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Tug-of-war over pulled WHO Italy report

A suppressed WHO report on Italy's pandemic response says hospitals were "chaotic," dangers to elderly went unrecognized, and training was haphazard.

A suppressed World Health Organization report critical of Italy's initial pandemic response says hospitals were "improvised, chaotic and creative," dangers to elderly went unrecognized and training was haphazard.

Crucially, the report showed the Italian health ministry had not substantially updated its influenza pandemic preparedness plan since the nation's 2006 bout with acute respiratory syndrome, or SARS.

"Italy was not totally unprepared for an epidemic when the first news bulletins came from China," said the 102-page report by the COVID-19 Emergency Team at WHO's European Office for Investment for Health and Development in Venice.

"Planning, however, remained more theoretical than practical, with little investment or translation of intentions into concrete measures," the report said. "The process nevertheless provided Italy with a legal and normative framework to react when the arrival of the COVID-19 epidemic in Europe took many by surprise."

Though the U.N. health agency pulled the report a day after it was posted to its website on May 13, a copy of it was uploaded to an Italian regional health documents center. On Monday, The Associated Press reported that a U.N. epidemiologist who denounced the report's withdrawal said he filed a complaint for being retaliated against after speaking out as a whistleblower.

“I couldn’t be silent,” Dr. Francesco Zambon, who led the 10-person team that wrote the report, told AP. “I’m doing this because I believe in the WHO and because I believe in the values of the WHO. One of them is integrity.”

'Factual inaccuracies'

The report was written to convey to the world the lessons that Italy learned after it became an epicenter of the coronavirus outbreak in Europe in late February, almost two months since the novel coronavirus was first detected in Wuhan, China. Since then 1.9 million Italians have become infected and 70,000 have died from among the nation's 60 million inhabitants.

"The sudden crisis situation caused some panic and overwhelmed contact-tracing capacities. Hospitals in the affected areas had to scramble to establish triage and screening procedures and safe patient circuits," the report said.

"Unprepared for such a flood of severely ill patients, the initial reaction of the hospitals was improvised, chaotic and creative," the authors noted. "It took some time before formal guidance became available. The immediate task was to get control over the flow of patients entering hospitals, knowing that these patients were worryingly contagious."

The report also said hospitals in northern Italy "were faced with a flash flood of severely ill patients entering emergency departments. The effect was chaotic and destabilizing." And among Italy's long-term care facilities, where half a million older people, along with their caregivers and loved ones, were in close contact on a regular basis, "the danger of the epidemic — for residents, staff and families — was not immediately recognized in all its magnitude, and protection, procedures and training came late and in a haphazard fashion."

The first news of WHO's withdrawal of the report came in an article by The Guardian last August emphasizing that "a severely outdated pandemic plan could have contributed to thousands of COVID-19 deaths in Italy."

After more news organizations reported that WHO pulled the report allegedly at the behest of Italy's government to spare it bad publicity, WHO's European regional office issued a statement on December 14 — four months after the initial news article on the controversy — explaining WHO's report on Italy was found to contain "factual inaccuracies" that were later corrected in anticipation of republishing it.

In their statement, however, U.N. health agency officials — who had not previously publicized or explained their decision to pull the report in May — did not specify the report's shortcomings.

"By the time corrections were made, WHO had established a new global mechanism — called the 'Intra-action Review' — as a standard tool for countries to evaluate their responses and share lessons learned," according to WHO's statement. "The original document was therefore never republished. At no time did the Italian government ask WHO to remove the document."

Zambon, however, told AP that he had been pressured to downplay Italy's out-of-date pandemic preparedness plan, which was essentially the same in 2016 as it was a decade earlier. “We couldn’t really say that the plan was updated because it was not true,” he was quoted as saying. A former WHO liaison to Italy, Dr. Ranieri Guerra, told Italy's La7 TV the nation's 2006 plan was nonetheless considered “current” until 2018.