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Medical workers are seen next to an ambulance outside the Cotugno hospital, in Naples, Italy, on Nov. 9, 2020.

CIRO DE LUCA/Reuters

Italy is losing its battle to avoid a second pandemic lockdown.

On Wednesday, five Italian regions, including Tuscany and Umbria, were added to the restricted list, bringing the total to 12. The latest additions mean that more than half of Italy has fallen into the high-risk “red” category or the medium-high risk “orange” category, both of which place severe limitations on movement and shop openings.

Essentially, those regions are isolated. Residents cannot leave their regions, and non-residents cannot enter them, except for necessary work, study and medical reasons. Bars, restaurants and cafés are closed. In the highest-risk areas, residents are basically confined to their homes but can leave for work, to buy food or to see a doctor.

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

The explosion in COVD-19 cases throughout the country – Italy surpassed one million infections Wednesday – means an effective national lockdown within a week cannot be ruled out and may come as early as this weekend, according to some media reports.

Filippo Anelli, head of the Italian doctors' association, known as FNOMCeO, has called for a 1½-month national quarantine, like the one that shut down Italy from March to May, to ease the pressure on hospitals, which are filling up at alarming rates. About 3,000 COVID-19 patients are in ICUs, with the number rising by 100 to 120 a day, he said in an interview Wednesday.

“The number of cases and deaths is rising faster than we expected,” Dr. Anelli said. “We face an implosion of the national health system.”

A new national lockdown would come as a tremendous blow to the Italian government and its pandemic-fighting credibility after winning international kudos in the summer for having largely eradicated community transmission. Only a month ago, Italian Prime Minister Giuseppe Conte ruled out a national lockdown, even as the number of infections was climbing rapidly. “If the contagion curve were to keep going up, it would be possible to consider lockdowns limited to specific areas,” he said.

A second lockdown would also deliver potentially devastating damage to the economy, which had bounced back strongly in the summer after two quarters of deep recession. Economists expect Italy – and the rest of the European Union – to fall back into recession in the fourth quarter as countries put curfews into place and tighten controls on mobility and retailing. Germany, France, Spain, Belgium, Ireland and other EU countries have rolled out restrictions that generally fall just short of the total lockdowns seen in the spring.

Italy’s new infections fell into the low double digits in June and July and began to climb in August, when mask use became sloppy and physical-distancing rules among holidaymakers were often ignored. The Italian government and the health authorities were slow to bolster the test-and-trace systems needed to detect asymptomatic cases and isolate those who were infected.

Since mid-October, the daily new case counts have ranged from 20,000 to almost 40,000. On Wednesday, Italy reported 32,961 new cases and 623 deaths, bringing the death toll to 42,953.

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“We don’t have a plan to get out of this,” Andrea Crisanti, the University of Padua microbiologist who has warned for months that the country lacks the test-and-trace capacity to prevent a second pandemic wave, said on Italian TV. “We have hopes.”

Massimo Galli, head of infectious diseases at Hospital Luigi Sacco in Milan, told reporters this week that “the situation is out of control” and that deaths among cancer and heart patients is rising as hospital beds fill up with COVID-19 patients and medics are diverted from other wards to treat them.

Hospitals are under strain throughout Italy because the virus has left no region untouched. In the spring, the infections were largely confined to the north, especially the Lombardy region around Milan. Once the northern hospitals reached capacity, they transferred some patients to regions with spare beds. Today, about half of all hospital beds are occupied by COVID-19 patients.

The hospitals in Piedmont, the northwestern region whose capital is Turin, are so overwhelmed that the regional health commission has asked medical charities around the world to send doctors. The San Luigi hospital near Turin was forced to place dozens of beds inside its conference room and chapel to accommodate the surge in patients.

Piedmont plans to hire doctors and nurses from China to fill its medical ranks as its own medics become infected and isolate themselves. The FNOMCeO site lists the deaths of 188 doctors since the start of the pandemic. About 16,000 medics have been infected with the virus, putting them out of action for weeks or months.

The European Commission has signed a deal with Pfizer-BioNTech to supply as many as 300 million doses of its vaccine candidate, which has been shown to be more than 90-per-cent effective in trials, to EU countries. Italy’s share would be 13.5 per cent. The commission also has vaccine supply contracts with AstraZeneca, Sanofi-GSK and Janssen Pharmaceutica. “A safe and effective vaccine is the only lasting exit strategy from the pandemic,” European Health Commissioner Stella Kyriakides said Wednesday.

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British scientists said on Tuesday that an 80% uptake of a COVID-19 vaccine may be needed to protect communities, but volatile levels of misinformation and vaccine mistrust could still undermine efforts to tackle the pandemic. Reuters

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