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ARTICLE
Italians locked down: people’s responses to early
COVID-19 pandemic public health measures
Virginia Romano1, Mirko Ancillotti 2✉, Deborah Mascalzoni1,2 & Roberta Biasiotto2,3
At the beginning of 2020, the widespread diffusion of SARS-CoV-2 rapidly became a
worldwide priority. In Italy, the government implemented a lockdown for more than two
months (March 9–May 18). Aware of the uniqueness of such an experience, we designed an
online qualitative study focused on three main dimensions: daily life during the lockdown,
relationships with others, and public health issues. The aim was to gain insights into people’s
experiences of, and attitudes toward, the changes caused by public health measures
implemented as a response to the COVID-19 pandemic. We conducted 18 semi-structured
interviews with Italian residents. The interviewees were recruited through mediators using
purposive sampling to obtain a balanced sample with respect to age, gender, education, and
geographical residence. Interviews were analyzed through qualitative content analysis. The
lockdown affected a variety of aspects of people’s life, resulting in a significant re-shaping of
daily activities and relationships. These changes, which entailed both positive and negative
aspects, were met with resilience. Even though public health measures were generally
considered acceptable and adequate, they were also perceived to generate uncertainty and
stress as well as to reveal tensions within the public health system. When tasked with
imagining a scenario with saturated intensive care units and the need for selection criteria,
respondents showed a tendency to dodge the question and struggled to formulate criteria.
Media and news were found to be confusing, leading to a renewed critical attitude toward
information. The findings shed some light on the impact of the lockdown on people’s daily life
and its effects on relationships with others. Furthermore, the study contributes to an
understanding of people’s reasons for, and capacity to respond to, emergency public health
measures.
https://doi.org/10.1057/s41599-022-01358-3 OPEN
1Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Bolzano, Italy. 2Centre for Research Ethics and Bioethics,
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. 3Department of Biomedical, Metabolic and Neural Sciences,
University of Modena and Reggio Emilia, Modena, Italy. ✉email: mirko.ancillotti@crb.uu.se
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Introduction
The severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) causes a highly transmissible acute
respiratory disease (COVID-19), which can present severe
symptoms leading to death. The first cases of COVID-19 were
reported in Wuhan, China, at the end of 2019 (WHO, 2020a).
The disease quickly spread worldwide and became a global threat.
On January 30, 2020, the WHO declared the COVID-19 epidemic
a public health emergency of international concern (WHO,
2020b), and on March 11, 2020, a pandemic (WHO, 2020c). On
January 31, Italy declared a state of emergency for the following
6 months. Italy was the first western country to be heavily hit by
the virus and to implement severely restrictive public health
measures. The northern regions of Lombardy and some provinces
of Piedmont, Veneto, and Emilia-Romagna—which were the
most affected areas in Italy at the time—were classified as a “red
zone”and were subjected to the most rigorous limitations on
socioeconomic activities and movements (Ministero della Salute,
2020a). On March 9, 2020, Prime Minister Giuseppe Conte
extended such measures to the entire country, without making
any distinctions based on the seriousness of the emergency at the
local level (Ministero della Salute, 2020b). All commercial activ-
ities, social activities, schools, and universities were closed. Only a
few enterprises that were deemed essential—e.g., pharmacies,
supermarkets, and newsstands—were open. People’s movements
were forbidden except for reasons (e.g., health and work) proven
by a self-declaration. With this, Italy entered ‘phase one’of
lockdown. Between February and May 2020, COVID-19 cases
peaked, reaching more than 800 deaths per day in the last weeks
of March (ECDC, 2020). The rampant increase in infections and
deaths overburdened the healthcare system, which was facing an
unprecedented need for intensive care units while suspending
regular healthcare services. Phase one lasted until May 18, 2020.
Subsequently, less restrictive measures were adopted—with a
partial and gradual re-opening of non-essential services—fol-
lowing a decrease in infections and deaths during the summer
period (ECDC, 2020).
Our research team realized that the lockdown, given its
exceptionality, constituted a unique opportunity to conduct social
science research. We decided to explore people’s responses to the
circumstances in which they were living using semi-structured
interviews with a sample of Italian residents. The present study
aims to understand the impact of the public health measures in
place in Italy following the COVID-19 emergency in spring 2020
on laypeople, and to explore their views on the measures and
public health challenges associated with the health emergency.
