New
public priorities

Although medical personnel have demonstrated – during the course of this pandemic – a moving dedication and a truly commendable spirit of sacrifice, Italy has witnessed the precarious situation of public health immobile after decades of bad and superficial investments.

Once the situation of heavy formal inadequacy and the structural deficit that highlighted this pandemic have been closed, a return to heavy investments in the health sector seems inevitable. Given the difficulties of each region in meeting the requests for beds (especially in intensive care) and PPE, the trend will be to increase resources destined for healthcare well beyond the current percentages.

In recent years, many European states have had the ability to maintain a strategic health structure. By choosing to prepare for scenarios such as the present one and not giving up the ability to contain emergency situations, they have demonstrated a programmatic ability and a long-term vision.

Italy, on the other hand, has invested heavily in health care but has squandered a large part of its investment by favoring private health care or spending badly on available resources. The failure to build standardized cost centers, together with the founding of nationalized industries capable of supplying healthcare articles and drugs at competitive prices, has constituted a great negative element with respect to the problem of supplying the necessary materials.

Public and private health

For the immediate future, the challenge for each state will be to achieve a significant increase in the public health budget, centralizing it as far as possible and at the same time implementing a vertical collapse of investments in private health. The latter is in fact a competitive entity which – while assisting the sick in traditional areas – has proved completely unable to deal with situations like this, played mostly in the first aid and intensive care departments.

Intensive therapies are a striking example of this public / private short circuit: since these are low profitability departments, the private health system has chosen not to invest in this sector, leaving the entire national system uncovered which, with great nearsight, it has misused resources and cut small hospitals, local facilities, beds and equipment.

Not only that: if the care facilities for the sick and the elderly are included in the concept of “private health”, the private offer has represented in all its plastic inadequacy even a pole of spreading the disease. A poorly guarded epicenter, fueled by poor and ineffective controls, not equipped with adequate containment and protection systems, poorly oriented towards the protection of the lives of workers, as well as guests.

If we combine this with the wicked decisions implemented by regional political bodies, to bring some patients to pay for quarantine in residential structures for the elderly, we are faced with a perfect picture of strategic misery and political inability.

The need to invest in public health – given the chronic lack of staff and infrastructure, the absence of new hires, the low turnover – will force to reverse the trend undertaken in recent years. This Copernican change of course will not necessarily result in the disappearance of private health as an institution.

On the contrary, it will continue to thrive without burdening the state. The state funds, in fact, will have to concentrate on fueling the public health system and making it competitive internationally, ready for challenges that cannot yet be foreseen.

Three measures for standardization

In the specific case of the 2020 epidemic, here are some measures (in addition to those already mentioned) that it will be useful to implement quickly to further reduce the incidence of infection:

• A strong territorial network, widespread, to test the presence of contagion in millions of individuals. A sort of civilian army that has the task of assisting the state in mapping the epidemic. This network, made up of trained but also “not necessarily health” operators (simple procedures such as measuring fever, taking samples and recording data will have to be applied: therefore, personnel with a strictly health profile need not be allowed). rapid screening and isolating the infected, family and any accidental contact from the rest of the population
• If serious cases are sent to hospitals, for the asymptomatic or less serious patients, a series of facilities will be needed in all regions prepared to host the mildly infected for the few days of isolation, presumably a couple of weeks. Examples of these structures could be barracks, some hotels, isolated residential structures etc. The aim will be to make the stay as mild as possible, with different degrees of attention based on the severity of the patient’s conditions. Only in this way will the infected people be removed and the risks of the spread of the virus on a large scale will be minimized once the restrictions are relaxed
• A monitoring system (fundamental node) that follows individual cases remotely. Length of stay, presence of symptoms but also reports on living conditions, type of income etc. Support for individuals is at this crucial stage.

The purpose of all this is to create an in-depth screening network and not to abandon a possible infection within families, only and obliged to self-evaluate.

The problem of the domestic spread of the virus would be eliminated and isolation efforts would be lasting. It would also avoid the paradoxical situation in which a potentially infected patient chooses to leave the house, risking to infect others in order to work or guarantee the survival of the family.

Apparently these measures may seem expensive: the invitation is to parameterize the cost of this operation at the risk of new systemic lockdowns. Easily, it will be understood that a targeted monitoring project is much more feasible and convenient than indiscriminate closures and complete blockages of the economic system.

Furthermore, doing so would vitalise the national economy by producing goods and jobs, not to mention the construction of a permanent protection network that will be useful in the future, in the case of new pandemic or natural events such as earthquakes, floods, unpredictable events and catastrophes.

Going back to the core of the discussion and then wanting to broaden our gaze beyond national borders, it is however evident that the fundamental centrality of public health has appeared in all States. The transversal requests of the population will be aimed at promoting a sort of national health guaranteed to all citizens, even in those countries that have made private health a well-established business and a practice that is difficult to reverse.

Finally, let us not forget the political and strategic implications of all this. In the project of a humanity more prepared for pandemic catastrophic events, a standardized form of health protection will constitute – together with universal income – the mandatory basis of every democratic country. An apparatus of minimum guarantees that allows citizens to be protected regardless of income, social position, contributory status.

Healthcare measure of democracy

The last thing to think about is that relating to the relationship between efficient public health and the creation of international political trust. With this epidemic, public health has in fact transformed itself from a simple series of devices necessary to guarantee health to a real tool for assessing leadership.

Managing and maintaining efficient health has proven to be a national security problem, as has the functioning of defense structures or the holding of democratic institutions.

Even in the perspective of future terrorist attacks that exploited the viral weapon as a vehicle for penetration or destabilization, the efficiency of the public health system will be the test on which leaders will measure themselves, their political footprint and – most likely – the their weight in collegiate offices should it be necessary to vote on issues relating to the security and internal management of nations.