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HEALTH

Coronavirus: Why Italy’s trailblazing rapid tests failed to stop the second wave

Italy was the first country in Europe to bet big on rapid "antigen" coronavirus tests, and its apparent success encouraged Britain, the United States, Slovakia and others to follow suit.

Published: 11 November 2020 16:19 CET
Updated: 16 November 2020 09:20 CET
Coronavirus: Why Italy's trailblazing rapid tests failed to stop the second wave
Photo: Miguel Medina/AFP

However the tests, which are roughly 80 to 90 percent accurate, have not stopped an outbreak that has rocketed from around 500 cases a day in August, when they were first rolled out, to more than 35,000 now – with the total number infections set to top one million on Wednesday.

IN GRAPHS: Track the spread of coronavirus in every region of Italy

“I believe these tests are not used properly at the moment, they are just distributed randomly to everybody,” Professor Andrea Crisanti of the University of Padua told AFP, saying the government has no overall plan.

He said their use as a measure to protect vulnerable people in care homes, for example, was “absolutely criminal” because positive cases could slip through the net.
 
 'No alternative'
 
A vaccine may well be on its way, but not in time to battle the current wave of infections in Europe and elsewhere.
 
Instead, policymakers are left scrambling for solutions that avoid a repeat of the economically devastating lockdown earlier this year.
 
Italy last week shut bars, restaurants and shops in the worst-affected areas and introduced a nationwide night curfew, but has so far stopped short of another  nationwide shutdown.
 
 
The antigen tests have become a crucial part of the italian authorities' efforts to avoid a second lockdown.
 
They take just minutes to produce a result and they are cheap, unlike the “gold standard” molecular PCR tests that are close to 100 percent accurate.
 
Photo: Alberto Pizzoli/AFP
 
“Having such an instrument is fundamental, you have a method to immediately understand if a patient has the virus. It is a good starting point,” says family doctor Francesco Stevanato, who has carried out roughly 50 tests from his clinic in Venice.
 
Rolling them out in airports, it was thought, could help protect the travel industry. With wider availability, schools and businesses could safely stay open.
 
Professor Sergio Abrignani of the University of Milan, who co-authored a letter with some of Italy's leading scientists in September calling for their widespread use, conceded that they were not an overall solution.
 
“But there are practical situations where the antigen test has no alternative,” he told AFP.
 
“For example, when I am boarding a train or a ship and want to reduce the risk. The molecular test takes too long to give me an answer.”
 
 Anyone who tests positive with an antigen test in Italy is supposed to get a PCR test to confirm the result.
 
But the real danger is false negatives – if the rapid tests have an accuracy level of 80 or 90 percent, infected people will return negative
results.
 
'No specific strategy'
 
“If your objective is to screen a community to know if transmission is there, fine,” said Crisanti.
 
However, he said that to halt transmission, rapid tests must be complemented by the accuracy of PCR tests, along with surveillance tools and
stay-at-home orders.
 
The Italian health ministry told AFP there was no specific strategy in place for testing beyond boosting capacity.
 
And the National Institute of Health, in charge of monitoring the epidemic for the ministry, could not provide any data related to the uptake of rapid tests.
 
An integrated approach is frustrated by the fact health policy in Italy is largely controlled by regional officials – creating wide variations.
 
But Crisanti said the government should have built a broader plan to capitalise on the lower number of cases after the lockdown.
 
“If they had built a network for molecular (PCR) tests, if they had integrated this capability with an information tool… and if they had built
infrastructure to make the beds available where they are needed, I'm sure we would be in a completely different situation.”
 
By AFP's Joseph Boyle and Giuliana Ricozzi

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BREXIT

‘In the dark’: Why Brits in Italy are still unable to prove rights to free healthcare

Despite UK and Italian authorities confirming that British residents covered by post-Brexit rules are entitled to healthcare in Italy, many still face "significant problems" in accessing it, the British government has said.