The social impact of the pandemic and public health measures
was investigated in several studies with different approaches and
methods. Studies conducted in European countries with a similar
focus on themes and data collection timeframe investigated
mental health and the psychological impact of the lockdown, and
the impact of lockdown on daily life (Ahrens et al., 2021; Mar-
tinelli et al., 2020; McKenna- Pérez-Rodrigo et al., 2021; Pieh
et al., 2020; McKenna-Plumley et al., 2021; Probst et al., 2020;
Schwinger et al., 2020,). In Italy, studies similarly aimed to
understand the impact of the lockdown, focusing on mental
health and everyday life disruption (Durosini et al., 2021; Ferrante
et al., 2022; Risi et al., 2021; Tomaino et al., 2021; Trifiletti et al.,
2022). Other studies focused on the perception of the public
health measures, and linked risk perception to behavior and
adherence to the measures (Atkinson-Clement and Pigalle, 2021;
De Coninck et al., 2020; Liekefett and Becker, 2021; Lo Presti
et al., 2022; Scholz and Freund, 2021; Savadori and Lauriola,
2021). Studies that included a wider timeframe in data collection
grasped the impact of the lockdown and the response to public
health measures over time (Marinaci et al., 2021).
In our work, we shared with some of the above-mentioned
studies conducted in Italy the interest in the impact of public
health measures in everyday life. Additionally, we provided a
public health perspective by exploring the response to the mea-
sures and investigating views on public health management and
challenges. The methodological approaches in studies conducted
in Italy were wide, including for example semi-structured inter-
views, surveys, questionnaires, and diaries, but shared an “online”
dimension, a shift in data collection which became necessary for
empirical research conducted during a pandemic (Lupton, 2020).
Our study, which was designed approximately a couple of weeks
after the implementation of the lockdown, also took a remote
approach to data collection.
Methods
Design settings. When we, as a research group, conceived and
conducted the present study, we were all (except one author living
in Sweden and helping us to anchor our views) experiencing the
lockdown ourselves. By reflexively considering the genesis of our
research (Berger, 2015), we were cognizant of the fact that our
circumstances reflected the conceptualization of the study, the
definition of the main research questions, and their oper-
ationalization in the form of a semi-structured interview guide.
Single individual interviews were carried out during the lockdown
when both the interviewer and interviewees were living in the
same circumstances.
Interview guide. The exploration of areas of interest started with
brainstorming within the research team. After the brainstorming
phase, each member of the team independently elaborated a
defined number of questions. After collecting all the questions,
two main dimensions were identified as reflecting the main ten-
sions found in the experience of the lockdown and public health
management of the epidemic.
1. Daily life during the lockdown: daily life changes and re-
arrangements, advantages and disadvantages, changes in
priorities, changes in social relationships, and perception of
others.
2. Public health response and pandemic challenges: percep-
tion of the public health measures, hypothetical criteria for
access to scarce critical care resources.
Each dimension was operationalized through its respective
specific set of questions. We also included a question on media
and information on the pandemic, which in our view was
important for contextualizing the situation people were living in
at that time. The final version of the interview guide included
nine questions (Supplementary information S1). Follow-up and
probing questions were used for clarification and elaboration. The
interview guide was tested once and, as there was no need to
make any changes, the material produced was included in the
data analysis.
Recruitment. The interviewees were recruited using purposive
sampling, the aim being a balanced sample concerning age,
gender, education, and geographical area of residence in Italy
(North, Center, South and Islands). Recruitment occurred
through mediators (Kristensen and Ravn, 2015), which were
recruited through the researchers’network via phone. Mediators
were provided with an overview of the research aim and setting
and were asked to suggest and contact potential respondents
within their social circle. If prospective respondents showed
interest in participating, mediators facilitated the contact between
potential interviewees and the researcher in charge of the
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interviews. After potential respondents received all the relevant
information on the study from the researcher and agreed to
participate, a video call appointment was fixed for the interview.
Recruitment occurred via phone call.
Exclusion criteria were working in healthcare and self-reported
positivity (at the time of the interview or earlier) for COVID-19.
We considered that, in both cases, perceptions of the entire
situation might have been greatly influenced by direct contact
with the virus, thus constituting a special and specific experience.
Trying to understand that experience was beyond the scope of the
present study.
Data collection. One of the authors conducted 18 interviews
between April 27, 2020, and June 6, 2020, by video call.
Approximately half of the interviews were conducted during
phase one of the lockdown. The others were conducted during
phase two. The average length of the interviews was 40 min. The
interviews were conducted in Italian. The sample size was chosen
based on saturation.
Ethical aspects of data collection. In Italy, in the absence of
legislation requiring the ethical approval of social science
research, our research was not applicable for submission to an
ethics review board. Our work conduct was inspired by the
principles expressed in the Declaration of Helsinki and in
accordance with relevant guidelines and regulations. It was also
informed by the code of conduct for professional sociologists
(http://www.societaitalianasociologia.it/p/codice-deontologico.
html). Participants were informed about the project aim and
rationale, the data treatment, that their participation was volun-
tary, and that they could withdraw at any time. All the infor-
mation was provided orally, and participants provided informed
verbal consent to participate. For further details, see the “Ethics
approval”section.
