Interview to Dr. Riccardo (ISS)

December 22nd 2020

Dr. Flavia Riccardo, medical epidemiologist working as a researcher within the Istituto Superiore Sanità (ISS) and member of the Advisory Board, has kindly offered her availability to discuss on some issues raised by the current pandemic outbreak relevant to the CBRN-ITALY project.

1. Dr. Riccardo, thank you for your time and availability for this interview. Could explain what is your role within the ISS and if and to what extent this has changed during the current epidemic outbreak?

Thank you for inviting me, I am a medical epidemiologist working as a researcher within the ISS. I specialize in infectious diseases, and prior to the COVID-19 pandemic my main interests in ISS focussed on emerging and vector borne diseases as well as preparedness. Since the first detection of SARS-CoV-2 I was involved in preparedness activities and, following this when Italy experienced local transmission, in surveillance and risk assessment.

2. The current crisis has posed unprecedented challenges to our health systems, our societies, our economies. What key lessons have been learned until now, in your view, in terms of epidemic preparedness and response in Italy?

SARS-COV-2 is a very unique pathogen and quite different from influenza viruses that have been the target for pandemic preparedness until now. This pandemic has highlighted fragilities and lessons learned in health systems globally, and many of those are common to several countries. We have become more aware of the risk of overwhelming healthcare system capacity rapidly due to an emerging virus with a higher transmission rate and hospitalization rate than influenza. We rediscovered the importance of contact tracing and of local public health services. We also enacted non-pharmacological measures on a wide scale to mitigate and contain the impact of a highly transmissible respiratory infection, an approach that was previously thought to be unfeasible.  I think that there will be global lessons to be learned alongside those that each country will glean from its own pandemic response review. I think epidemic preparedness and response will change after SARS-CoV-2 not only in Italy but worldwide to ensure we are better prepared to future threats of this kind.

3. Data are crucial to understand the evolution of the epidemic and to adopt adequate control measures. Have some limitations emerged during this crisis with reference to data (for instance, in relation to the different data collection methodologies adopted at the regional level) and can data quality and accessibility be improved somehow?

There are always data limitations during a public health emergency of this scope. During my past career, I experienced how in very large humanitarian emergencies we often need to make very rough sense of very shaky data. It was not the case this time. Although with understandable difficulties and all due caveats given the difficult situation, Regions put a tremendous effort in data collection and reporting. The data we received was complete and timely enough to allow not only epidemiological monitoring bur also a weekly assessment of risk taking into account probability, impact and of health system resilience. This was done in a context of continuous exchange and validation with regional authorities. In addition, data was accessible from the very first weeks initially through bulletins, then dashboards and finally through open data. All systems can be improved, of course, however I would like to stress that the investment at all levels on data analysis and interpretation has been significant in Italy throughout the pandemic.

4. Looking at the role of public communication during a health crisis, some confusions is sometimes raised by the different opinions of experts and scientists on key issues (for instance, on the safety and effectiveness of vaccines adopted through the emergency use authorisation). Can this confusion be somehow managed, for instance through the adoption of harmonised emergency communication guidelines?

Infodemia has emerged as one of the most challenging elements of this emergency. Harmonization of planning in risk communication among institutions and agencies is certainly important and should always be strengthened, however those plans are recognized only by the institutional partners they engage. They are not necessarily acknowledged by individuals who provide personal expert opinions or work in different institutions. Therefore, I believe harmonized planning alone will not solve the infodemia that accompanies large outbreaks. However, as public health professionals we should aim in becoming more effective and coherent in our risk communication activities in order to provide clear, simple and useful messages to the population that can encourage risk minimizing behaviours.