Interventi

An action plan for Italy and Covid-19

This document presents the structure of an Action Plan and practical immediate measures to manage the current crisis, drawn from the contributions of experts in many different fields. Given the nature and complexity of the issues, this remains an open agenda that requires continued input and expertise from around the world. The active participation of other contributors is therefore warmly welcomed.

di Corrado Passera

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This document presents the structure of an Action Plan and practical immediate measures to manage the current crisis, drawn from the contributions of experts in many different fields. Given the nature and complexity of the issues, this remains an open agenda that requires continued input and expertise from around the world. The active participation of other contributors is therefore warmly welcomed.


17' di lettura

EXECUTIVE SUMMARY
Governments and leaders around the world today are facing enormous pressure and have the same overriding two objectives:
1. Limit the number of deaths and suffering from Covid-19;
2. Ensure the financial survival of families and businesses, and then kick start a new phase of economic growth in order to avoid a devastating economic depression.
The two objectives are closely linked: it is imperative to avoid choosing between our physical and economic wellbeing.

Every measure taken so far needs to be augmented and reinforced. We need a wide-ranging, short- and medium-term Action Plan that effectively addresses the health and economic crises, and that acknowledges the possibility that therapies and vaccines for Covid-19 will not be developed for many months.

It must be everyone's goal to reopen our society and economy as quickly as possible and to develop lasting economic growth. But forcing this re-opening in as little as a few weeks will have terrible consequences. A clear path can be set out now so that a safe reopening of society and the economy is able to take place in the shortest possible period of time. We will need to adapt our healthcare and other community facilities to deal with the inevitable impact. The timing will depend on our ability to adapt these facilities and manage the virus itself also in order to minimise the risk of another wave of infections.

During the period in which our healthcare facilities and communities are being adapted, the measures that have already been put in place will need to be maintained to prevent the virus from spreading. In the meanwhile, we need to equip ourselves with the tools to better manage the infection and ensure the financial survival of families and businesses.

At the same time, we need to create the conditions required for the Italian economy to recover. We must take action to support the sectors most affected by the crisis and accelerate the development of those that can drive growth.

Co-operation within Europe is very important. Above all, the role of the European Union is crucial in kick-starting growth and financing investment.
A plan of this magnitude requires strong and centralised coordination with all necessary expertises around it. Communication with businesses and the public is crucial.
FOREWORD
Governments and leaders around the world today are facing enormous pressure and have the same overriding two objectives:
1. Limit the number of deaths and suffering from Covid-19;
2. Ensure the financial survival of families and businesses, and then kick start a new phase of economic growth in order to avoid a devastating economic depression.
The two objectives are closely linked: it is imperative to avoid choosing between our physical and economic wellbeing.

Many actions have been taken in Italy and Europe during these first few weeks of the crisis but it is clear that we need more: we need further action and we need to make the actions we have already taken more effective. Getting the country back on track in just a few months is achievable but we need to be determined and we need more resources. We must be clear to distinguish between temporary measures to mitigate the crisis and structural measures that will create the conditions for fast and sustainable economic growth.

We must act urgently. If we do not, the situation will get out of hand:
- Healthcare facilities are in many cases bursting at the seams and are able to stay in operation only thanks to the selfless actions and sacrifices of doctors and medical staff. There is a limit to the physical endurance of these heroes and we know that many people will die of other causes than Covid-19 because we did not have the capacity to treat them.
- Many businesses have already collapsed and many more are running out of financial reserves.
- Many families are reaching the end of their endurance – they may have suffered immense personal and financial losses, they may be lacking basic necessities and they are facing the increasingly unbearable discomfort of forced ‘imprisonment'.
- Social resilience and cohesion may soon be at risk in many parts of the country, and we must now expect that vultures of all kinds will seek to take advantage of a deteriorating situation.