Data analysis. Interviews were audio recorded and transcribed
verbatim. Transcripts were analyzed through qualitative content
analysis (Hsieh and Shannon, 2005). After each interview, the
research team discussed together impressions and preliminary
themes and evaluated the efficacy of the interview guide (no
adjustments were made throughout). All the authors read and
became familiar with the content of the interviews. We used the
dimensions and the interview guide as a structure for organizing
the coding of the transcripts. Along the same line, the results are
presented according to the dimensions or specific questions. The
analysis was conducted on the Italian transcripts. Selected
excerpts were translated into English for incorporation into the
manuscript as representative quotes.
Results
A total of 18 respondents participated in the study. Their socio-
demographics are described in Table 1.
Daily life during the lockdown. The lockdown caused major
changes in the participants’life. It affected multiple aspects of
their existence, from the most trivial daily routines to a redefi-
nition of their relationships in the family and with others.
Impact. When asked about the impact of lockdown and public
health measures on their daily routine, most respondents
described a process including a phase of understanding and
acceptance of what was going on followed by progressive devel-
opment of and adjustment to a new routine. This was generally
associated with a coping strategy that was useful not only in
practical terms to keep things going but also in managing stress
and anxiety. Though most respondents experienced initial diffi-
culties in accepting the changes, they also reported adapting to
them relatively quickly:
Q1. Right after the lockdown, everything went upside down
because I went from work, work, work to home, home,
home. In the beginning, I was frightened by this but, set
aside the economic worries…I enjoyed it a lot because
being used to organizing and planning, to be very
systematic, I created a new routine for myself. Because
not having a routine was a bit frightening for me I kept
setting my alarm at the same time as always, I have a dog
and I kept walking it at the same time, I exercised regularly,
as far as possible. (Int. 17).
Work routines and the need to rearrange them followed the
same path as the extra difficulty of transforming the spaces
needed to work from home. For most respondents, working from
home was perceived as a chance to spend more time with the
family and on hobbies, as well as to have a less stressful lifestyle
overall. Some respondents also indicated that the limitations on
in-person social interaction resulted in stress relief. Most
respondents experienced having more time (e.g., travel/commut-
ing time):
Q2. This has clearly cut down my need to move around to
zero, which given what I do is my most frequent activity
and, as a consequence, it also solved my stress of having to
move from one side of the city to the other and gave me
more time to do “office”stuff. Another positive thing is that
I got to spend more time with my daughter because clearly,
with her being home from school and me spending the
morning at home, she would often exercise with me, and it
was a nice way to spend some time together. (Int. 16).
Relationships. The public health measures and new rules enforced
to control the spread of COVID-19 polarized people’s behavior
and feelings into a clear-cut distinction between what is
acknowledged as “us”vs. “them.”Respondents admitted that they
had both observed others’behaviors and blamed others for not
respecting the rules; they had also been criticized in the same way
by others:
Q3. Look, I always respect rules, I get very annoyed when
people don’t respect them, and I’m even more in this phase.
Table 1 Sociodemographic data on the respondents.
Sociodemographic characteristics N
Gender
Female 7
Male 11
Age group
25–34 5
35–44 7
45–54 1
55–64 3
65–74 1
75–84 1
Education
Higher education 6
Secondary education 12
Area
Center 7
North 6
South and Islands 5
Total 18
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Because if it’s compulsory to wear a mask, then it’s
compulsory to wear a mask, if visiting relatives is not
allowed, then you can’t visit relatives, while what you see is
people going from one house to another, exchanging kids
from one house to the other to do homework together and
they tell you, it’s ok because we don’t have Coronavirus!
Right! And how would you know?! (Int. 7).
Q4. Something that really annoyed me was the people who
are called “balcony sheriffs”because, even if you were just
going to take out the trash and you were maybe walking
100 meters, they would scream at you that you should have
stayed at home. I thought this was really too much, I think
we’re all closely following the rules and that strolling was
cut to the minimum, just to get some fresh air. (Int. 16).
Somehow, the pandemic allowed people to publicly show their
disappointment with or overtly criticize others. Social control was
therefore experienced either actively or passively by all respon-
dents. According to respondents, what also changed dramatically
was the tendency not to trust other people’s ability to engage in
responsible behaviors. In some cases, these accusatory attitudes
were understood and tolerated as being a result of people’s fear,
but, in general, most respondents were disappointed because they
saw the emergency as a chance for society to change for the
better, to incentivize solidarity and tolerance, something that, in
their view, only occurred to a limited extent.
