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HEALTH

Lockdowns and vaccine scepticism – how France and Italy are struggling to get Covid under control

While many countries are at least talking about easing Covid-related rules, in France and Italy people are bracing for extra restrictions. Clare Speak in Bari and Emma Pearson in Paris discuss the situation in their respective countries.

Lockdowns and vaccine scepticism - how France and Italy are struggling to get Covid under control
France and Italy are both struggling with a lockdown exit strategy. Photo: Jean-Pierre Clatot/AFP

What is the situation now?

France – the whole of France is under a 6pm-6am curfew and bars, restaurants, cafés, gyms, cinemas, theatres and tourist sites have all been closed since October. In February the French government ruled out, for now, a third lockdown, but extra restrictions including weekend lockdowns are being imposed in areas that have a high level of the virus.

Italy – There’s a nationwide curfew in place from 10pm-5am and a ban on non-essential travel between all regions. Other rules vary by region depending on local infection rates. In areas designated higher-risk ‘red’ and ‘orange’ zones, bars, restaurants, gyms, cinemas, theatres, museums and most shops are shut. For now, the government hopes this system will mean Italy can avoid another national lockdown.

Emma: So Clare, France has in the last couple of weeks changed its strategy from national rules to regional restrictions. We tried this over the summer and it didn’t seem to work so I’m a bit sceptical, but it seems like Italy has been following this strategy for some time – is it working?

The southern French city of Nice is now under weekend lockdown because of the high number of cases. Photo: Valery Hache/AFP

Clare: I think a lot of people were quite sceptical here too when Italy’s tiered system was first introduced in November. I have to admit I thought we’d all be back under lockdown by now. But four months later it’s still going. 

But is it working? The government seems to think so. The health minister said this week that it’s staying in place as it’s the only way to respond fairly to the different situations in each part of the country. The aim overall though seems to be keeping the infection rate at a manageable level, rather than squashing the curve. New infections and the death toll had been slowly, steadily dropping overall since the tiered system came in, but the infection rate is now rising again. There are concerns that we’re at the start of a feared ‘third wave’ but it’s still too early to be sure.

READ ALSO: Where and how much are coronavirus cases rising in Italy?

A lot of towns and provinces in Italy are being put under local lockdowns now because of the rising numbers and local outbreaks – is anything like that happening in France?

Emma: Yes, we’re seeing very much the same thing. In France this week 20 départements, including Paris, have been labelled ‘alert’ areas because of the rising number of cases and some places including Nice and a large stretch of the Riviera have been put on a weekend lockdown.

Overall cases in France have been on what they call a ‘high plateau’ of about 20,000 new cases a day since mid December, but there are some areas where cases are rising really rapidly and that is worrying authorities. There’s also a lot of concern about new variants of the virus – more than half of all cases are now new variants.  What’s the situation with case numbers in Italy?

Clare: New variants are the big issue in Italy right now too. Up to 50 percent of new cases are thought to be due to variants in some regions, and they’re the cause of a lot of the outbreaks that are leading to the local lockdowns.

It’s interesting that cases in France have plateaued under the national restrictions. The same had been happening here for about two months, with overall cases staying at around 12,000 a day. But it’s now up to about 17,000 and rising.

Bars are open until 6pm in some regions of Italy. Photo: Vincenzo Pinto/AFP

Emma: We seem to test a lot in France, the tests are free for everyone and available via the pharmacy, so I’m never sure exactly how seriously to take international comparisons of case numbers – what’s the situation with getting a test in Italy? Is it easy to do and do people get tested regularly?

Clare: It’s easy to do if you pay for it. Testing varies by region, but here in the south of Italy at least you can’t often be tested under the national health service. The only people who can access free tests are teachers, healthcare staff or other key workers. I don’t think many people get tested regularly – private testing costs at least €25 a time. I’ve only had it done once and it cost €60. I know it’s more expensive in some countries, like the UK for example if you need a test for travel, but the cost is still a barrier for a lot of people.

Emma: So what exactly is open in Italy now?

Clare: It depends on your regional restrictions. So if you’re in a red zone, pretty much everything is closed except essential shops. But a lot of things are actually open if you’re in a lower-risk area, including museums and art galleries.

Right now my region is a ‘yellow’ zone which means bars and restaurants can open too – until 6pm, anyway. This was supposed to stop people gathering for a spritz in the evenings, but in practice it just means aperitivo hour has moved forward to 5pm.

Emma: You have bars! I’m so jealous, all our bars have been closed since October. On the other hand though, all French schools have been doing in-person teaching since May, they stayed open right through the second lockdown and apparently French pupils have had the highest number of in-person teaching days in Europe over the last year. 

The government made a choice to keep the hospitality and leisure sectors closed in order to be able to open schools, a decision I obviously applaud in the abstract, even if I could kill for a Martini – what’s the situation with schools in Italy?