We must accept however that there are no shortcuts and it would be a mistake to pursue them. We must do everything we can to reopen society, but doing so in just a few weeks, even if done in waves by age group, would have an enormous cost on human life without actually achieving anything on the economic front. Indeed:
- Our healthcare facilities are already at full capacity and reopening our society in a very short time would be catastrophic as it would not be possible to treat the many new patients that would arise.
- It is pointless to ask companies to reopen immediately: many people would face an impossible dilemma if asked to return to work given the high probability of falling ill and the near certainty that they would not be properly treated.
- It is an illusion to think that below a certain age the risks from Covid-19 are very low. The statistics tell us that young people who fall ill almost always survive if properly cared for. But if the number of people falling ill were to explode, as would happen if society were to reopen too soon, a large number of people of all ages would not be able to be treated properly, with terrible consequences.
- It would be extremely difficult and impractical to seek to separate the population by age group and allow each to follow different lifestyles. Infection between people of different ages who inevitably live in close contact with each other would be unavoidable. We should not forget that grandparents often live at home or look after their grandchildren, and that it is children and young people in general who, precisely because they are asymptomatic, become the main spreaders of the virus.

Countries such as the United Kingdom, which considered taking these shortcuts, have had quickly to change their approach. Others have very different demographics to Italy and different forms of social organisation (Israel's average age is about half ours). Other countries, such as Germany or Sweden, have healthcare facilities that are better equipped.

We need a comprehensive action plan – both for the short and medium term – to supplement and reinforce the measures taken so far. We need a plan that gives us time to manage the health emergency while still allowing us to tackle the economic emergency and build the conditions needed to kick-start growth. The initiatives below are just some of those that will be necessary; others will have to be proposed by experts in various sectors. Some of those listed need further elaboration; some have already been planned; and some have been suggested elsewhere – it is important that all useful contributions are tied together into a single cohesive plan of action.

The different parts of the action plan need to be co-ordinated and carried out simultaneously:
- Contain and manage the infection
- Strengthen healthcare and community facilities
- Ensure the financial resilience of households and businesses
- Create the conditions for economic growth in Italy and Europe

1. CONTAINING AND MANAGING THE INFECTION
To contain the infection, lockdown and social distancing measures must be maintained and made stricter if necessary. Work will need to be done to make this lockdown as short as possible, but it should be maintained as long as necessary to sufficiently strengthen healthcare facilities (see point 2). Lifting the lockdown without ensuring we can withstand the impact could have catastrophic consequences and make subsequent lockdowns harder to manage. The experience acquired so far should enable us to introduce more effective procedures and protocols to manage new outbreaks.

Confining people in their homes must be made sustainable, especially for those such as the elderly who are not completely self-sufficient. Some private entities such as the large retailers, voluntary and community groups and also the military and Civil Protection organisations must be mobilised and co-ordinated to ensure supplies of food and pharmaceutical products as well as guarantee a minimum level of essential services to those unable to secure them for themselves. We need to work on how to improve home delivery of basic necessities.

Knowledge of the scale, change and spread of the infection is imperative. The data and statistics that we are currently using appear to be totally inadequate, if not to mention misleading. It is essential to test, sometimes repeatedly, people most at risk and to carry out large-scale testing, by focusing on priority segments, on the entire population. Wherever possible, testing should be done at home to avoid further infection. Data collected at home and from the health services has to be sent to a single monitoring and analysis point of contact. This does not mean that the Regions will be stripped of their rights, but creating a central authority for data is essential – see below.
The availability, quality and rapid centralisation of relevant data can make a difference to the length of the crisis and to the possibility of anticipating further waves of infection. Various monitoring and tracking apps are being developed and experimented with across the world which could greatly contribute to the containment of the virus and the reduction of the more extreme isolation measures, as well as the detection of new outbreaks. (Regarding the use of personal data, see some observations below.)
Co-ordinated work across borders is important. There are many proposals and it is important to identify which ones can be most effectively implemented across Italy in a unified way.

It is essential that entire industrial and logistical supply chains are maintained. Saying for example that pharmaceutical companies should remain open is not enough if the companies that produce the packaging for the medication are closed and the logistical equipment needed to deliver the medication to the final user is not operational. Companies from different sectors could be authorised to open if they are considered to be of particular strategic importance and if they can guarantee compliance with the best safety measures. Obviously, some supply chains are highly integrated at European level and proper co-ordination is required.

Further in-depth study is needed of essential supply chains, their operations and the leading companies involved to ensure they function better.