Q5. Coronavirus created an “us”and a “them.”A very
distinct “us”and “them,”and this “us”and “them”is even
more fragmented than it was before. And by “us”I really do
mean my home, and “them”is everybody else, so you’re ok
only if I know you, not even my neighborhood anymore…
While in the first weeks we were all close together, we all
loved each other, now this thing just blew up into a
thousand pieces, and it’s a community that needs to rebuild
itself. (Int. 15).
Aside from affecting relationships with others, most inter-
viewees also admitted that the pandemic situation impacted their
closest relationships. Many reported a negative change in their
perception of close relationships, newly discovered attitudes that
made them uneasy, and a general lack of openness in discussions
and communication. This caused them to reflect on the meaning
of friendship and to rethink what is important in meaningful
relationships with friends.
Although less frequently perceived than the negative aspects,
some respondents also talked about the positive consequences of
the situation, such as a heightened sense of humanity and
solidarity visible through tangible acts, offering an occasion for
people to show strength and resilience. The use of a face mask
was positively referred to as an act of respect for others and not
perceived as a mere limitation.
Public health. The lockdown and other public health measures
generated different reactions among the participants. In this
section, participants’perceptions of and views on the measures
are described, together with the scenario of overloaded intensive
care units.
Opinions on public health measures. Among most of our sample,
the general perception and overall evaluation of the measures
implemented to control the pandemic were positive. Respondents
expressed various reasons for supporting their positive attitudes
that ranged from considering the measures adequate to stronger
expressions of support. In the latter case, the measures were
described as indispensable, rightful, and timely as well as needed
to promote the common good; in other cases, respondents also
indicated that, in their opinion, the lockdown should have been
implemented earlier, thus showing even greater support for this
containment strategy:
Q6. Well, the beginning was very bad because we had all
reasons for the lockdown to be done a lot earlier…. I think
that at the very beginning only Almighty Money was in
control, and still is now, to change the topic, I heard that
they want to restart Series A [the Italian national soccer
championship, Ed], and I think this is just nonsense, only
linked to economic interests and not to public health
factors, because we don’t care if they can or cannot play
football, it’s just a game. (Int. 7).
The interviewees also shared their negative emotional response to
these measures, a response that was filled with uncertainty, fear, and
confusion. The latter was often linked to possible misunderstandings
and perceived lack of clarity concerning what was or was not
allowed as well as what constituted the right behavior in different
social situations. For instance, in some cases, respondents found it
difficult to clearly understand whether they were or were not allowed
to go to work, and this uncertainty generated feelings of frustration.
The limitation itself was not as stressful as the impossibility of clearly
understanding the actual situational applicability.
Restrictions were often described as being in opposition to
economic interests and the need to maintain productivity.
Respondents often mentioned lobbying mechanisms of various
kinds that promoted either postponing the lockdown measure or
speeding up the re-opening of economic activities.
In the respondents’opinion, the pandemic has brought to light
the need to restructure the national healthcare system. In their
view, the COVID-19 health emergency has challenged an already
strained healthcare system and the management of healthcare
resources. The scarcity of resources and the lack of coordination
and preparedness between the regional and national levels
impacted the efficacy of the pandemic response.
The pandemic also raised awareness of inequalities. Different
socioeconomic and working conditions—exemplified by house
size, proximity to nature and outdoor spaces, the ability to work
remotely, and an unaffected regular, stable income—were
perceived to inevitably affect the extent to which restrictive
public health measures were bearable.
ICU criteria. It was admittedly difficult for respondents to express
themselves about what criteria should be used to select which
patients would be included in/excluded from intensive care units
(ICUs). Whether they properly answered the question or tried to
dodge it, one common mechanism was to distance themselves
from determining in advance something that was not their
decision to make. Concerns were voiced about who should make
such life-or-death decisions, including the opinion that no one
should. Typically, the issue was deemed to be an ethical dilemma
that should ultimately be resolved by healthcare professionals.
Attempts were made to answer the question by opposing its
premise, such that the scenario was improbable or, on the con-
trary, realistic, and therefore efforts should be made to prevent it.
Respondents identified as possible selection criteria age,
survival likelihood, role/function in society, and previous
behaviors toward the collective. Concerning age, respondents
stated that younger people should be prioritized:
Q7. It’s a matter of life expectancy, it’s not that the value of
an elderly person’s life is lower, but if we evaluate based on
how much one has lived, obviously the young person
should be given the opportunity to live more than a person
who has already lived a long time. (Int. 10).
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Concerning role/function in society, healthcare professionals
and researchers were pointed out. Behaviors against the collective
were mentioned as potential exclusion factors, e.g., lockdown
transgressors or perpetrators of serious crimes. Nonetheless,
concerns were raised that it would be unfair to prioritize some
groups over others or to place one group at the bottom of the list.
