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Lack of equipment is another serious concern. At a time when the World Health Organisation is emphasising the importance of testing to expose symptom-free cases, healthcare staff in the south have told us they are often working without face masks even in the emergency units. Staff who appear healthy are required by law to keep working even after they come into contact with Covid-19 cases, increasing the risk of hospitals becoming hotspots. While a number of countries are stepping up financial efforts to increase testing capacity, Italy’s southern regions will struggle to respond to the crisis in similar ways.

A social disease

Previous epidemics show us that we ignore social factors determining the spread of disease at our peril. As the disease moves around the country we need to understand how it will put different groups of people at risk. We are already seeing how coronavirus exacerbates existing problems in Italy’s social and economic structures.

Teresa Franzese reportedly caught the disease from a neighbour whose family members were infected. Eight members of Luca and Teresa’s family were waiting in the house when a specialised team arrived to collect the body. The whole area is host to mostly low-income households and has very high population density levels. The poorest basement and ground-floor dwellings, known as bassi, can have up to eight people co-habiting in a single room. In such spaces self-isolation is impossible. Overcrowded migrant centres are concentrated in many of these same areas. The people living there face similarly challenging conditions and lack access to even basic healthcare. A case in one of these centres in Milan confirmed health workers’ fear that contagion was already underway in those kinds of spaces.

Coronavirus poses a particular threat to the elderly. In Italy, because care for the elderly is overwhelmingly a family affair, it is difficult to isolate them and keep them safe. The government passed extraordinary economic measures in an effort to contain the economic effects of the crisis, including cash transfers to freelancers, mortgage and utility bill freezes, and sick leave for those in quarantine. But for those employed informally, like many migrant workers, or frontline factory workers, the risks remain high.

Trust, trust, trust

Our work during the 2014-16 Ebola outbreak in Sierra Leone taught us that trust is key to ensuring collective support for stringent emergency measures. This is especially important as the emergency deepens and spreads to the south, given the economic and social realities in those regions.

Italians have historically low trust in institutions, and this is particularly marked in some areas of the south. For example, in neighbourhoods like Luca and Teresa’s, poverty, a lack of opportunities, and the presence of organised crime have long strained inhabitants’ relationship with the authorities. Many did not initially buy into the government’s alarm over a new epidemic originating in China and affecting the rich northern regions, and were reluctant to follow new regulations.


[1][2] Social science research: a much-needed tool for epidemic control ➤[3] “You think this is an Ebola Office?” Rebuilding trust in the aftermath of Sierra Leone’s outbreak, by Luisa Enria | Mats Utas ➤[4] Eurobarometer ➤