2. STRENGTHENING HEALTHCARE AND COMMUNITY FACILITIES
Many of our healthcare facilities are on the brink of becoming unsustainable with some already past this point. They are running only thanks to the generosity and sacrifice of their staff. But they are unable to deal with an increase in patients and soon may not even be able to maintain their current level of service. We must take drastic action and use extraordinary measures if we want to reduce the level of lockdown within a reasonable timescale.

We must create several thousands more intensive care beds in a very short period of time, and either install them in existing hospitals or in new facilities. Standard procurement procedures (auctions, tenders, deferred payments, etc.) cannot apply to this equipment and all the other healthcare provisions required. Demand has skyrocketed across the world. Both in central government and at a regional level, certain officials must therefore be given absolute commissioning powers. It is clearly necessary to have supervision and co-ordination of all public and private facilities run at a supra-regional level to ensure optimal use of the country's resources.

It must be remembered that creating new intensive care units will require not only equipment but also medical staff and paramedics, who must be recruited and trained rapidly.

Where essential medical equipment and supplies cannot be procured, they will have to be manufactured instead. In Italy, we definitely have the industrial skills required to produce and assemble everything we need from machinery to masks. Most private businesses are extremely willing to restructure their operations as required. If necessary they should be compelled to do so.

We must urgently work out whether the equipment required is already available on the market and whether it has to be supplemented by internal production, and if so, how.

We should provide telemedicine from home for non-acute and recovering patients, including the required logistical support for those who are not self-sufficient. The voluntary sector can play a key role here. We must also create non-hospital-based care facilities for those less seriously-ill patients who do not require hospital treatment, but who cannot remain at home. Many private facilities of various types could be quickly provided with the necessary medical supervision, and many underused military and other public facilities could also be converted quickly. Beyond the Covid-19 crisis, we need to build different structures and care mechanisms: we need to apply a “community approach” beyond the traditional hospital model – patient centered approach - we have generally followed until now.

This is already happening to a certain extent in Lombardy: the main problem is co-ordinating all the initiatives and implementing them methodically.

Such a system of co-ordinated intervention can profoundly change the outlook for the management of the virus and the prospects for recovery of those infected. Italy has in many cases shown great efficiency at critical times. Although the healthcare situation is very different in the various regions, if we act with the necessary determination we could complete this part of the programme in 1-3 months.

At some point it will be necessary to have the political courage to accept a reasonable compromise between a functioning society and safety. We may have to learn to live with the virus, rather than definitively to defeat it. This will require adapting our behaviour, work organisation and lifestyles until a vaccine and/or therapies are available on a large enough scale.

If the infection rate is contained, if we improve our understanding of the way the virus spreads and if healthcare facilities are brought up to scratch, it is likely that a gradual and at least partial reopening of society will be possible, even without definitive treatments and vaccines. It is also possible that this reopening could happen at different times in different regions.

But it is also crucial to ensure the financial survival of all families and businesses experiencing hardship, at least for the rest of 2020.

3. ENSURING THE FINANCIAL RESILIENCE OF FAMILIES
Huge numbers of families are undoubtedly already in, or about to enter, serious financial difficulty, and a minimum level of peace of mind and security must be guaranteed for the months to come to lessen the risk of panic.

All families in trouble must be able, on demand, to have bank, tax, pension and utility payments frozen.

Everyone who loses their income, either employed or self-employed, should receive unemployment benefit for the next months, through a simple self-certification process. The system for making requests and receiving regular payments should be handled possibly by electronic banking tools, and a single body should be identified by the state to make the payments, for example Poste Italiane (the Italian Post Office). The procedure should be simplified as much as possible, and we should be prepared for some abuse of the system.

We need to work out a suitable payment structure. Is existing unemployment benefit suitable or do we need a special, capped, “Covid-19 payment” for 3-6 months in line with a person's declared 2019 income?

In addition to reducing the income level required to receive unemployment benefits, a blanket advance payment of termination indemnity benefits/pension funds could also be introduced for employees.

All poverty-reduction programmes due to expire in the next few months should be automatically extended.

4. ENSURING THE FINANCIAL RESILIENCE OF BUSINESSES
When it comes to businesses, the work undertaken must clearly distinguish between actions aimed at survival and more structural measures. Some of the structural measures can be achieved independently at a national level and others will require EU involvement.

