In a characteristically stern but satirical video message last week, Vincenzo De Luca, the president of Campania, warned citizens in the southern Italian region that if the coronavirus infection rate continued to rise there would be another lockdown.
“There is no third way,” he said after announcing the mandatory wearing of face masks outside. “Masks must be worn on the face, not on the elbow. If the alternative is between having people dying on the street or taking a pleasant stroll, there will be no doubt … everything will close.”
He struck a more serious tone on Saturday after Italy’s most densely populated region, and one of its poorest, registered the highest daily tally of new infections in the country. After showing images of a crowd without masks outside a college and revellers in a bar where there was an outbreak, he said: “We must return to the strict behaviour of February, March and April, otherwise we get sick.”
It was partly De Luca’s no-nonsense style that enabled Campania to declare itself “Covid-free” in June, and determined his recent re-election. But three months on, authorities are counting on citizens falling into line again after a dramatic rise in infections. The daily rate more than doubled in the last week to 401 on Saturday, putting the region slightly ahead of Lombardy, where Italy’s pandemic began.
Enrico Coscioni, Campania’s councillor for health, said: “It’s as if De Luca is the father of a community, he says: ‘Kids, we’re in a difficult moment and have renewed fears, we need to be responsible.’
“His messages worked as people understood. We need them to work again. The population density is worrying – in some areas we have the highest in Europe – and this is why De Luca has issued lots of controls across the territory.”
Italy’s southern regions managed to avoid the worst of the initial phase of the pandemic, mostly as a result of the contagion being slowed by the national lockdown, but also because of action by local governors who were keenly aware that their hospitals would not have been able to cope as well as those in the richer north.
Concerns are mounting after new infections in Italy jumped to over 2,800 on Saturday, the highest in five months. Walter Ricciardi, the scientist advising the health ministry, said last week that Campania and Lazio, the region surrounding Rome where 261 new cases were registered on Saturday, were the most at risk.
“Fundamentally, Ricciardi is correct because if you don’t intervene quickly, things risk getting out of hand,” said Maurizio Di Mauro, the director of Cotugno hospital in Naples, which specialises in infectious diseases.
“It was a miracle that Campania managed to get the infection rate down to zero in June, as due to the population density the risk of catching the infection by walking down the street is extremely high. So we need to be strict. It makes me very angry to see people not following basic rules.”
Similarly to Lazio, infections in Campania started to increase more alarmingly in August, mostly because of cases imported from abroad, either by tourists or returning holidaymakers, or from Sardinia, where there was an outbreak in several nightclubs. Lazio and Campania introduced swab tests at airports for those flying in from at-risk countries; Campania has gone a step further with compulsory tests for all people arriving at Naples’ Capodichino airport.
Infections are now spreading to older age groups after initially mostly affecting the young, raising worries about the approaching flu season. Hospital admissions in Campania have increased from 57 in mid-June to 434 on Saturday, with 40 people in intensive care. The number of people currently infected has leapt to over 7,000 from around 270 in the middle of June.
People have also been turning up at hospital emergency units, one of the reasons for outbreaks in the north at the beginning of the pandemic, looking to be tested.
“We had people coming straight from the airport to do the test,” said Di Mauro. “It was difficult to make them understand that emergency units are for the sick and not screening.”
To their advantage, hospitals in Campania have had time to prepare for the possible shock of a second wave, increasing the number of beds in intensive care to more than 800 in recent months. Covid units reopened in August in anticipation of admissions.
“Compared to six months ago the situation in regards the capacity to manage the phenomenon has definitely improved,” said Raffaele Troiano, a doctor in Naples.
“But we are all anxious about the flu season overlapping with coronavirus. I worry about the system coping with a huge volume of people. Two things are required to try and manage it: flu jabs and respecting the rules.”
Troiano believes one of the reasons people dropped their guard in the summer was because some high-profile Italian medics announced that the virus was weaker.
“There was no scientific proof of this,” he said. “But people relaxed and started to deride those who wore masks – there was a more festive climate.”
The hope now is that De Luca’s messages will again encourage citizens to help stave off the worst. Stiff fines are in place for those who break the rules.
“His communication is very effective, severe as well as funny,” said Troiano.