READ ALSO ANALYSIS Was France right to keep its schools open during the pandemic?

Clare: The Italian government said it aimed to do the same thing late last year. So most schools were able to teach in person, except for high school classes, who’ve been on at least 50 percent distance learning. But lately it’s all become a lot more complicated.

More regions have been moving schools to distance learning, and more businesses have been allowed to reopen. This week the government said that all schools now need to close in red zones, as the concern is that new variants are affecting young people more. So it seems like they’ve completely changed the strategy here now.

Emma: I guess we should maybe talk vaccines too, this is increasingly a sore subject in France as our rollout of the programme is pretty glacial.

We’ve managed to give 3 million people their first jab, which is miles behind countries like the UK and Israel (although we have more than 1 million people fully vaccinated with the second dose too which is actually higher than the UK) and people are getting increasingly frustrated about the slow pace.

READ ALSO 6 reasons why France’s vaccine rollout is so slow 

Even those who are in the priority over 75s group tell us it’s often really hard to get an appointment at the local vaccine centre. How’s it going in Italy?

Clare: I think we’re in a similar boat when it comes to vaccines. Italy has given about 4.5 million shots and has 1.5 million people fully vaccinated. At this rate, most adults wouldn’t be fully vaccinated until December. So there’s a lot of frustration with it here too. But there is hope, as the new government has just announced plans to speed things up significantly – the aim now is to have about half of the population vaccinated by June.

Some of the delays are caused by bureaucratic problems though, and then there’s also the fact that some people in the few priority groups who are eligible actually refuse the vaccine.

Emma: Is vaccine scepticism a problem in Italy? We seem to have really high levels of it in France, around 50 percent of people are telling polls that they won’t definitely be vaccinated.

Clare: Yes, it actually is quite a big problem here too –  the government has made 10 vaccines mandatory in the past few years because vaccination rates were falling so much. With the Covid vaccine, there seems to be really widespread confusion about safety and effectiveness.

Italy’s public health messaging on this has not been particularly clear or reassuring so far, so that will definitely need to change if the government is going to reach their vaccination targets.

Emma: Yes, communication in France has also not been good, particularly about the AstraZeneca vaccine. I think the government has been wary about doing too much of a PR ‘push’ around vaccines in case it just makes people even less inclined to get them – since a lot of French people like nothing more than telling their government where to stick it! But the more hands-off approach doesn’t seem to be working either.

Let’s hope both our governments get their act together by the summer . . .

Member comments

  1. It’s incorrect to say tests are more expensive in the UK. They are free and available on self-referral to anyone with symptoms and to people who has been advised that they were in close contact with someone with the virus. It’s only people who choose to get a test without symptoms or exposure that pay anything, e.g.because you want to travel or to get early release from self-isolation after arriving in the UK.

    Also 1M people with the second dose when first dose numbers are so low is nothing to brag about, it’s just 1m people left at far higher risk for longer than needed and remaining more able to spread the disease to others. Initial timelines are based on the pre-approval trial practices which is all the pharma companies had at the time to base recommendations and efficacy statements on. We now have real world data and far larger sample sizes to make more educated decisions with – and those studies are showing time and time again that such tight timeless are not needed. Governments should be criticised not praised when they put lives at risk by not following the science as it improves – particularly when it’s based on politicking. Needless delays on vaccines, particularly the first dose, are literally killing people.

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HEALTH

‘Behind the times’: Why women in Italy struggle to get menopause treatment

For many women living in Italy, accessing HRT means paying for private treatment and, in some cases, travelling abroad in order to find a doctor willing to prescribe the medication they need.

'Behind the times': Why women in Italy struggle to get menopause treatment

Sitting in her garden in rural Tuscany, Tara Gould, a 55-year-old British national, reminisces about her old job back in the United Kingdom. 

“It was such a support group for people like me, so to be able to work for it and help other women was such a bonus,” Tara says.

The support group Tara worked for was the Latte Lounge, an online community for UK women over the age of 40 going through menopause. The site had resources such as articles, help finding a nearby specialist and in-person events. Tara managed the emails sent in by women who were either asking questions or struggling.

READ ALSO: Public vs private: What are your healthcare options in Italy?

“I had a few women reach out to me who were feeling suicidal and had nowhere to go or no one to ask about what they were going through. Talking to them about their options and helping them out, helped me out too.

But in Italy, she says, “I cannot find any support network like that here.”

In the two years she’s been living here full-time, Tara has had to go back to the UK for her hormone replacement therapy (HRT) which is crucial in managing symptoms such as hot flashes, sleep problems, and low moods. 

“In Italy, it is like what it was like in the UK 30 years ago, and coming from there two years ago was a massive shock to the system,” she adds.

“Women just have to grin and bear it.”

She believes the situation in Italy boils down to a lack of knowledge and possible embarrassment about discussing menopause. While the UK is far from perfect on the issue, she says, there is help available for women needing it, while Italy is “behind the times”.