An enormous number of businesses are in, or are about to enter, financial difficulty. We must ensure that as few of these as possible close permanently by providing the financial resources needed to keep going for the next few months. And these measures must be done immediately.

All businesses, up to a certain size, must be able on demand to have bank, tax, pension and utility payments frozen.

Businesses should be stopped from laying off employees for the rest of this year, and temporary redundancy payments should be made available and paid automatically to any type of business that requests them.

All businesses up to a certain size should be offered on demand and via self-certification a guaranteed interest-free long term loan equivalent to 25-30% of their declared turnover for 2019, potentially in two instalments (along the lines of the Bridge Plan proposed by the Minima Moralia Association).

All state-run bodies should settle accounts with suppliers and pay any accumulated overdue business payments.

The banking system can, and must, play a crucial role in many of the system-wide initiatives. The sums available for the Central Guarantee Fund and the Cassa Depositi e Prestiti must be increased significantly, and bank guarantee schemes such as those provided in Germany, France, the UK and Spain should be introduced.

Benefits and loan payments are often not made quickly enough to keep up with the needs of hard-pressed families and businesses. While the resources needed exist, the centralised distribution mechanisms are proving to be slow and inefficient. We should therefore use the decentralised mechanisms that already specialise in managing financial resources, such as Poste Italiane. Widespread use of self-certification for families and bank guarantees for businesses could be introduced temporarily to speed up processes. These forms of assistance must act as, and be perceived as, a temporary stepping stone towards recovery, rather than becoming disincentives for work.

5. ACCELERATING THE RELAUNCH OF BUSINESS IN ITALY
This is not the place to list all the well-discussed elements that should be included in a medium-term plan to foster sustainable development in Italy from infrastructure development and education to law and the tackling of bureaucracy. However, this dramatic moment in our lives must inspire us to introduce some very strong and extremely simple incentives to unleash the potential of business and power a sustainable recovery.

A “Super Industry 4.0” programme should be introduced. Businesses that invest this year and next year should be able to benefit from particularly favourable tax treatment, even more beneficial than that set out in the Industry 4.0 law. For those who invest in the next 18 months, the benefit should also be extended to subsequent years.

We must introduce a series of favourable tax and pensions benefits for businesses that expand their staff numbers this year and next year.

We must reward businesses that do particularly well regarding growth in investment and employment: all businesses that reach certain minimum investment and recruitment thresholds in the next 18 months should be able to rely on zero taxes on their profits for a significant number of years.

At the same time, we need to launch a series of targeted interventions in sectors hit particularly hard by the crisis that will struggle to recover in the short or medium term. Similar attention must be given to launching a series of targeted interventions in sectors that can drive the recovery.

We need particular focus on the world of startups, which could make a major contribution to the post-virus world but which are at heavy risk of not surviving the crisis.

Getting the economy moving in the years to come will clearly also require an enormous injection of public investment and public contributions to private investment. It is unlikely however that countries such as Italy, devastated by the events of 2020, will be able to find enough resources in their state budgets. The European Union, which already has an important role to play in holding the entire plan together, will therefore have an essential and invaluable role when it comes to public and private investment.

6. CREATING THE ENVIRONMENT FOR ECONOMIC GROWTH THROUGHOUT EUROPE
With or without Covid-19, this is the time for the European Union to speak up and act decisively. It needs to avoid becoming trapped between the USA, China and Russia, and it must not be overwhelmed by a tide of populism that springs from recession and brings with it dramatic social consequences.

To restore sustainable growth it is necessary to launch a historic programme of public investment and incentive for private investment, to the tune of €3-5 trillion euros within the next few years.

Prioritised areas for investment should be physical and digital infrastructure, research and innovation, education and training. We have before us an extraordinary opportunity for modernisation and the creation of employment opportunities in all sectors, including in public administration, not to mention the potential for accelerating the energy transition.

Such investments will be chosen and managed at an EU level, not given as grants for individual countries to administer but centrally run as an imaginative spur to the single market which will foster the EU's global competitiveness.

Investments on this scale could not be sustained financially by any single country and need to be financed at EU level: Eurobonds; EIB (European Investment Bank); EIF (European Investment Fund); EFSI (European Fund for Strategic Investments); new European funding, etc.

