An Italian Pharmacist-Mayor's Lesson from Testing His Town to Save a Region

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This story was supported by the Pulitzer Center.

One thing that has changed for Giulianio Martini since his father owned their historic pharmacy in northern Italy are the candies. The barley lollipops, once handmade by Martini's father and dispensed to the children who came through the storefront with their parents, are now pre-packaged, pre-purchased. The chamomile flavor, however, remains unchanged.

As a two-term, 10 year mayor of Vò, he's seen the ongoing health crises from both medical and municipal sides.

"The pharmacy has become a municipality desk for people who have problems, he said on a recent Wednesday. "If they need something, they write what they need and I put the bits of paper in my pockets ... then when I come up to the town hall we deal with them."

Martini and his wife operate two pharmacies in Vò. The family's client was the first in Europe to succumb to the coronavirus. The death came amid a campaign of COVID-19 testing that in the early days of the pandemic had gone virtually unmatched, an effort which led the Veneto region in which Vò sits to have one of the lowest infection rates nationwide, despite its proximity to the Lombardy region, home to Milan and the nation's highest mortality rate.

The town, with 3,000 residents and roughly 9,000 in the rolling hillsides beyond, played host to a study which for the first time revealed large asymptomatic cases mingling alongside symptomatic cases.

The decision to test an entire city came after Martini learned of the first death, which he heard about through a reporter. He bolted to his wife's pharmacy to make sure all those who had come in contact with the patient, including his son, also a pharmacist, were not infected.

Those memories remain now as his town faces the possibility of a second wave.

"We are very careful not to take anything for granted," Martini said. "I reckon it's possible that it might come back any day."

It was "like holding three elections"

The city of Padua, the largest metropolitan area near Vò, was destined to become the center of the outbreak. It was spared this fate, in part because of the testing carried out in Martini's region.

East of Milan, on the territorial boundary of the Lombardy region, Padua (population 250,000) and its namesake province offer a different tale of how to manage a pandemic and coming waves of infection. When countries were hoarding PPE, toilet paper and hand sanitizer, Padua stored testing swabs. Thanks in part to the relationship between Martini and the head doctor at Padua, Vò offered a testing ground for later lockdown measures and ongoing efforts to contain the spread through flu season in the fall.

Padua had one of the highest number of infected, hospitalized, and deceased due to the novel coronavirus. Touring the Padua hospital offers a glimpse at how proactive planning (the hospital bought several million test kits in February when the virus broke outside of China) and strict lockdown measures have led to supreme dominance over the disease.

Nearly five months since the coronavirus appeared in Italy, the contagion is not defeated. But here in Padua and its environs, including Vò, there is a noticeable slowdown. One of the largest in northern Italy, the hospital in Padua employs 7,276. Fewer than 18 were ever infected while working there.

Out of 4,600 residents from Castiglione D'Adda, one of the municipalities located near one of the two former red zones, one of which was near Padua and within the same region as Vò, 40 tested positive without knowing they had contracted the disease. All asymptomatic, the volunteers escaped from official statistics: they came into contact with the disease, they did not develop it, and now they could be instrumental in getting the country out of lockdown.

Following the country's first death, in Vò, Martini gathered the town's 3,000 people over several days to test them for both the novel coronavirus and antibodies. "Taking 3,000 people to get tested means having 40 to 60 nurses and doctors who have to do everything," Martini told Newsweek. He said the efforts were "like holding three elections, but more than that, because pretty much everyone came whereas elections have a 60-to-70 percent turnout."

The swarming effort, which occurred in late February and early March became a flashpoint for regional politicians who claimed they had insisted on the testing campaign. When the governor of the Veneto region wanted to take credit, the man who had become known nationwide as the "Swab King" in local media was vaunted into the spotlight.

Andrea Crisanti, the Director of the Laboratory of Microbiology and Virology at the Pauda Hospital and who is on leave from Imperial College, London, published the findings from Vò in preprint.

Padua hospital Italy
A bio containment chamber of the hospital in Schiavonia on April 08, 2020 in Padua, Italy. There have been well over 236,000 reported COVID-19 cases in Italy and more than 34,000 related deaths, but the officials are confident the peak of new cases has passed despite rises in some regions. Photo by Stefano Mazzola/Awakening/Getty Images

"We found out there was 3 percent of the population infected," Crisanti told Newsweek at his office adjacent to the microbiology lab where swabs from across the Veneto region were still coming in slotted trays to be tested by hospital technicians. "We interviewed every single person that was infected, we collected their story, connections, we reconstructed all the transmission chain, we collected for each individual the symptoms that they had, then we carried out the second test nine days after."

Their findings, in mid-April, came as an initial shock to countries that were still grappling with how to prevent the spread of the virus: the researchers working in Vò with the cooperation of Martini found that more than 40 percent of the town's infected population were asymptomatic.

"And also we observed that the combination of these two testing campaigns completely annihilated the transmission," Crisanti told Newsweek. "And this to me represents an example of how to deal with an outbreak. Since then, I champion a completely new approach for dealing with the epidemics. This means that not to use the swab only for diagnostic purposes, but also for active surveillance."

"This can limit the spread massively"

It is a revelation forgotten as regions across the United States struggle to reopen their economies: the Veneto region maintained a 9 percent mortality rate, despite bordering the Lombardy region with a mortality rate of roughly 20 percent.

Luciano Flor, the general director of the hospital which conducted the testing at its microbiology lab near Crisanti's office, and Daniele Donato, the healthcare director, told Newsweek the lessons learned at Vò have aided in the swift reopening of the city and commercial businesses, including the resumption of normal operations at the hospital.

"The fact that we have these asymptomatic who tested positive allowed us to contain the emergence of new outbreaks, because the moment we find asymptomatic positives, we go into this person's family and contacts and we start isolating," Donato said. "And this can limit the spread massively."

Flor and Donato now require individual tests for each of their 8,000 staff on a rolling basis. On a recent visit, the hospital campus was busy. Patients sat in an open-air atrium waiting for appointments that ranged from coronavirus-related to procedurals given what was learned in Vò.

"We guaranteed transplants, we guaranteed the major surgical operations," Donato said of the continuation of elective treatments which the hospital does not plan to suspend in the event of a second wave.

Enzo della Montà, 67, a farmer living in Vò, had continually tested positive for the disease caused by the novel coronavirus.

Three weeks ago, he tested negative and has rejoined the town which is, like him, enjoying summer out of quarantine.

Alessio Perrone contributed reporting from Padua and Vò.

An Italian Pharmacist-Mayor's Lesson from Testing His Town to Save a Region | World