Introduction
As of January 8, 2021, the number of deaths caused by the COVID-19 pandemic has reached 1.9 million worldwide (Johns Hopkins University, January 8, 2021), and it is unclear when people will gain herd immunity. This terminal stage of a pandemic is achieved when a large enough segment of the population is immune to the disease, making it unlikely that it will continue to spread from one person to another.
In order to discuss the unfolding of the events related to the COVID-19 crisis in Italy and its management, it is necessary to provide a definition of pandemic. The word “pandemic” comes to us “from Greek pandemos ‘pertaining to all people’ … from pan- ‘all’ … + dēmos ‘people’ ” (Online Etymology Dictionary, n.d.). Thus, a pandemic involves people worldwide; it differs from an epidemic, which affects a more restricted or contained area, such as a community. In essence, a pandemic is a global epidemic. The term “pandemic” does not tell us anything about the severity of the disease, rather indicating the extent of its diffusion; the word “pandemic,” therefore, refers to a disease’s geography.
In addition to this contagion geography, another element that needs to be considered when defining a pandemic is the disease’s novelty. The World Health Organization (WHO) defines a pandemic as “the worldwide spread of a new disease” (WHO, 2010). The novelty of the disease is crucial because it deepens the uncertainty faced by the affected communities.
A pandemic in disaster science and crisis management can be described as a transboundary crisis (Ansell et al., 2010; Boin, 2019; Goldin & Mariathasan, 2014; Quarantelli et al., 2006) or a catastrophe (Quarantelli, 2000, 2006). In a catastrophe, it is most likely that neighboring communities cannot help one another and, instead, compete for scarce resources (Quarantelli, 2000, 2006). Unlike emergencies and disasters, catastrophes make the impacted communities more vulnerable, since they cannot seek help from neighboring communities; there is a loss or a lack of both facilities and response personnel. Moreover, while all disasters are local, insofar as they always impact local communities, catastrophes are distinguished by the fact that they demand attention from the national government (Quarantelli, 2000; Quarantelli et al., 2006). The definition of COVID-19 as a transboundary crisis provides a better idea of the event’s level of management and governance. Transboundary crises, as the words indicate, do not have boundaries, whether legal, political, or geographical (Boin, 2019). Pandemics are well-established examples of transboundary crises (Baekkeskov, 2015).
This first chapter will provide an overview of crisis management, with a focus on the management of COVID-19 in Italy. The chapter discusses some of the elements related to the Italian case that make it difficult to manage transboundary crises (Boin, 2019), such as:
- The existence of multiple domains and multiple manifestations: Transboundary crises may involve several countries;
- The incubation and rapid escalation: The level of development of transboundary crises varies – they can rapidly escalate or be reabsorbed, and then can explode again;
- The difficulty of pinpointing where a crisis started and how, exactly, it evolved;
- The involvement of multiple actors with conflicting responsibilities: Transboundary crises can generate crises of governance and leadership; and
- The lack of ready-made solutions: Transboundary crises require non-routine responses.
In this chapter, we will see the characteristics of the novel coronavirus, COVID-19, and how it compares to other pandemics, followed by a discussion of the elements of crisis management and governance. Next, we will move on to a timeline of the Italian management of COVID-19, describing how events unfolded and highlighting the deep uncertainty that decision makers and laypeople alike encountered in handling the situation. As one of the first Western countries to respond to COVID-19, the Italian government faced uncertainties about which protective actions it ought to recommend to contain and mitigate the effects of the virus. In the initial stage of the crisis, there was deep uncertainty regarding the modalities through which the virus spreads, how long it stays on surfaces, and how people get infected. Exacerbating the problem was a crisis of governance and leadership that was generated by the conflicting involvement of the central and regional levels of the Italian government in organizing the response and recovery effort, and we will examine this in some detail. The lack of ready-made solutions will be clearly illustrated by a brief excursus on the policies that were enacted by the government, coupled with people’s behaviors as they sought to adapt to a new way of living. The chapter will conclude with an overview of the book’s organization and structure.
COVID-19 and previous pandemics
Pandemics are not a new threat to humanity. The earliest report of a pandemic is Athens’s plague (430 BC), which killed approximately 25% of Athens’s population and whose origins are still unclear (Leonard, 2020). Understanding and comparing previous pandemics is helpful because it provides an opportunity for emergency managers and institutions seeking containment to reduce the uncertainty over how to respond, mitigate, and recover from a pandemic event, provided that similarities can be found. Pandemics can be compared to each other based on their origin, duration, disease diffusion, mortality rate, vulnerable populations, and historical context. However, comparison is not always easy since pandemic events are loosely defined, and therefore, there is not always agreement on which events to consider as pandemics. For instance, the WHO, the main organization in charge of declaring an event’s pandemic status, declared HIV an epidemic of global proportion, but not a pandemic.