This “call to arms” represents an opportunity for a visionary reframing of the European project, understanding that no European country can save itself on its own. Such a massive new commitment would not be used up in the service of existing debt, rather all countries would together be funding new investments with the goal of underpinning states' future wellbeing and sovereignty.

CONDITIONS FOR IMPLEMENTATION
Every component of the action plan must be carried out simultaneously if we want to emerge from this emergency in the best possible condition and if we want to restore hope to our communities.

An action plan on this scale and in this timeframe can succeed only under a unified management and chain of command; this is essential for ensuring speed and the quality of actions taken. It is obviously up to the government to decide how this is co-ordinated and where the “war room” is located. Special laws or suspensions of constitutional rights are not necessary, but it is essential to guarantee:

A single issuer of regulations (or, at least, very strong co-ordination) to avoid separate ministries and separate regions continuing to issue different and competing directives.

A co-ordinated chain of command to which all national and local structures must refer. Tens (if not hundreds) of decision-making centres spread around the country are not conducive to efficiency: 20 health systems which react differently and do not work as one cannot guarantee the best possible crisis management.

Centralisation of data: this is not about taking constitutional powers away from individual regions, but a central data co-ordinator with the necessary powers should be created with immediate effect. Standardised data should be available at national level, the best data analysis and machine learning technologies should be applied to plan and understand the implications of any decisions and to give Italians better information.

Management and co-ordination of different working groups into which professional resources on loan from businesses, universities and civil society can be channelled. These working groups should also act as the central point of contact and filter for proposals: today, if somebody wanted to propose solutions or collaboration they literally would not know who to talk to. We are at risk of losing extremely valuable opportunities from which other countries are already benefiting.

Creating a truly unified management and chain of command – which lasts right through to the return to normality – is the most difficult organisational challenge, but the social and financial costs of not succeeding are enormous. No crisis can be managed without strong and competent co-ordination and there are many ways this can be achieved.

Everyone in our community should contribute to the success and work together on a programme of this kind.

Managing such a dramatic situation with such an uncertain set of outcomes requires an unprecedented communications strategy. To build trust and ensure the maximum involvement of the whole community a daily bulletin reporting deaths and infections is not sufficient.

The public must be convinced that a comprehensive plan exists and that the situation, though difficult, is under control and being managed by experts and trustworthy hands.

It must be continually demonstrated that everyone's involvement is required and that sacrifices are being shared equally.

The reaching of a series of small, and more significant, milestones must also be demonstrated, to show that the plan is moving in the right direction.

Positive examples of virtuous behaviour should be celebrated (and negative behaviour sanctioned).

A different approach to communication is needed, completely distinct from typical political discourse and a marked change from the first phase of this crisis. To maximise inclusivity we need communications which are transparent, informative and accountable. Such an approach will allow trust to be maintained as we proceed through clearly-defined milestones on a shared path together.

A final point on the necessity of emergency legislative measures. This emergency cannot be managed by following our standard procedures. Special commissioners are needed for example to make urgent procurements and investments. Countless small and big decisions need to be made quickly regardless of the possibility of some wastage.

But there are some aspects of our life which could be irrevocably damaged by adopting emergency measures such as the unconstrained use of personal health data and individual behaviour tracking. Obviously there is no objection to using data in sophisticated ways to identify emerging health trends, to monitor their development and to allow for the development of alert mechanisms. But no emergency can justify the kinds of pervasive control over individuals which we have seen in other countries with questionable levels of democracy.

Systems being created to track individual movement in some parts of China, for example, seem particularly worrying and present obvious long-term risks of abuse. It is possible however to create a more widespread and sophisticated use of relevant data without transgressing inviolable privacy barriers – some particularly interesting examples are beginning to emerge, among them the “Immuni” system recently created by key players in different industries.

The crisis we are currently living through can be managed. Even without effective treatments and vaccines in the short term, we can aim for a gradual resumption of our society in the coming months. However, we have to avoid shortcuts which would make this crisis even more serious and uncontrollable. A well-managed, comprehensive and co-ordinated plan is within our reach and many lessons are emerging which will serve us well in the future, once Covid-19 is defeated.

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