Lifting all coronavirus restrictions to pre-lockdown levels would overwhelm Italy's intensive care unit capacity within a month, according to modelling by the group of experts that advises the Italian government.
The technical scientific committee (CTS) estimates there would be a peak of more than 150,000 people requiring admission to ICUs by June if daily life returned to how it was pre-crisis, with the total figure surpassing 430,000 by the end of the year.
It comes as governments across Europe are wrestling with the question of when and how rapidly to ease lockdowns that have now been in place for weeks.
Italy, which was the epicentre of the outbreak in Europe, has an ICU capacity of 9,000 units and even just reopening schools, while leaving all other measures in place, would see that capacity essentially reached in October, the model suggests, estimating that a cumulative total of 48,500 people would require intensive care by the end of the year in that scenario.
The CTS report, which was published by major Italian media outlets this week, lays out three baseline and 46 detailed scenarios assessing the rate of transmission of the virus in different areas of the economy, places of social contact, and age groups, as well as the impact of factors such as social distancing and the use of face masks.
The report says economic activities can be gradually reopened on the condition that they are coupled with social distancing, remote working, and restrictions on people’s movements, transport, and recreational and after work contacts.
Italian prime minister Giuseppe Conte announced on Monday that some of the measures imposed seven weeks ago would be relaxed from May 4. Factories, building sites, and parks will reopen, people will be allowed to visit relatives, and individual athletes can resume training.
However, team sports cannot yet recommence, placing doubt on whether the Italian Serie A season will be able to kick off again. Travel between regions is not permitted, religious services remain banned, and there are currently no plans to reopen schools in the near future. Shops, museums, and libraries can open in mid-May. Restaurants, bars, and hairdressers will remain shut until June, though takeaway services can resume. Physical distancing measures remain in place, and on public transport, which will continue to run on limited services, face masks will be mandatory.
The package of measures announced by Conte is broadly in line with the recommendations contained in the CTS report.
The model developed by the government’s scientific advisers divided the workforce into seven sectors and considered transmission rates among different age groups as well as different places of potential contact, such as on public transport.
Many of the assumptions in the model, including the proportion of those infected that go on to require ICU treatment, are based on data from Lombardy, the region in Italy hardest hit by the coronavirus. The CTS modellers assume that individuals that catch the virus are equally infectious, whether they display symptoms or not. They also make the assumption that wearing face masks may reduce transmission by 15%–25%, though warn that there isn’t definitive scientific evidence to back this claim.
The goal of any combination of measures is to keep the reproduction rate of the virus — R0, which represents how many people the average person with the virus infects — below 1.0. The current estimate for R0 in Italy is 0.5–0.7, the report says. Anything even slightly above 1.0 would have a notable impact on the capacity of Italy’s health system to deal with a renewed outbreak, the report adds, cautioning that the room for manoeuvre is therefore limited.
In Germany, R0 reached 1.0 again this week before dropping back to 0.9. Earlier this month, Germany started easing its lockdown. Smaller shops opened their doors and it was announced that schools would gradually start to reopen from next month. Social distancing measures remain in place, and bars, restaurants and cinemas closed. Larger gatherings are banned until Aug. 31.
German chancellor Angela Merkel has called for extra caution, warning that a transmission rate of 1.1–1.2 would see the country's health system reach capacity within a few months.
In Spain, which with Italy was the country in Europe worst hit by the crisis, construction and manufacturing have already resumed. Young children can leave their homes for one hour a day, hairdressers can take appointments, small businesses will reopen in mid-May, and restaurants can offer takeaway services. Cinemas, churches, and theatres will also be allowed to open their doors next month but must be no more than a third full. Most schools will stay closed. The country hopes to gradually return to a "new normal" by the end of June.
Denmark has reopened some of its schools, while France will start easing restrictions from May 11, when businesses can reopen. But cafés, restaurants, and museums will remain closed for now and large gatherings are banned. Schools will reopen progressively, initially for younger children, and public transport use will increase but continue to run on reduced capacity.
In the Netherlands, prime minister Mark Rutte has announced that most restrictions will be in place until May 19. Meanwhile, primary schools and daycares may reopen after May 11, children under 12 can do sports outdoors from this week but large events are cancelled until September.
Both the Dutch and French football leagues are set to be cancelled for the remainder of the season. A decision on the German Bundesliga is expected soon.
Small shops in Austria have already reopened and museums will be allowed to do so from mid-May. In Greece, some shops will reopen on May 4, schools gradually from the following week, and cultural sites later in the month. However, limits on movements between regions will initially stay in place. Hotels, restaurants, cafés, and shopping centres are set to open again in June.
Despite a gradual softening of lockdowns, social distancing measures will remain the norm across much of Europe for the foreseeable future.
The Italian model estimates that the impact of reopening most of the identified sectors of the economy would keep R0 below the required level if strict social distancing measures remain in place. However, some activities, such as people dining in restaurants, are self-evidently a greater risk given the nature of the business.
Crucially, however, without social distancing and some limits on recreational activities and public transport, ICUs could be overwhelmed by the end of the year, the report notes.
There is currently no scenario where reopening schools is advisable, and depending on other factors such as the effectiveness of face masks and contact tracing measures, as well as the extent of community contacts and use of public transport, restrictions on more vulnerable age groups may need to be introduced.
In conclusion, the Italian experts recommended the reopening of economic sectors linked to construction, manufacturing, and commerce and to allow for outdoor physical activity for individuals and household groups, as long as stringent social distancing measures remain in place. They advised extra caution with places where extensive community contact is more likely, such as markets and malls, suggesting a gradual lifting of restrictions to be assessed every 14 days. The experts argued that remote working, limits on public transport, and bans on mass and group gatherings should continue. The use of masks was also recommended.
As of April 28, more than 200,000 people had tested positive to the coronavirus in Italy and 27,359 had died.