Contact tracing failed in Italy, and it’s important to know WHY.

Italy is still fighting the COVID-19 pandemic, albeit with (fingers crossed) much better perspectives than in the spring of 2020. Right now, one of the few things that seem certain is that digital contact tracing, with the official app called “Immuni”, was irrelevant at best, or a total failure at worst. I already reported this in October 2020, but now there are more data to explain why and how this happened.

In short, Immuni did not work because “the whole system around the app did not work”, according to a very detailed report (Italian only!) on “Who killed Immuni, and why”. Personally, I do not completely agree with all the conclusions of that article, but it is irrelevant. As a minimum, those conclusions are useful food for thought, or starting points, about how to face the next pandemic with digital tools. So here they are, albeit heavily summarized.

Politicization

The public political debate around Immuni created distrust around digital contact tracing, rather than supporting it: various political parties lined up as monolithic partisan blocks for or against the application, thus discouraging its download and use.

Bad communication

Regardless of political squabbles, late and badly managed communication (also by some “technicians” and public servants) allowed unfounded controversies and conspiracies to rage.

“Late” arrival

Immuni arrived in late May/early June of 2020, when lockdown had ended and almost everybody, government included, hoped that, thanks to the continuous fall of contagions and the arrival of summer, there was almost no more need for contact tracing.

Little political will

Regardless of timing, a very common feeling around Immuni was that the government itself never really believed in it. Starting from its first “beneficiary”, that is the Ministry of Health: “the focus was [almost exclusively] technological, security and privacy aspects, losing sight of the public health ones. [But] this is also due to the fact that true public health experts in Italy always stayed away from Immuni. Perhaps out of reluctance towards technological tools, that is believing that an app could never work as well as a human”

In any case, during 2020 both the head of government Giuseppe Conte and the Ministry of Health Roberto Speranza “basically never mentioned Immuni”.

Little or no integration with regional healthcare systems

In the field, the main problem of Immuni was the so-called “code-loading” part of its usage.

Immuni users were supposed, as soon as they tested positive to COVID-19, to immediately, anonymously notify all their “contacts”. If they voluntarily decided to do it, that is. In theory, to do so, they had to interact with a representative of their regional public healthcare system.

In practice, many of those representatives had no idea of how to actually perform that procedures, and several italian regions just boycotted Immuni, more or less officially: “since we do not own the actual governance of that whole process, it was impossible for us to integrate and handle it”, said for example the president of Veneto.

Some of the reasons for this boycott were concrete problems, that is little or no digitization of their database, and little to zero capability to interface whatever should have happened “thanks” to Immuni with the rest of the system, from admitting sick people to hospitals to interviewing them to complement digital contact tracing.

The end result did not change, of course: very, very few notifications were actually sent through Immuni, making it just absent in several regions, and overall irrelevant nationwide.

Other reasons, in no particular order

At least through all of 2020,

• the fragmentation of healthcare systems did not help fight the pandemic. At all levels, including contact tracing
• nobody felt they knew for sure what they were legally required to do (or allowed to not do) if Immuni notified them of contacts with someone positive to COVID-19. People at risk of losing their job without unemployment insurance if they voluntarily (that is, not forced by law) to self-quarantines just ignored the notifications
• the impossibility (during 2020) to get tested immediately after a notification, not days or weeks later, made many notifications useless

What is the future of digital contact tracing in Italy?

That’s a nice question. The most likely answer right now, according both to that article and to myself, is that:

1. nobody knows
2. on the positive side, the Immuni debacle forced everybody, from the Government down, to face how complex it is to handle healthcare in a digital age, with or without pandemics, and learn what does not work
3. nobody should forget any of the lessons, to be ready for the next pandemic