Western Europe, particularly Spain, Italy Germany and France, has been hit with infection levels not seen in many months, sparking fears of a fully-fledged second wave. Image Credit: Pixabay

After suffering one of Europe's earliest and fiercest outbreaks, Italy emerged as an unlikely role model for its handling of the coronavirus pandemic.

The country managed to reduce infections dramatically in June and July after two months of strict lockdown, while its fatality rate, once one of the world's highest, fell to a handful per day. The White House's coronavirus response coordinator Deborah Birx and top infectious-disease expert Anthony Fauci both praised the country's response in recent days.

As cases flare in Europe - many linked to young travelers returning from summer holidays - Italy's success may now be in jeopardy. Italy recorded 1,071 cases Saturday, the most since mid-May but still well below the new peaks recorded in Spain and France.

The intensity and duration of Italy's lockdown is widely seen as one of the reasons why cases didn't pick up quickly after curbs started to be gradually lifted in early May, but rather kept falling. Restrictions were maintained for a full six weeks after new infections peaked, and schools never reopened unlike in France or Germany.

Paradoxically, the fact that Italy was hit first - and hard - by the pandemic strengthened its response. Images such as those of army trucks loaded with coffins in the northern city of Bergamo started circulating at the height of the infection in March, and played a role in driving home the gravity of the situation.

Rules prescribing the use of faces masks are, somewhat uncommonly for Italy, largely respected. It is normal to see people wearing them in the streets, while indoors, in shops and offices, they are almost ubiquitous.

The relative success was due to "the strict lockdown, the use of masks and the increasing testing until July," said University of Milano-Bicocca virologist Francesco Broccolo. "Italians are now used to being more careful and there could be fewer people susceptible to the infection because of an immunity."

Yet, those accomplishments now at risk, and Italy is experiencing a resurgence in cases just like the rest of Europe. The government has acted to stem the contagion, becoming one of the first European countries to require tests for arrivals from popular destinations like Greece and Spain. It then went further by closing down nightclubs and requiring face masks to be worn after 6 p.m. in public gathering areas.

"We can't waste all the sacrifices we've made in past months," Health Minister Roberto Speranza said in a Facebook post Aug. 17. "The numbers of the infection in Italy, even though among the lowest in Europe, are rising."

As tourists keep coming back in August, cases could rise further, Broccolo said, especially as some regions have been slow to set up testing at airports.

Almost a third of Italian new cases in the week to Aug. 16 were imported from abroad, the National Health Institute said. The ratio climbs to almost half in the Milan area, especially arrivals from Croatia, Malta, Spain and Greece, Lombardy Health Secretary Giulio Gallera said Aug. 18.

The fact that most of the infected are asymptomatic and that the median age of new cases is 30 further complicates things.

In recent days, Italy has stepped up testing and tracing. Daily tests are now at levels last seen in early June, while the positivity rate remains low - less than 1.5%, compared with more than 3% for France and Spain.

Domestic transmission remains an issue, though. About 30% of cases in the Lazio region around Rome are now linked to arrivals from the Italian island of Sardinia, prompting the government to consider some travel restrictions, Corriere della Sera said Aug. 20.

"I'm optimistic that a new lockdown won't be needed," said Broccolo. "But to avoid that we need to do more tests. And we had to do it earlier, with quick testing. And never lower the guard. We were becoming too complacent."