The age criterion was specifically rejected in some instances,
based on relational and sentimental grounds:
Q8. Yes, they are indeed elderly people, but they are still our
grandparents, our uncles, and our parents, so even if they’re
grown up, it’s not right that we should no longer have them
with us (Int. 11).
Social class or strata were also mentioned as factors that should
not be considered as criteria when deciding who should have
access to intensive care.
Information and media. Respondents’experience of the lock-
down and their view on the public health measures were inevi-
tably affected by the information they had about the ongoing
situation. Most of the respondents used TV, the internet, social
media, and online newspapers as their main sources of infor-
mation. Respondents also consulted other sources of information
such as press releases, newspapers, radio, official government
websites and resources, medical doctors, virologists, experts (in
this category, both public figures, and personal contacts), jour-
nalists, and local and international news. Most of the respondents
shared a feeling of exasperation with TV and the media in general
during the pandemic: Information was found to be sensationa-
listic, and the media were perceived as lacking objectivity,
amplifying the problem, and providing confusing and contra-
dictory information, thus causing an increase in anxiety and a
general lack of trust in media and information.
Q9. My trust in the communication and information
system is decreasing…. That’s because you don’t know
where to turn and can’t be certain you are turning to
someone who can tell you something reasonable, correct, or
useful…. You hear one person and then another who says
exactly the contrary, you read one thing and then
something else that again says the opposite. This has been
difficult to accept and, moreover, it makes the search for
correct information difficult. (Int. 8).
Respondents pointed to the importance of having a critical
attitude toward the media, and they evaluated the reliability of the
media and news by consulting and comparing more sources.
Q10…. seeing the news, the first question one asks oneself
is: OK, who said that? Where does this news come from?
So, now that the news is no longer considered reasonable a
priori, we check to see if someone else says something
afterward. Now, it’s like this: there is [a piece of news], is it
valid? Is it not? Who is saying that? What’s the source?
Show me that it’s true. (Int. 15).
Discussion
Reshaping daily life as a process. Respondents in the present
study reported on the lockdown as a process more than some-
thing static; they described how puzzling the situation was and
the whole process of progressive adaptation to such a complex
and unprecedented situation. The need to talk about the lock-
down in a complex and dynamic way justifies and supports our
methodological choice of in-depth interviews. Respondents
described how they had realized what was happening and coped
with the situation by making a series of progressive adjustments.
They reported strategies they had used to rearrange both their
time (work and leisure) and their spaces (where to work, where to
live), and through these changes, they unveiled their personal
sensemaking tension in relation to the pandemic (Angeli and
Montefusco, 2020).
One of the most striking social effects of COVID-19 was the
polarization between “us”against “them,”characterized by the
need to identify categories one can blame. As repeatedly reported
by the respondents, during the Italian lockdown, the positive and
communal feeling associated with everyone being together in an
extreme and unprecedented situation was quickly followed by a
heightened search for someone to blame. Some of the
interviewees reported feeling this strong social control over
themselves and being the object of shame, even when they were
not breaking the rules. “Covidiots”is the new term used for
people who find it hard to adhere to the rules because they are
either “too weak, too stupid, or too immoral to do the right thing”
(Reicher and Drury, 2021). “Pandemic fatigue”has also been
associated with this uneasiness with rules, a general tendency to
get “tired”of them, and, at the same time, negative feelings about
those who break them (Michie et al., 2020). This same attitude of
blame permeated interactions on social media, here with even
more strength (Choli and Kuss, 2021). This narrative of blame
leads to the bitter idea that COVID-19 presented as a “missed
opportunity”for humankind to be better and do better.
Nonetheless, the one clear positive effect COVID-19 had on
social relationships was to strengthen those that were already
valuable, and to cherish and underscore their preciousness.
