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EXPLAINED: Has Italy’s Omicron wave peaked?

The health minister said on Tuesday that Italy has reached the peak of the fourth wave, as daily Covid cases hit a new high of over 220,000. But scientific experts remain cautious about making predictions.

People outside Milan's Galeria Vittorio Emanuele II shopping centre. 
Photo: Miguel Medina/AFP

As Italy recorded a new daily high of 228,179 coronavirus cases on Tuesday, Health Minister Roberto Speranza stated that “We are at a peak and the hope is that in the coming days there will be further decline in the curve”.

Tuesday’s number of infections was the highest yet since the start of the pandemic, and the 24-hour death toll at 434 was the highest in Italy’s fourth wave so far. 

However, the latest weekly data appear to show that the rate of contagion is slowing overall, while hospital admissions and the test positivity rate are stable.

While many are optimistic that this slowdown means Italy’s Omicron-fuelled fourth wave has – or is about to – hit its ‘peak’, the country’s most prominent scientific experts are taking a more cautious tone.

“We’re seeing important signs of a slowdown in the epidemic in Italy” but “as to the question of whether we have reached the peak, the answer could be ‘no'”, Nino Cartabellotta, president of the Gimbe foundation for evidence-based medicine, said in an interview with Radio Cusano Campus on Wednesday.

He joined other health experts in pointing out that it was too early to see whether the recent return to school and work after the Christmas holidays, from January 10th, would fuel a new rise in the infection rate.

Some have warned that Italy, like France, could see more than 300,000 new cases a day before infections peak.

People queue outside a pharmacy in Milan to be tested for coronavirus on January 4th, 2022. Photo: Miguel MEDINA / AFP

Cartabellotta also noted that it is still too early to see any impact of the mass return to school and work following the Christmas holidays, which for many people in Italy only ended on January 10th.

Roberto Battiston, professor of Physics at the University of Trento, said the situation should be clearer “in about a week”.

“If the Rt (transmission rate) drops below 1 it means that the peak has passed and we are in a phase of decline,” he said in an interview with Corriere della Sera.

Italy’s current Rt number is 1.22, with significant regional variations.

“Of course, these predictions are never perfect, because there are many variables involved and not all of them can be measured in advance,” he added.

“There are also regional differences, which in some cases bode well: in Umbria, for example, Rt is falling below 1.1.”

“Of course, these predictions are never perfect, because there are many variables involved and not all of them can be measured in advance,” he added.

“There are also regional differences, which in some cases bode well: in Umbria, for example, Rt is falling below 1.1.”

Fabio Ciciliano, a member of the government’s scientific advisory panel, said “we will notice the peak when it has passed,” but stressed that overall Italy’s “weekly increases are now reduced compared to those of the previous weeks, showing that the curve is starting to fall”.

“Compared to the number of cases – over two million currently positive – the hospital situation seems to be under control,” he added.

Covid-related admissions to intensive care “seem to be decreasing”, he said, while “hospital admissions remain stable.”

What does reaching the ‘peak’ actually mean?

“The data we are talking about is not that of daily new infections, but the total number of infected people present at any given moment,” Battiston explained.

This is the number labelled ‘current positives’ or attualmente positivi in Italian health data reports. At the moment, there are 2,562,156 known positive cases, after an increase of 6,878 on Tuesday.

“The peak is exceeded when the number of recovered is higher than that of new infections,” Battiston said. 

“Unfortunately, there are objective elements of uncertainty in this calculation. First: how reliable is the number of newly infected? Many positives are asymptomatic and some opt for do-it-yourself tests, staying at home but without reporting their situation to the health authorities. Second: how reliable is the number of recovered?”

Does this mean Italy’s health restrictions will soon be relaxed?

While experts stress that reaching the peak doesn’t mean the Covid-19 emergency is over or that precautions should end, would it mean the Italian government is likely to roll back some of the recently tightened health measures?

In response to the rapid surge in cases, Italy has repeatedly tightened rules on vaccinations, the use of green passes, masks and other precautions, with another decree due to be announced by Thursday expected to further restrict the movements of people who remain unvaccinated.

Meanwhile in the UK, where health experts say the Omicron wave is around 20 days ahead of that in Italy, the government on Wednesday announced it was scrapping rules on wearing masks and working from home.

Italian health ministry officials suggested this week that prevention measures could soon be eased.

At a glance: What Covid-19 rules are now in place in Italy?

“We appear to have reached the peak and shortly we will see a decrease in cases, which will enable us to review measures”, Health Undersecretary Pierpaolo Sileri told Rai Radio1 on Tuesday.

“Today, however, the number of infections is not important, but the number of hospitalisations and people in intensive care,” he noted.

Sileri said measures taken to curb contagion risks must not be seen as “something fixed and infinite, but changeable according to the situation the virus puts us in”.

