The closure of Italian kindergartens in pandemic times

Italian cardiologist Dr. Massimo Mapelli, ponders in this article that “one of the things I don't understand (even as a physician) is the closure of kindergartens during the COVID-19 pandemic”.

Being a physician, and a parent, amid the pandemic

Dr. Massimo Mapelli, a cardiologist from Bergamo, Italy, reflects in this opinion piece that “one of the things I don't understand (even though I'm a physician) is the closure of kindergartens during the COVID-19 pandemic”.

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Dr. Massimo Mapelli, a cardiologist from Bergamo, who works in Milan, reflects on his views about the closure of kindergartens during the complex COVID-19 pandemic period in Italy. He shares his thoughts in this opinion piece: "I'm not an epidemiologist or a psychologist, I just observe the world around me as a scientist. This week my son went from the protected environment of a single family unit and the kindergarten where he always met the same people, to a much higher number of possible exposures to contagion".

My name is Massimo Mapelli…

...and I am a cardiologist from Bergamo who works at the Centro Cardiologico Monzino, IRCCS in Milan, Italy. Like many other hospitals in Lombardy, even if they are hyper-specialised, during the last year we have been forced, in synchrony with the waves of the COVID-19 pandemic, to temporarily reduce some services for cardiology patients, having to devote ourselves to the management of COVID-19 patients. This has unfolded as an extremely demanding work pattern from a human and professional point of view, to which we have sadly become accustomed. 

My partner, Dr. Paola Zagni, is a paediatric neonatologist at the Macedonio Melloni Hospital, Milan. Like every intensivist, she works with weekly shifts of daily and night guards as well as being on call in case of need. We are among the 'privileged' who have been able to receive a vaccine against COVID-19, a concept that should be repeated over and over again in these days when we are witnessing a cacophonous debate on the vaccines’ now undeniable safety and efficacy.

My son E. is about to turn 15 months old, and since last October he has been attending a nursery school in Milan which is so close to our house that we can see the front door from the balcony. Even if we observe him through the lens of his parents, he is undeniably a sociable child, smiling with adults and children alike, but that is not what I want to talk about. Given the historical lack of public nurseries in the city of Milan, which can meet less than half of the needs of many working parents, we enrolled him in a private nursery school, but that's not what I want to talk about either.

A few days ago, with the transition of the city of Milan into the red zone [Italy has implemented a red and orange COVID-19 geographic zone national system since April 2021], our nursery school also closed its doors. The news has been bouncing around on the Whatsapp chats of parents, who over the weekend had to organise the care of their children through the weeks to come.

Specifically, since we could not (and would not, given the particular situation) suspend our work as full-time hospital physicians, this meant entrusting E. to a whirlwind of people organised on a tight schedule: three different babysitters and four grandparents over 65, of whom only one is vaccinated and two live in the Emilia Romagna region. Although we are not particularly wealthy, we are probably more fortunate than the average of our Italian contemporaries and at the moment we can afford the nursery school fees and the cost of the baby-sitters. I won't even talk about this aspect, which I think is crucial for many young couples who are asked to make huge sacrifices.

What I would like to talk about, and what I can't really understand, is the reason for all this. In E.'s kindergarten a series of precise procedures have been in place for many months to contain the infection: the children enter the nursery at staggered and very precise times, without ever meeting other parents, everyone's body temperature is repeatedly tested and their hands disinfected, the children are divided into small groups (called bubbles) to limit contact. Last but not least, the teachers wear FFP2 masks all day long, as recommended by the WHO, in order to better contain contagions from the dreaded variants and, since a few weeks, they have also been vaccinated against COVID-19. We personally take E. to and from the nursery on a short walk, and for more than a year we have been limiting the occasions on which we let him meet his grandparents. At work, we protect ourselves against contagion with all the available devices, of which we, as scientists, are 'big fans'.

It's hard to imagine people more enthusiastic than health workers - who are exposed to the ugliest face of the disease on a daily basis - about scrupulously complying with all the tough measures that have been imposed on us over the past year. But while we continue to be horrified by the photographs of the movida (nightlife) on Milan's Navigli and tirelessly explain to family and friends that "no, it's not like the flu!", we really cannot understand the reason for closing a nursery school.

I'm not an epidemiologist or a psychologist, I just observe as a scientist the world around me: E. this week went from the protected environment of a single family unit and the kindergarten where he always met the same people (all of whom, except for 4 other children, were vaccinated) to an extremely higher number of possible exposures to contagion. The 6 extra people required weekly in her care in addition to her parents belong to 4 different households and are not vaccinated. Each of these, for personal or work-related reasons, encounters a potentially large number of other people who are exponential vehicles of contagion (clients, relatives, wives, children, boyfriends, friends).

Last but not least, there is a logistical aspect that should not be underestimated: nursery schools and kindergartens are in the vast majority of cases, neighbourhood schools. Parents accompany their children on foot or by car, avoiding public transport and often not meeting anyone. Babysitters and parents, on the other hand, are forced to travel many kilometres to reach the children they have to care for, crowding trams, buses and trains. The scientific and technical committee that assists our legislators in their decisions is not made up of bureaucrats or politicians, but of physicians, epidemiologists and high-ranking public health professionals. Is it really possible that they have not done so? This is something that really ponders my mind in the current situation.

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