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Italy’s ICU Capacity Could Be Overwhelmed If Schools Reopen, A Report Says

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Italy’s ICU Capacity Could Be Overwhelmed If Schools Reopen, A Report Says

Lifting all coronavirus restrictions to pre-lockdown levels would overwhelm Italy’s intensive care unit capacity within a month, according to modelling by the group of experts that advises the Italian government.

The technical scientific committee (CTS) estimates there would be a peak of more than 150,000 people requiring admission to ICUs by June if daily life returned to how it was pre-crisis, with the figure surpassing 430,000 by the end of the year.

It comes as governments across Europe are wrestling with the question of when and how rapidly to ease lockdowns that have now been in place for weeks.

Italy, which was the epicentre of the outbreak in Europe, has an ICU capacity of 9,000 units and even just reopening schools, while leaving all other measures in place, would see that capacity essentially reached in October, the model suggests, estimating that 48,500 people would require intensive care by the end of the year in that scenario.

The CTS report, which was published by major Italian media outlets this week, lays out three baseline and 46 detailed scenarios assessing the rate of transmission of the virus in different areas of the economy, places of social contact, and age groups, as well as the impact of factors such as social distancing and the use of face masks.

The report said that economic activities can be gradually reopened on the condition that they are coupled with social distancing, remote working, and restrictions on people’s movements, transport and recreational and after work contacts.

Italian Prime Minister Giuseppe Conte announced on Monday that some of the measures imposed seven weeks ago would be relaxed from May 4. Factories, building sites and parks will reopen, people will be allowed to visit relatives and individual athletes can resume training.

However, team sports cannot yet recommence, placing doubt on whether the Italian Serie A season will be able to kick off again. Travel between regions is not permitted, religious services remain banned and there are currently no plans to reopen schools in the near future. Shops, museums and libraries can open in mid-May. Restaurants, bars and hairdressers will remain shut until June, though takeaway services can resume. Physical distancing measures remain in place and on public transport, which will continue to run on limited services, face masks will be mandatory.

The package of measures announced by Conte is broadly in line with the recommendations contained in the CTS report.

The model developed by the government’s scientific advisors divided the workforce into seven sectors and considered transmission rates among different age groups as well as different places of potential contact, such as on public transport.

Data produced by Google, which fed into the model, showed that mobility was down some 90% when the lockdown was at its strongest.

Many of the assumptions in the model, including the proportion of those infected that go on to require ICU treatment, are based on data from Lombardy, the region in Italy hardest hit by the coronavirus. The CTS modellers assume that individuals that catch the virus are equally infectious, whether they display symptoms or not. They also make the assumption that wearing face masks may reduce transmission by 15-25%, though warn that there isn’t definitive scientific evidence to back this claim.

The goal of any combination of measures is to keep the reproduction rate of the virus — R0, which represents how many people the average person with the virus infects — below 1.0. The current estimate for R0 in Italy is 0.5-0.7, the report says. Anything even slightly above 1.0 would have a notable impact on the capacity of Italy’s health system to deal with a renewed outbreak, the report adds, cautioning that the room for manoeuvre is therefore limited.

In Germany, R0 reached 1.0 again this week before dropping back to 0.9. Earlier this month, Germany started easing its lockdown. Smaller shops opened their doors and it was announced that schools would gradually start to reopen from next month. Social distancing measures remain in place, and bars, restaurants and cinemas closed. Larger gatherings are banned until 31 August.

German Chancellor Angela Merkel has called for extra caution, warning that a transmission rate of 1.1-1.2 would see the country’s health system reach capacity within a few months.

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