An hour’s drive west of Venice, at the far end of a valley of rolling green hills, lies the small town of Vò. There are only around 3,000 residents, and everybody knows everybody. The kids go to the same school. People wave at one another in the street. The nonnas are on warm terms with the local grocer, who is friends with the pharmacist, who happens to be the mayor’s son.
On an unseasonably warm day in late February, Vò became the subject of a huge experiment. Wearing masks and gloves, standing in line a metre apart, almost all of the town’s population filed through the lobby of the G Negri primary school. One by one, they gave their names and addresses before their nostrils were swabbed and their sputum tested for traces of Covid-19. Those who were unable to make the journey received home visits from doctors, anticipated by phone calls beforehand.
Days earlier, a resident of the town had become the first in Italy to die from the virus and the results of the tests were not good: 89 people tested positive. “Everyone knew at least one person with coronavirus,” said Giuliano Martini, the town’s mayor. The national government – which had until then viewed the threat to Italy as minimal – scrambled into action; Vò was placed under two weeks of lockdown.
Yet now, while hundreds of thousands in Italy are infected, Vò is “virtually virus-free”, said Luca Martini, a pharmacist and Giuliano Martini’s son.
Italy has been hit significantly harder by the coronavirus pandemic than its neighbours, but epidemiologists are struggling to understand why. At the time of writing, 110,574 people in the country are infected, of whom 13,155 have died. While the total lockdown appears to have caused the rate of new cases to plateau, the slow progress and the continually high mortality rate are dispiriting. Overcrowded hospitals and an ageing population probably play a part, as may as the northern region’s close business ties with China.
But many also suspect that Italy’s approach to testing has been deficient. In Germany, where the fatality rate is around 1.2 per cent, compared with 11.9 per cent in Italy, more than half a million people are tested each week by a robust and decentralised healthcare system. In Italy, testing has been mostly limited to people who exhibit severe symptoms. Even those who have been exposed to sufferers are advised merely to isolate themselves.
But Vò is different. When the coronavirus made landfall, Luca Zaia, the regional governor of the surrounding region of Veneto – which also encompasses Venice and Padua – made the call to close the town’s borders, quarantine its residents and test its entire population. It helped that the mayor of Vò, Giuliano Martini, is a pharmacist by trade; his first reaction to Covid-19 was to rush to his son’s pharmacy and urge him to wear a mask and gloves, long before such things had been widely adopted.
Locals were bewildered by the virus’s uncanny reach. “I wasn’t surprised by the fact that there were cases in Italy, or in Veneto, but I was shocked when I learned that the first case was in my tiny town of Vò,” says Serena Zago, a resident of Vò and tattooist, who learned the news while working on a design for a client. She now has “Covid-19” tattooed on her forearm.
While Vò closed its doors, “the rest of Italy was living everyday life”, remembers Giuliano Martini. “They were going out to restaurants, going to parties, working.”
“They did an experiment on us,” said Mauro Facchin, the owner of a local winery. “But we’re happy about this, because it went well… It allowed them to find a solution.”
Once the two weeks had lapsed and the virus’s incubation period had run its course, the town asked to be tested again. The mayor drafted in Professor Andrea Crisanti, a highly regarded microbiologist from the nearby University of Padua, who would process the results in his lab. Crisanti had asked to be involved because he believed that Vò’s circumstances presented a rare opportunity for him to carry out research on the effects of testing on coronavirus transmission, using an entire community as a sample. It would allow him to see “exactly how the virus worked inside a closed population”, says his colleague, Stefano Merigliano, who was involved in the experiment.
While the results of the first test had been alarming, the results of Crisanti’s follow-up test were encouraging: the proportion of infected people in the town had dropped from 3 to 0.15 per cent. By 19 March, Vò had recorded no new cases.
Merigliano said the experiment had allowed him to obtain a “full picture” of the coronavirus’s rate of transmission. He learned that “this virus is a very, very uncommon one”. With most viruses, Merigliano explains, “you become infected and transmit the infection when you are ill”. With Covid-19, “transmission in 50 per cent of cases is made by asymptomatic people, with no ability to detect the disease”.
This extraordinary rate of asymptomatic transmission has led Crisanti’s team to recommend very widespread testing as the only way to effectively track and contain the virus’s spread. Crisanti told reporters that he suspected that at least a quarter of a million people in Italy were carrying the disease, most with little or no symptoms.
Luca Martini said the newspapers from Bergamo are filled with tragedy – “ten or 12 pages of obituaries each day” – while in Vo, three people have died. “I firmly believe that widespread testing saved us all.”
As one of the first places to impose a rapid and successful quarantine, Vò also offers insight into the post-virus world. Residents remain anxious about reinfection, and many are reluctant to spend time outside their homes. As the rest of Italy continues to struggle with social distancing, the residents of Vò are embracing the notion that it could be safer to remain locked in their homes for longer still.
“When the town opened back up, before the countrywide lockdown was imposed, people were still thinking things would get better soon,” says Luca Martini. But now, “people are more scared of going out than before – we’re safer today than we were when people could come in and out, and bring the virus back”.
On 28 March, a new case emerged in Vò, followed by another. The infected people, who had caught the virus outside the town, were placed under quarantine immediately, but the new cases served as a reminder of the perils of lifting a lockdown prematurely.
While Vò was initially quarantined to prevent the virus from spreading to the rest of the country, Vò’s residents now view the quarantine as the best way to protect themselves. “There is a fear of going out,” says Mauro Facchin, who is eager for the town to be tested a third time. Serena Zago agrees. “I trust that the total block on our country will help things get back to normal.”
Luca Martini has settled into quarantine for the long haul. He doesn’t expect normality to return for at least a year. “First, we ought to open up the more essential shops, and limit the number of people that can get in them, then open up the restaurants and not the bars, just for lunch and not for dinner.”
This is a view shared by many experts. The medical journal Lancet Public Health recently urged China to extend its lockdown of schools and workplaces to prevent a new outbreak, and the country is already quarantining those returning to its shores for 14 days, according to Nature.
Stefano Merigliano says avoiding reinfection is a question of following three simple rules. “Identify people with the virus, isolate people with the virus, and defend yourself from the virus. If we don’t continue to test, the infection will restart. When you open [towns back up], you must have many rules to avoid contact.”
In cities, where blanket testing is more difficult, if not impossible, contact tracing – the testing of symptomatic people and those who have been exposed to them – is the best solution, says Merigliano. But to do so effectively will be much easier when it is possible to test for antibodies, as many may have already recovered. As for when it will be safe to return to normal life, he has no idea.
Until that time, Vò’s residents are unperturbed by the prospect of a longer quarantine, which has been extended by another two weeks across Italy. Ludovica Rossetto, another resident, told me it’s easier in Vo, because everyone knows each other and helps each other out, and everybody has a garden. Zago agrees. “I would rather stay at home until this thing concludes,” she says.