new COVID-19 case on April 12. Its economy is holding up well. The International Monetary Fund expects flat growth in 2020 in Taiwan, a remarkable achievement given the output plunges in most other countries.

Italy and other European countries snatched defeat from the jaws of victory. By late summer they should have invested heavily in test-and-trace systems and labs and moved quickly to isolate hot spots. They didn’t, and outbreaks such as the one in Sardinia happened. By trying to avoid restrictions, governments virtually guaranteed them.

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.