The WHO loosely defines pandemics as “the worldwide spread of a new disease” (WHO, 2010). Elevating an infectious disease to pandemic status is not something to be taken lightly, as it might have global financial and social repercussions. The WHO system declares that a virus has reached pandemic status when there is a sustained and widespread diffusion of the virus to humans, based on six pandemic alert phases (WHO, 2009). Phases 1 through 3 signal the virus’s diffusion primarily to animals and to some human beings. Phase 4 concerns sustained human transmission. And Phases 5 and 6 occur when there is widespread human transmission. These phases of alert should guide governments internationally to plan and act accordingly. However, the Council of Europe memorandum, issued in June of 2010, reported criticism toward the WHO for declaring H1N1 (swine flu) a pandemic without disclosing potential conflicts of interest (O’Dowd, 2010). Critics objected that the status of the 2009 H1N1 influenza did not justify the pandemic declaration and only created panic among governments and a waste of public resources. In 2010, Wolfgang Wodarg, the head of health at the Council of Europe, stated that raising H1N1 influenza to the status of a pandemic was
one of the greatest medical scandals of the century… . We have had the mild flu – and a false pandemic… . In order to promote their patented drugs and vaccines against the flu, pharmaceutical companies have influenced scientists and official agencies, responsible for public health standards, to alarm governments worldwide.
(Macrae, 2010)
A similar situation also occurred for the Western African Ebola epidemic in 2014, when the agency was accused of downplaying the event.
Officially, after the WHO elevated H1N1 influenza (swine flu) to the status of a pandemic, COVID-19 was the second declared pandemic of the twenty-first century. On March 11, 2020, the WHO declared the novel coronavirus (COVID-19) outbreak to be a pandemic, with diffusion to 114 countries, 118,000 cases, and deaths (WHO, 2020). The WHO delayed declaring COVID-19 as a pandemic, even though it had warned the international community about it on more than one occasion. The declaration of COVID-19 as a pandemic was not a decision taken lightly by the WHO, as it was fully aware of the consequences of such a statement on social lives and worldwide economies. The behavior of the WHO surrounding its definition of COVID-19 as a pandemic shows how a pandemic is not an easily identifiable event. In this, pandemics are notably different from other hazardous events, such as earthquakes and hurricanes, which have much clearer identifying characteristics.
From an epidemiological point of view, COVID-19 is a severe acute respiratory syndrome coronavirus (SARS-COV 2) that was first identified in December of 2019 in Wuhan, China. The disease is airborne, meaning that it can be transmitted from an infected person through sneezing, coughing, laughing, and contact with infected surfaces. The 2009 H1N1 (swine flu) was also transmitted through respiratory droplets and infected surfaces. However, H1N1 was not as severe as COVID-19, and it was soon redefined as a mild flu. Symptoms of COVID-19 range from sore throat and fatigue to nausea, vomiting, and diarrhea. However, some people can be asymptomatic. The existence of asymptomatic infection significantly complicates our ability to determine the number of infected people. And this, in turn, can make infection containment almost impossible if it does not involve aggressive testing to find and isolate those who are infected.
The containment of COVID-19, compared to that of the 2013–2014 Ebola disease, is much more difficult. Ebola was more preventable, since it was not airborne; it was transmitted through contact with contaminated blood or bodily fluids. Thus, in the case of Ebola, it was easier for people to identify the threat and avoid contact with it. With COVID-19, though, avoiding infection involves self-distancing and quarantining – much more complicated processes. Beyond this, in comparison with other pandemics, COVID-19 has the longest incubation period: from 2 to 14 days and, in some cases, up to 27 days (Yuko, 2020).
Pandemics should also be compared in terms of the exposed population, the global population, and the moment they occur in history. The 1918 Spanish flu, like COVID-19, was a respiratory virus, and it spread all over the world through the soldiers fighting World War One. The disease probably originated in the USA and was transmitted to humans from pigs. The Spanish flu killed more people than the war did, with an estimated 50 million deaths. The vulnerable population was aged 65 and younger, with a concentration in the age group 20–40 years old (Marantette, 2021). Compared to the Spanish flu outbreak, the world is now more populated; “there were fewer than 2 billion people in 1918, and now there are 7.5 billion” (Mineo, 2020). Another difference is that the population is now more mobile; people did not travel by air in 1918. Today’s society is also more complex – due, among other things, to the increased interconnectedness of the supply chain.
If all these factors are not enough, the sustained spreading of COVID-19 is also exacerbated by the variants of the virus. There are already three variants that have been identified worldwide: the English, the Brazilian, and the South African. In particular, the English variant seems to spread more quickly and to be more deadly than other forms of the virus. Other COVID-19 variants recently identified take their names from the Greek alphabet, such as the alpha, beta, gamma, delta, and lambda variants. The delta variant seems to be of greatest concern as of August 2021. In terms of ending the pandemic, there are several vaccines now available, but their effectiveness in general, and their effectiveness against the variants specifically, are not yet fully known. The management of the COVID-19 crisis, and in particular the role of government in its containment, is punctuated by deep uncertainty about the new social and physical environments in which both people and institutions must learn to live and to which they must adapt.