Complexities in public health. Complexity and adaptation were
also described in the process that brought governments to pol-
icymaking surrounding the pandemic. Sensemaking in
complex situations appears to permeate society at various levels,
from the individual psychological one to the collective and poli-
tical dimensions of regulations and emergency management
(Angeli and Montefusco, 2020). The measures enforced in Italy to
curb the spread of infection in the country were generally well
accepted as necessary. Positive reactions to the need to implement
anti-COVID-19 rules were also reported in other countries
(Alanezi et al., 2020; Meier et al., 2020). The general acceptance of
mitigation measures is connected to the general public perception
of the risks associated with the spread of the COVID-19 virus
(Motta Zanin et al., 2020). Where risk was perceived as stronger
and mortality was higher, such as in the UK, Spain, and France,
“the highest adherence (to rules) was reported”(Alanezi et al.,
2020). Economic interests were often perceived as a potential
obstacle to implementing measures that were in the best possible
public interest as if there were a conflict between the right-
eousness of the measures and the survival of the economic sys-
tem. In the literature, it has been estimated that the best possible
solution for both public health and the economy appears to be “a
prudent opening…whereas costs are higher for a more extensive
opening process”(Dorn et al., 2022). What these measures clearly
showed was the existence and exacerbation of socioeconomic
inequalities in the population. As noted by Carta and De Philippis
(2021), “the economic repercussions of the COVID-19 shock
impacted low-income households more heavily than higher-
income families, implying a substantial increase in labor income
inequality.”The increase in inequalities tended to affect pre-
existent fragilities both on a microsocial level, e.g., gender issues,
and on a macrosocial level, i.e., developing countries over the so-
called first world (Meraviglia and Dudka, 2021). In other words,
COVID-19, which was initially called the ‘great leveler,’actually
turned out to expose ‘the fault lines in society’and amplify
inequalities at many different levels (Marmot and Allen, 2020).
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The scenario of saturated ICUs leading to available resources
only being allocated to some patients who may benefit from life-
sustaining treatments was deemed improbable by some respon-
dents. In general, it was a difficult issue to discuss. Even more
problematic was specifying criteria for the allocation of scarce
resources, i.e., how to choose who to treat and who to exclude
from intensive care. Albeit problematic, the scenario was not at all
improbable. Indeed, already on March 6, 2020, the Italian Society
of Anesthesia, Analgesia, Resuscitation and Intensive Care
(SIAARTI) issued a series of recommendations and ethical
considerations to help clinicians involved in the care of critically
ill COVID-19 patients in settings marked by scarce resources
(Vergano et al., 2020). The opinions of the respondents in the
present study were not too distant from SIAARTI’s recommen-
dations, especially considering the Triage principles and criteria:
Age, comorbidities, and the functional status of any
critically ill patient should carefully be evaluated. A longer
and, hence, more “resource-consuming”clinical course may
be anticipated in frail elderly patients with severe
comorbidities, as compared to a relatively shorter and
potentially more benign course in healthy young subjects.
The underlying principle would be to save limited resources
which may become extremely scarce for those who have a
much greater probability of survival and life expectancy, in
order to maximize the benefits for the largest number of
people. (Vergano et al., 2020).
Lay people’s opinions and SIAARTI’s recommendations
converged on the notion that age is a decisive criterion for ICU
admission, but on different grounds. Although torn, most
respondents seemed to apply a sort of fair innings argument,
i.e., the view that there is some span of years that is reasonable for
a person to have lived and if a decision must be made concerning
whom to save, the life of the younger person should be
prioritized. This view may easily be considered ageist, but
appears to be supported by commonsense morality (Bognar,
2015). SIAARTI’s recommendation was justified by a maximiza-
tion principle based on medical considerations. It is noteworthy
that SIAARTI’s recommendations also stressed the importance of
informing the patients and/or their proxies about the extra-
ordinary nature of the measures in place, including the decision-
making process behind withholding or withdrawing life-
sustaining treatments, due to a duty of transparency and to
maintain trust in the healthcare service (Vergano et al., 2020). In
fact, the lack of transparency and the fear that some groups could
be unfairly privileged constituted an often-discussed matter of
concern in the interviews. The groups whose prioritization could
be tolerated included healthcare professionals and researchers.
This should probably not be interpreted as a form of compensa-
tion for their exposure to higher risks of infection or the heavy
burden of their work, but instead, for the role that these categories
of people could play in shortening the sanitary emergency and
saving as many lives as possible. At the other end of the spectrum,
among the groups mentioned that should be given the lowest
priority, were lockdown transgressors and perpetrators of serious
crimes. The answer to the normative question about ICU
selection (or resource allocation) criteria could be derived by
leveraging the values of utilitarian, egalitarian, and prioritarian
approaches (Yuk-Chiu Yip, 2021). Most respondents swung
between the former and the latter. The principle of distributive
justice, intended as equality of access to finite health resources,
did not appear to inform respondents’views. Although previous
studies on lockdown transgressors highlighted the fact that
individuals considered their own (mis)behavior morally proble-
matic, they also had different neutralizing strategies against
feeling guilty (Cullen et al., 2021; Márquez Reiter, 2021).
Nonetheless, people who were compliant with lockdown rules
seemed to pass negative judgments on transgressors.
Navigating information. During the COVID-19 pandemic and
the imposed lockdown, information technology, and digital
media acquired prominent importance in people’s lives, not only
as a source of information on the pandemic, but also as a tool to
work, learn, teach, connect with others, and engage in many other
activities remotely, while living at home in a digitally connected
world (Feldmann et al., 2021; Tropea and De Rango, 2020).