READ ALSO: Why are medicines so expensive in Italy?

Tara is not alone in feeling this way. A post on the topic in one expat Facebook group this month sparked a lively discussion, attracting hundreds of comments from women in Italy sharing their personal stories, advice, and observations on the differences in menopause treatment between Italy and other countries.

But, she says, continuing to travel back to the UK for this routine treatment is “becoming too expensive for me especially as I’m paying into the SSN here too.

“I shouldn’t have to go back to the UK for this.”

Tara returns to the UK once her medication finishes and forks out around €600 each time she goes: €100 for flights and €500 for the HRT medication via private healthcare. 

“It should be a standard medical procedure, but it isn’t here. I can’t keep on going back to the UK and paying out every time I need something, because it is a need not a want.”

Tara started going back to the UK after her family doctor in Italy told her they didn’t prescribe HRT and advised her to buy it online, go abroad or go to a gynaecologist. 

“I thought it was outrageous that a female doctor was telling me these things, especially someone trained in the medical field advising a patient to buy medication online.

“I don’t feel hopeful,” Tara says.

Without her oestrogen, Tara says her anxiety goes through the roof making everyday life a struggle. She’s too worried she’d be dismissed in the same way her doctor dismissed her if she went to a private gynaecologist here. 

“It’s worrying. I don’t know what I’ll do. There must be someone here, but I don’t know how I feel. They tend to be more city-focused, and if I’m going to Rome I might as well go to the UK,” she adds.

In a recent study named Menopause: Knowledge, attitude and practice among Italian women co-written by Italian biologist Paola Mosconi along with six other researchers, more than half of their study sample (women with menopause) had not received any information about the condition and possible therapies.

Another survey conducted in 2021 found only 7.6 percent of the 1028 Italian women surveyed were on HRT. The majority of them were on herbal remedies.

Whilst a global shortage of HRT was widely reported last year, both the studies found medical expertise in the field of menopause to be only “satisfactory”.

READ ALSO: OPINION: Why Italy’s private healthcare isn’t always worth the cost

This is in spite of the Italian health ministry’s webpage outlining the numerous benefits of hormone therapy for menopausal women, such as improved heart health and a reduced risk of strokes.

Tara says she feels as though the lack of information on this topic trickles down into society, as she has tried talking to her Italian friends about it with little success.

For Liguria-based Noah, from the United States, the experience of obtaining HRT from her doctor was not an easy task.

Like Tara, she finds there is a huge lack of education for practitioners and the general public not just on HRT but around menopause in general, which differs from her experience back home. She also thinks views on it are outdated.

She moved over to Italy four years ago whilst she was going through the change. 

“Our family doctor would not prescribe it and lacked any knowledge around it so she sent us to private clinics instead,” Noah says. “I can laugh about it now, because I finally have it, but it was very frustrating in the beginning.”

Noah and her husband, who is Italian, found out about a doctor in another region who specialised in menopause and whose work on the condition was published in medical journals. She got her HRT from him. Whilst Noah felt very comfortable in his care, she had to stop visiting him because of the distance.

“We went back to our family doctor with literature on the use of HRT and the effects of stopping it abruptly. She then did her own research and now has started prescribing it to me,” Noah says.

Noah largely considers herself lucky. Nevertheless, she has to drive 45 minutes to another town in the region to pick up her prescription.

READ ALSO: ‘Very professional but underequipped’: What readers think of Italy’s hospitals

Tuscany resident Kelly Hodgson, like Noah, has also had to do extensive research into the benefits of HRT before she was prescribed it. She found the process of obtaining her medication extremely time-consuming and disheartening. 

“I had to do all the research myself until finally I found a gynaecologist who is open to HRT,” Kelly explains.

Kelly feels like she should have been able to get HRT from her doctor rather than pay privately. She argues that Italy is advanced in most areas of medical care – but not for menopause.

She thinks a huge reason why doctors are hesitant about giving it out is because they associate it with a high cancer risk.

“There is so much scaremongering,” she continues. “My doctor is female and she point blank said to me no, because I could get cancer, even though I’ve been on the contraceptive pill for years which comes with its own cancer risks.

“I come from a family with osteoporosis so HRT is beneficial to me. If I were in the United Kingdom now, I’d have access to it without having a full gynaecological visit before it’s prescribed.”

Kelly says friends from Turin who are also going through the menopause have had to go privately too, rather than get treatment from their doctor. 

“There has to be more education on menopause here,” Kelly concludes.

For Noah and Kelly at least, their journey to get their medication is within the country. For Tara, unless things change culturally and medically, going abroad is the only option she feels comfortable with.

“The way Italians think about menopause is the old-fashioned way everyone used to think. They view us as grumpy old women rather than looking at the reasons,” Tara says.

“It’s just something you have to deal with. It’s frustrating to say the least.”

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