Introduction

COVID-19, a devastating virus outbreak that has not only affected humans all over the world but a wide range of animals as well had been declared to be a global health emergency by the World Health Organisation in January 2020 (Cucinotta & Vanelli, 2020). People who fall prey to this deadly disease develop various symptoms such as difficulty in breathing, fever, cough, nasal congestion, fatigue, among other symptoms. For older people, generally, people above the age of 60 years, are at more susceptible to encountering the virus and face more complexities such as pneumonia, dyspnoea and other chest symptoms. Studies say that nearly 75% of the patients who are diagnosed as symptomatic patients of disease get pneumonia (Velavan & Meyer, 2020). 

Italy is one of the many countries that has been severely affected by Coronavirus and had a high mortality rate. Hence, I have chosen the topic "Second Wave of COVID-19 in Italy" for this assessment, and I will be proposing a recommendation for the emergency response plan and recommendation for this public health emergency that will be exclusive for the target location, Italy.

Context of the Public Health Emergency

When the first case of the virus made an appearance in Italy, nobody suspected the case, and the 30-year-old patient who indeed was carrying the virus was admitted to the intensive care unit of the Italian hospital, Codogno Hospital in Lombardy (Malara, 2020). The patient had a history of atypical pneumonia; however nobody suspected him of being infected by the virus, and within the next 24 hours, Italy had 36 positive cases who had no connection with the man. After these events took place in February 2020, the Government of Lombardy and local health authorities formed an emergency health setting to respond to the virus outbreak. All the 74 hospitals together in Lombardy had an ICU capacity of 720 beds before the emergency following which the COVID-19 Lombardy ICU Network decided first to increase their surge ICU capacity and come up with appropriate measures to contain the virus (Grasselli, Pesenti, & Cecconi, 2020). 

     Regarding Figure 1, Italy saw a considerable rise in deaths within a month after the first reported case of the virus that rose even higher to several 13155 documented deaths within another month. Italy has the largest population of older adults in all of Europe. The leaders had been continuously debating whether or not they should be imposing a lockdown in the country as that might make older people more susceptible to acquiring the virus if they come into contact with any unreported case in their surroundings. However, once things seemed to quieten in between, it was not the end. As November approached, the Italian hospital ICUs saw more corona patients' admissions, and the death toll soared to 850, which has been measured to be the highest since March (Kitson, 2020). 

Figure 1: The Mortality Rate of COVID-19 patients in Italy

(Source: Livingston & Bucher, 2020)

According to the community health concept and behaviour model, certain elements are focused upon for health promotion around the globe to keep people safe during this COVD-19 pandemic. The elements include the promotion of living healthily during the pandemic, prevention of any sorts of health problems, treatment of health disorders related to the virus, rehabilitation of the patients following which their conditions will be evaluated, and the reports shall be sent for research that will help the global medical industry know more about the virus. (Van den Broucke, 2020) In this community health concept and behaviour model, the care providers, educators, advocates, researchers and the leaders in Italy can play an active role. It can be applied to the places that are most visited by the people, and awareness could be spread with its help.

Approach to Health Emergency Preparedness and Response

The Ottawa Charter was formed in the First International Conference on Health Promotion in 1986 that was held in Ottawa, Canada. According to the Ottawa Charter, there are five basic strategies for global health promotion. These include; building healthy public policies that foster equity and benefit everyone, creating supportive environments for health to it is a safe space for the vulnerable, strengthening community action for health to set priorities for the community health welfare and making strategic plans to achieve better community health, developing personal skills that include interpersonal skills as well as behavioural development and lastly, re-orienting the health services (Ottawa Charter for Health Promotion, 1986). 

Figure 2: Public Health Emergency Preparedness and Response Model

(Source: Public Health Emergency Preparedness and Response Capabilities National Standards for State, Local, Tribal, and Territorial Public Health Centers for Disease Control and Prevention Center for Preparedness and Response, 2018)

This is a 3 step model which includes the assessment of the current state of the COVID-19 pandemic, the determining of strategic activities to develop short-term and long-term goals to fight the virus outbreak and the development of plans based on the capacity of the organisation. Since this model will be exclusive to the second wave of COVID-19 in Italy, there are some key points we need to consider before the development of this model (RCCE Action Plan Guidance, 2020):

1.  The level of risk the virus now imposes on the Italian population, the perceptions and needs of the population and the capacity of the Italian health industry.
2. This action plan is specifically going to develop for the second wave of the virus hitting Italy and will consider the current situation to set the priorities and objectives based on the evolution of the virus currently.
3. There need to be regular assessments of the segments of people under risk and other stakeholders before developing the plan. There shouldn't be any bias or assumption involved in the formation of this plan, and it should be based solely on the data collected from Italy. 
4. The plan should be equal and inclusive of all the people who are at risk because of the virus. 

According to the first step of assessing the current state, we need to collect all the existent information we have about the Italian community. For the second step, we will need to look for organisations that can be collaborated with after which we will develop messages that will cause awareness about COVID-19 health protection steps and updates on the pandemic situation. These messages will be exclusively designed to suit the Italian audience. Lastly, for the third step, we will develop the plan keeping in mind the human and financial capital required to support the plan, define the budget and distribute the roles. Once the plan has been developed, it will be implemented and monitored for a defined period to see how well the objectives are being met and further actions would be taken accordingly (RCCE Action Plan Guidance, 2020).

Community-led Emergency Response

Since this pandemic has affected people all around the globe, people need to put efforts as a community to contribute towards public health welfare. When communities attempt to respond to, cope and recover from such emergencies, it is known as "community resilience" and the World Health Organisation Regional Office for Europe has always stressed on how important it is for people to build community resilience to address the public health priority and this COVID-19 pandemic is no exception (South, Stansfield, Amlôt, & Weston, 2020). A safe community will be fully aware of the risks of the virus, and they will actively assess and monitor these risks to minimise more infections. They will follow sustainable practices to build a long-term foundation to achieve their goals and commit themselves to keep following it for a long time to sustain the safety of their people (IFRC Framework for Community Resilience, n.d.). The communities need to act in collaboration with the public services to coordinate their efforts and bring greater impact, some of the public services being the parish councils, local businesses, faith organisations etc. (South et al., 2020). 

     We need to understand the Italian community, map out their structure, beliefs, capacities and perceptions (Costa, Faria, Alessandri & Caprara, 2016). For this, we will need to collect their basic demographic data, community structures, dynamics, trusted communication channels, assess their current capacities and challenges. Next, we need to engage the community leaders to go through the response plan and come up with local solutions that the community will be able to adapt. They need to discuss matters like social distancing, public and religious gatherings, transportation etc. Once the plan has been made, we need to check for the spread of false rumours and information that might cause panic about the COVID-19 situation (World Health Organization, 2020). The plan needs to be monitored and analysed based on the community feedback as they are the target audience of the plan. The key stakeholders of the community response plan need to actively play their roles in supporting the implementation and monitoring of the plan to build trust in this pandemic (Lee, Sniderman & Marquard, 2020). 

Conclusion

This report serves to propose a recommendation for the emergency response plan and a recommendation for how we can go about health promotion in Italy. We initially analysed the situation in Italy and discussed the measures the government took to contain the virus. The emergency response plan is exclusively designed to cope with the second wave of Covid-19 in Italy, taking into consideration the current situations.