Introduction

Italy was ‘patient zero’ of the Western world with regard to the spread of COVID-19. Furthermore, it was the first country after China to undertake severe quarantine measures at the national level. Beginning in early 2020, COVID-19 strongly and repeatedly hit the country, leading to a harsh health, social and economic crisis that the national government tried to deal with using a wide range of solutions over time.

The health crisis has put the Italian National Health System (NHS) under pressure and highlighted the differences between its Regional Health Systems (RHSs). This happened on at least two occasions. Firstly, during the first wave of the crisis in spring 2020, the pandemic outburst was mainly located in the north-west area, where regions put in place different strategies to address the spread of the new virus within their borders, mostly relying on the fundamentals of their regional healthcare systems. Secondly, during the second wave in autumn 2020, the national monitoring of the regional evolution of the pandemic helped to draw even more attention to the extent to which subnational governments were reacting differently to it.

The aim of this chapter is to understand the impact of COVID-19 on territorial inequalities with regard to access to healthcare. For this purpose, it will first introduce the concept of ‘one NHS composed of 21 RHSs’, focusing on health inequalities and healthcare disparities between Italian regions. Then, the analysis will focus on what happened during the pandemic crisis at the regional level during two different periods: the first wave of the crisis from February to June 2020 and the second wave from the beginning of November to the end of December 2020. With regard to the first wave, data from the Civil Protection concerning the three most affected regions – Lombardy, Veneto and Emilia-Romagna – will be used; data on the virus’s spread, hospitalisation rates and domestic isolation rates will enable us to learn about the coping measures adopted by the three subnational governments. The results will facilitate a reflection upon the different regional reactions to the crisis and the impact that those reactions had on citizens’ lives. The second part of the analysis will focus on four regions that were classified as highly risky by the national government according to the monitoring system adopted on 3 November 2020: Lombardy, Calabria, Tuscany and Emilia-Romagna.