ROME — The morning’s coronavirus testing had just begun, and Luca Spagnoli’s pharmacy looked like almost any other in the Italian capital, with a line of people that kept coming and coming.
The first person to arrive was preparing for a New Year’s trip with friends. The second was a 59-year-old departing later that day for Switzerland. But soon, there were too many people to count — and some of them were coughing, sniffling, fidgeting anxiously.
Wp Get the full experience.Choose your plan ArrowRight
“Another positive?” Spagnoli, the head pharmacist and owner, was saying just an hour later.
In this omicron-driven phase of the pandemic, with hospitalization rates relatively low but infection rates skyrocketing, Europe’s pharmacies have become increasingly central — offering rapid antigen tests in makeshift outdoor tents at a breathtaking pace.
Story continues below advertisement
The demand for testing has quickly transformed the pharmacies, which in Italy tend to be small, family-run businesses rather than large chains. Before, those pharmacies served the straightforward purpose of selling medicine and items such as diapers and shampoo. But now, carrying out hundreds of swabs per day, they have gained new prominence in public life, becoming settings of tension, relief and sometimes great distress.
Advertisement
Not all countries have leaned as heavily on pharmacies. Germany has set up big, privately run testing centers. Britain has made widespread use of at-home testing kits, delivered free, with results sent to the National Health Service via an app. The United States has a mix of appointment-based testing at chain pharmacies and clinics, and at-home testing. But Italy’s system resembles that of several other European nations, including France.
Those involved in Italy’s testing say the system has the advantage of being able to trace and log every positive. The pharmacies report results immediately to the government. And a fine awaits anyone caught breaking isolation rules.
Story continues below advertisement
“With an at-home kit, if I test positive, it’s up to my goodwill,” said Marco Cossolo, the national president of Federfarma, a federation of pharmacy owners. “I might act as if I didn’t test positive and throw it away.” He said the pharmacy system allows for tight “monitoring.”
Advertisement
While swabs have become hard to find in some countries — including the United States — the Italian model so far seems to be holding up, with tests available, if people are willing to wait in line. Several days this week, Italy administered more than 1 million coronavirus tests, a per capita rate more than twice that of the United States. The vast majority happened at pharmacies like Spagnoli’s.
“I can tell you my caffeine intake has reached epochal levels,” said Spagnoli, 39, a third-generation pharmacist.
Amid the omicron spike, his pharmacy is conducting some 100 antigen tests per day, and, lately, 20 or so have been turning up positive. The tests are conducted in a rented prefabricated cabin — “it’s for construction sites,” Spagnoli said — set up out front, and one after the next one recent morning, people were stepping inside, handing over an information form and getting swabbed.
Advertisement
Story continues below advertisement
Then, they waited outside for the results.
The person performing the swabs on this day was a local nurse, and the first tests were complication-free. “Negativo,” he said, telling the initial arrivals to go into the pharmacy and pay 15 euros.
But then came the first positive, and the nurse walked over to a 17-year-old, Vanessa Brandello, and pulled her aside to a quieter space on the sidewalk. He handed her a pamphlet with guidelines for isolating. He explained that she could get a PCR test, if she wanted, to confirm the result. Her shoulders slumped.
“If someone has a cold, could that be the reason they test positive?” she asked.
“No,” the nurse said.
Story continues below advertisement
Brandello stood outside the pharmacy for several more minutes. She called her dad. She started to cry. She couldn’t quite make sense of it. She kept repeating that she’d been scheduled to get a booster in less than a week.
Advertisement
She explained that she had taken the test because she woke up with a sore throat and a dry cough. But now she feared going home, because she didn’t want to infect a grandparent who lived with her family. The alternative, she said, was to stay with her boyfriend, and lock herself in a space she said was “smaller than a bathroom.” Even though she was unlikely to become seriously ill, she said she already felt sick “psychologically.”
“I’ll hole myself up and shed some more tears,” she said.
Italy created its testing system late last year, when the first pharmacies erected outdoor tents, planning for an emergency that most anticipated would last one winter, not two. At that time, the country was administering swabs at one-fifth the level that it is now.