“Therefore all the rules which we are putting in place may be modified again in a short space of time.”

However, with the government set to introduce further restrictions from February 1st, it looks likely that the rules could become stricter before being eased again.

Health Minister Speranza stressed meanwhile that vaccines had prevented the need for more restrictive measures, such as the lockdowns and business closures seen in 2020 and early 2021.

“With these numbers of infections, without vaccines we would have been forced to take very tough measures”, Speranza said.

Italy is relying on its health pass system to keep businesses open, and has made vaccination mandatory for over-50s and some employees in efforts to prevent serious cases of Covid-19 from overwhelming hospitals.

“The vaccine remains our fundamental weapon,” Speranza said, adding that 89.9 percent of the Italian population aged over 12 had received at least one dose as of Wednesday.

For further details about Italy’s current Covid-19 health situation please see the Italian Health Ministry’s website (available in English).

For members


EXPLAINED: Why is Italy’s coronavirus infection rate rising again?

After Italian health ministry data showed Covid cases are on the increase for the first time in weeks, why is this happening and is it likely to continue? Here's what Italy's health experts say.

EXPLAINED: Why is Italy’s coronavirus infection rate rising again?

The number of Covid cases detected in Italy has been falling for the last five weeks. But it began to rise again in early March, according to the latest data published by the Higher Health Institute (ISS) and the health ministry on Friday.

“During this week there was an inversion in the trend of the Covid-19 curve in Italy,” confirmed ISS President Silvio Brusaferro as he presented the data at a press conference. 

“In recent weeks it has been decreasing. Last week the decrease slowed down, and this week we are witnessing a curve that begins to rise again”.

The increase came despite the fact Italy has strict health measures in place including the requirement to show proof of vaccination or recovery under ‘super green pass’ rules, and a mask mandate for all indoor and some outdoor public places.

In the last two weeks, the incidence of Covid infections in around half of all Italian provinces has stalled or risen, health ministry data showed.

The number of known current positive cases is once more nearing a million, and the weekly incidence rate has risen to 510 cases per 100,000 people, up from 433 the previous week.

On Monday, official data showed new cases were up by 30 percent week-on-week, while the test positivity rate is 14.1 percent.. 

Giovanni Rezza, the health ministry’s director of prevention, confirmed that hospitalisation rates are still decreasing for now.

“Regarding the occupancy rate in the hospital wards and intensive care, we are at 12.9 percent and 5.5 respectively,” he said at Friday’s press conference.

People wearing face masks at the Capitoline Hill in Rome. The Italian government eased the requirement to wear masks outdoors after a decline in the number of Covid-19 cases in February, but the rule still applies in some settings. Photo by Vincenzo PINTO / AFP

Though Italy’s health experts are urging people to remain cautious, they stress that it is too early to know whether the situation is likely to worsen further.

“There is no reason for us to be alarmed ahead of time”, immunologist Sergio Abrignani, a member of the government’s scientific advisory board, told newspaper Corriere della Sera on Monday. 

The increase in cases is due to “a series of factors”, he said, “and it is not guaranteed that it will persist.”

Nino Cartabellotta, president of Italy’s evidence-based medicine foundation Gimbe, said it would take “7-10 days” to see whether this is truly a reversed trend or “just a rebound”.

“We now have a fairly high circulation of the virus. We still have a million positives and 40,000 cases per day,” he cautioned in an interview with Radio Cusano Campus. “There is no doubt about this. But the element of concern is that the descent has stopped and there are also hints of an ascent”.

Experts attributed the rise to several factors, including colder weather, and decreased caution as people look ahead to the planned end of certain health measures in Italy.

Decreasing vaccination rates are also thought to be a major factor, as well as new “sub-variants” of coronavirus, Brusaferro noted at the press conference.

“Omicron sub-variants, such as 2, the most transmissible, are growing,” he said.

Cartabellotta also said the rise may be due to “the sub-variant Omicron 2 , of which we know nothing” as well as the recent spate of very cold weather meaning “we are more indoors where the virus spreads more”. 

He said the rise was also connected to public behaviour, with Italy now looking ahead to a promised relaxation of the health measures – even though the government is yet to confirm details of the plan.

Italy eased some measures in early February, including the requirement to wear a mask in all outdoor public places.

“In Italy the increase in Covid cases is linked to a series of factors, including a certain relaxation on the part of the population, coinciding with the end of the state of emergency – which has been sold, even though it is a deadline of a purely regulatory nature, as a sort of watershed”.

Italian Prime Minister Mario Draghi confirmed in late February that the country’s state of emergency – the condition that allows the government to pass emergency laws by decree – will end on March 31st, after more than two years.

This doesn’t automatically mean the end of health measures in Italy. However, Draghi also confirmed that ‘super green pass’ rules would be lifted “gradually” from April.

The government is expected to give further details of plans for easing the rules on Thursday, March 17th.