During the COVID-19 pandemic, a massive amount of infor-
mation, as well as misinformation, spread through the media,
generating a so-called “infodemic”(Banerjee and Meena, 2021).
The answers that respondents gave on media and information
topics provided evidence of the key role trust played in their
attitudes toward and relationship with information and media.
Respondents in the present study seemed to be seeking strategies
for a critical attitude that would allow them to navigate the
overflow of information during the pandemic. They looked at
media and information with a renewed critical lens: The infor-
mation provided during the pandemic was often perceived as
confusing and sensationalistic, thus leading to the development of
strategies for analyzing sources’trustworthiness, but also to a
general lack of trust in media and information, which was also
reported elsewhere (Van Scoy et al., 2021).
Understanding change. To interpret the changes in people’s
mindset and trust during the pandemic and the lockdown in
relation to the observed information, and the changes that people
faced as a result of the public health measures in place, we used
the mindsponge mechanism framework (Vuong and Napier,
2015). The framework includes a multi-filtering information
process and an inductive attitude that offers an understanding of
the processes at stake in the change of mindset, cultural values,
and identity. It seeks to understand “how an individual absorbs
and integrates new cultural values into her/his own set of core
values and the reverse of ejecting waning ones”(Vuong and
Napier, 2015). It should be noted that information processes and
decision-making during the COVID-19 pandemic were in the
context of a life-and-death situation. Survival pressures (including
social survival) had been driving information processes (Vuong,
2022) that shaped policymakers’decisions (issuing the lockdown)
and citizens’responses (making behavioral adaptations). It is in
such pressured conditions that the ideas of lockdown and adap-
tation were deemed valuable on both a societal and
individual level.
The situation that the population in Italy had to face during the
early pandemic phase and the lockdown is comparable to a
change in cultural and societal values and context. Public health
measures were adjusted according to the progressive acquisition
of knowledge on the virus and the disease, and based on a daily
assessment (e.g., the impact of the pandemic as the number of
affected individuals, deaths, resources, etc.) of the worldwide and
the local (at a national, regional, city-specific) context. At the
same time, the public health care system struggled to meet the
demand of people in need. The lack of adequate resources (e.g.,
facilities, structures, ICU departments, suitable protective gear)
meant that, while the number of cases increased, the lack of
intensive care units was a daily issue, entire hospitals were
reconverted to COVID-19 departments, and all the other care
services were suspended. Standardized monitoring and diagnos-
tics systems were still under development and dependent on
limited knowledge at the time. Individual behavior, social
interactions, and movements were all regulated through norms
that frequently left shaded areas in applicability and
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Content courtesy of Springer Nature, terms of use apply. Rights reserved.
understanding. During the early phases of the pandemic and the
lockdown, the public discourse that framed the implementation
of the public health measures leveraged specific values: respon-
sibility, courage, and sacrifice (Palazzo Chigi,
2020a,2020b,2020c,2020d). The imposed and advocated
changes in habits and lifestyles were framed as a collective effort
for public health and the protection of all, especially those most
vulnerable. National unity and pride were recurrent themes in the
speeches of Prime Minister Conte when addressing the public to
comply and cope with the imposed restrictions. The motto “Io
resto a casa”(I stay at home) embodied all the above-described
new public values emerging as a response to the national health
emergency.
The changes that respondents reported in our study can be
interpreted as the results of a filtering process, which consists of a
dynamic integration and evaluation of information and new
values. Against this background, the development of new routines
can be interpreted as the beneficial result of a mindset change in
managing stress. Expectations towards others and society were
rethought and re-evaluated based on the perceived polarization of
values of solidarity and tolerance vs. attitudes of blame, distrust,
and social control. Both close relationships and social relationships
were affected by the new mindset. An evaluation of cost and
benefit intervened in the evaluation of the public health measures,
perceived as important and necessary, but also stressful and
framed in uncertainty. Respondents’responses to the measures
can be understood within a mindset change that included an
increase in awareness of public health challenges and social
inequalities. Trust played a major role in the filtering process of
the information received by the media. Respondents elaborated on
trustworthiness criteria to evaluate the news, and this process was
the result of a renovated (mostly negative) perception of media.
Other studies with a focus on responses to the early public
health measures implemented in Italy during the early pandemic
phase, and on themes related to those we analyzed in our work
interpreted change in everyday life, behavior, and emotional and
psychological response. They achieved this through a theoretical
framework that connected the effects of the macro-level change
(referring to concepts of risk society) to the micro-level
experiences (referring to the concept of framing) (Risi et al.,
2021); personal construct theory framework (Tomaino et al.,
2021); and Semiotic-Cultural Psycho-social Theory (Marinaci
et al., 2021). Using the mindsponge mechanism framework
allowed us to introduce a novel theoretical approach to the study
of social change as a response to public health emergencies where
a fast-paced development of information occurs, and impactful
and restrictive public health responses are required.