Since then, pharmacies have become the go-to place for testing. There are 20,000 pharmacies across the country, 14,000 of which offer swabs. Some pharmacies have swapped out their testing tents two or three times, replacing them because of wear and tear. Some pharmacies have upgraded to more durable cabins. Some have set up online appointment systems. A few have installed touch screens at the entrance, so people can take a number for their place in line. Pharmacists say that, along the way, their own lives have been pushed in ways they never imagined.
Advertisement
Story continues below advertisement
“We were even open on the morning of Christmas,” said Fabrizio Donadio, whose family owns the pharmacy in Morano Calabro, a Calabrian hilltop town that has seen an explosion of cases and special restrictions. “Let’s just say we haven’t gotten any rest.”
The pharmacies of Italy bear little resemblance to the palatial chains common in the United States. Here, they are compact. Many, in an homage to ancient apothecaries, are decorated with ceramic urns once used for herbal remedies. In Rome, a few pharmacies have frescoed ceilings. They don’t sell candy bars or breakfast cereals or greeting cards.
The pharmacists who run these places say they are earning more money because of the testing. But one pharmacist said the income was “damn hard-earned.” Spagnoli quipped that he might as well be the richest man at a cemetery, not because he was so worried about covid-19, but because there was no downtime for leisure.
Advertisement
Story continues below advertisement
Pharmacists say they are constantly juggling duties. Either they perform the swabs or engage nurses — who are in high demand — to do the work. Each test result needs to be logged on two government websites.
“Now and then, one site is working, the other not,” Spagnoli said.
Gimbe, a research foundation in Bologna, Italy, that tracks the pandemic, says the testing system has many drawbacks. The group noted that so many asymptomatic people are lining up for tests and then being referred for confirmatory PCR tests that people who really need PCR tests aren’t being tested “in an adequate amount of time.” The foundation also claimed this week that the antigen tests have a 30 to 50 percent chance of producing false negatives — a higher rate than generally cited by other scientists. (The Food and Drug Administration has said that rapid tests may be less effective at identifying the omicron variant.)
Advertisement
Story continues below advertisement
There were points earlier in the pandemic when testing positive could be more dire. Lower hospitalization rates strongly suggest omicron isn’t as severe as delta and earlier strains of the novel coronavirus. But people who administer swabs say they still sense anxiety among the people lining up.
One nurse stationed in a tent at a pharmacy in San Vito Romano, a town an hour outside Rome, said the fear was “constant.” Part of it may be that the ambiance of the testing sites hasn’t changed: the protective covers, the face shields, the sanitizing spray used after positive tests.
“I’ll try to reassure them a bit,” said the nurse, Marco Riccardi. “I tell them, you’re vaccinated. You might have a fever. But a few days at home and it’ll be over.”
The mandatory isolation period in Italy is at least 10 days.
But part of the fear stems from experiences from earlier in the pandemic.
Advertisement
Story continues below advertisement
Outside Spagnoli’s pharmacy, Piero Perilli, 75, a retiree, was so jittery waiting for the results of his swab that he struck up a conversation with a woman beside him. She tried to put him at ease. She said omicron was more like a cold.
Then the nurse came out of the cabin and said Perilli’s name.
“Negativo,” the nurse said, handing him a sheet of paper.
Perilli, before entering the pharmacy to pay, raised his arms to the sky.
“Thank God,” he said.
After coming back outside, he explained that he had been thinking of his wife, who died five months ago of covid-19.
There on the sidewalk, Perilli described calling the ambulance after she kept fainting. He described her initial text messages from the hospital, before she took a turn for the worse and was put on a ventilator. She was only 63, not in great health, but Perilli, 75, had long joked that he had picked a younger partner because he would get to die first and avoid being alone.
“I was kidding,” he said. “But it was real.”
And now he was alone. He still had his daughters and a dozen good friends, but he said his new life was “damn hard.” He was searching for ways to rebuild it — like volunteering at a museum, for instance — and one of those ways had been a recent Christmas lunch, hosted by one of his daughters.
It turned out one of the people at the table had been positive.
Perilli said he had heard that omicron caused a milder illness. But he was nonetheless relieved, he said. The sheet of paper from Spagnoli’s pharmacy meant there’d be no quarantine, no isolation.
“Given my state of mind, that would be hard to handle these days,” he said.
Read more:
Vaccine mandates are spreading. Italy shows what to expect.
Portugal has nearly run out of people to vaccinate. What comes next?
Real-world data from U.K. suggests omicron is less likely than delta to send people to the hospital