Published: 22 May 2024 13:38 CEST
Updated: 23 May 2024 11:57 CEST
'In the dark': Why Brits in Italy are still unable to prove rights to free healthcare

Cancer patients are among those in need of treatment but unable to access the Italian national health service amid confusion over post-Brexit rules, campaigners say, after clarifications from the UK and Italian governments have so far failed to resolve bureaucratic deadlocks at local authority level.

Since the end of the Brexit transition period in 2021, many British nationals resident in Italy covered by the Withdrawal Agreement (WA) have reported difficulties in proving their right to free healthcare under the Italian public system.

The problem was exacerbated this year after the Italian government in January hiked the minimum annual fee for ‘voluntary’ healthcare registration from €387 to €2,000, which many said they were unable to pay.

The British government in February stepped in to clarify that UK nationals covered by the WA should not be subject to charges for healthcare, and on its Living in Italy website it advised those affected to show their local health authority office (Azienda Sanitaria Locale, or ASL) an official note published by the Italian health ministry on February 15th which sets out their rights (find it here, in Italian.)

WA beneficiaries “can compulsorily enrol (iscrizione obbligatoria) with the Italian National Health System,” states the final section, pointing out that the deal, “in Article 23, provides for equal treatment with domestic nationals.”

But for some local health officials, even this written confirmation does not appear to be enough to clear up the confusion.

READ ALSO: ‘Life or death situation’: Brits facing high Italian healthcare costs amid rule change uncertainty

The UK government on Friday, May 17th, updated its guidance to say it had become aware that “some beneficiaries of the Withdrawal Agreement are facing significant problems accessing health services and renewing their healthcare cards,” despite its advice to show local health authorities the official note.

British nationals continue to report that local health authorities around Italy remain unwilling to issue them with a health card, while campaigners say the situation is further complicated for some by the fact that Italian authorities have also refused to issue proof of their permanent residency status, which entitles them to free healthcare.

This was the case for Graham Beresford, a British citizen living in Abruzzo who has been diagnosed with a rare cancer and remains unable to access the free healthcare he is entitled to, as he says local authorities don’t understand the post-Brexit rules.

Graham told The Local in April that the government’s clarifications on the issue had made little difference – his ASL continues to demand he pay the 2,000-euro charge.

READ ALSO: Can I get a refund after wrongly paying Italy’s €2,000 healthcare fee?

“Every time I go to my ASL office, I always feel like I’m dismissed,” Graham said. “I told the ASL worker I need medication for my cancer and she replied lots of people come in here with sob stories.

“There genuinely seems to be no compassion whatsoever.”

Graham’s story was reported in The Guardian on May 12th ahead of UK foreign secretary David Cameron’s first major meeting with European commission vice-president Maroš Šefčovič to discuss post-Brexit relations.

Campaigners also wrote to Cameron in April to appeal for help with the “desperate” situation faced by those unable to access care in Italy.

In its update to the Living in Italy website on Friday, the British government stated: “Since [the health ministry’s note] was published, and particularly in recent days and weeks, it has become clear to us that not all Italian authorities are consistently following this guidance.”

“We are urgently speaking to all relevant parts of the Italian government to clarify the situation so that we can give clear advice to those affected as soon as possible. 

“We also know that this problem is linked to the many difficulties some are experiencing with obtaining an attestazione di soggiorno permanente and/or the Carta di Soggiorno permanente. We are working to help with these issues too.

“We will update this page as soon as we have further news.”

READ ALSO: ‘We are desperate’: Why the UK must help Britons with Italian healthcare charges

Clarissa Killwick from Beyond Brexit, a group for UK citizens in Italy, said the situation “should never have been allowed to happen” and that there had been “a series of communication failures and inconsistencies.”

“We’re not far short of five months after the introduction of the €2,000 new minimum for voluntary contributions and there is still no clarity,” she added.

“There are fraught exchanges in public offices because people on both sides of the counter are in the dark or with conflicting information.

“People need information they can rely on, unequivocally. What do you say to someone who is waiting for an operation but has no idea what is going on?”

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