Limitations and strengths. Being explorative, the present study
does not have any aspiration to be representative or generalizable
to the wider population. We believe that the main value of the
present work is to provide a privileged look at people’s experience
of the earliest public health measures implemented in Italy during
the outbreak of the COVID-19 pandemic. Both the study con-
ception and the data collection occurred during the lockdown,
allowing us to capture what it meant to experience the lockdown
while experiencing it ourselves. This work may be seen as a
starting point for further investigations into the social impact of
the lockdown as a public health emergency measure that caused
changes and restrictions in all aspects of people’s life. Although
the process of changing mindset takes time, and the time frame
considered in this study is relatively short (data collection
occurred around two months after the beginning of the lock-
down), we noticed that respondents reported changes, related to
the experience of the pandemic and of the public health measures.
Long-term changes at the individual and societal levels will be
appreciated with further studies.
Conclusions
The analysis conducted on the response to the public health
measures implemented in Italy in February–June 2020 allowed us:
to shed some light on the impact of the lockdown on people’s
daily life and relationships with others; to explore views on the
measures and on the problem of limited access to ICU during a
public health emergency and the dilemma it creates; to grasp the
transformed attitudes toward media and information. The
insights obtained, which captured people’s responses to the ear-
liest measures implemented in one of the most affected countries
worldwide during the first wave of COVID-19, will be valuable
for public health and emergency preparedness in possible future
health emergencies because they highlight the changes in the
social dimension caused by public health responses to health
emergencies. Public health policy-making and planning may
benefit from a qualitative study such as the one we conducted
because it contributes to revealing people’s attitude and response
to policy, and, in turn, anticipate or justify or contextualize policy
success. Indeed, social aspects and public views are key to policy
success (Vuong, 2018). By interpreting social changes as processes
within the infosphere (for instance, through the information
processing approach (Vuong and Napier, 2014)) and then ana-
lyzing the information inputs, policymakers and researchers
could make assessments and effectively develop policy. As
exemplified in the understanding of the COVID-19 vaccine
production process (Vuong et al., 2022), a theoretical approach to
the interpretation of change and innovation in relation to infor-
mation may be useful for the management of health emergency
responses and relevant public health policy design.
Data availability
The data that support the findings of this study are available from
the corresponding author upon reasonable request. The data are
not publicly available due to privacy or ethical restrictions.
Received: 25 April 2022; Accepted: 14 September 2022;
Note
1http://www.societaitalianasociologia.it/p/codice-deontologico.html.
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Acknowledgements
This work was supported by the Department of Innovation, Research and the University
of the Autonomous Province of Bolzano—South Tyrol.
Author contributions
VR substantially contributed to the conception and design of the work. She conducted
the interviews and analyzed and interpreted the data. She drafted the manuscript. MA
substantially contributed to the conception and design of the work. He analyzed and
interpreted the data. He drafted and critically revised the manuscript. DM contributed to
the conception and design of the work and critically revised the manuscript. RB sub-
stantially contributed to the conception and design of the work. She analyzed and
interpreted the data. She drafted and critically revised the manuscript. All the authors
provided final approval of the version to be published and agreed to be accountable for
all aspects of the work in ensuring that questions related to the accuracy or integrity of
any part of the work are appropriately investigated and resolved.
Funding
Open access funding provided by Uppsala University.
Competing interests
The authors declare no competing interests.
Ethical approval
In Italy, there is currently no law that establishes institutional review and ethical approval
in the field of social sciences. Additionally, no law describes review and approval
exemptions. As regulated by the Ministerial decree of 18 March 1998 and Law of 11
January 2018, no. 3, only clinical research is subjected to ethics evaluation. Therefore, our
research was not subjected to any review nor ethical approval and did not obtain a waiver
from an institutional review board, because in Italy there is no legal requirement to do so.
All the standards for research were respected and informed by the code of conduct for
professional sociologists
1
. The study was conducted according to the principles expressed
in the Declaration of Helsinki and in accordance with relevant guidelines/regulations.
Informed consent
Before the interviews began, the research objectives were explained to the participants,
who were informed that participation was voluntary and that they could interrupt the
interview or quit at any time. Participants provided their informed verbal consent. To
protect participants’confidentiality, transcripts were pseudonymized.
Additional information
Supplementary information The online version contains supplementary material
available at https://doi.org/10.1057/s41599-022-01358-3.
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