COVID-19 Pandemic In Italy Research Articles

Did the pandemic change behaviours in Italy? An analysis on the main NCDs behavioural risk factors

Abstract Background The indirect effects of the COVID-19 pandemic on healthy living behaviours are multiple and complex to assess. The aim of the study is to assess the impact of the COVID-19 pandemic in Italy on: smoking, alcohol, fruit and vegetable consumption, and sedentary lifestyle, through the Italian Behavioral Risk Factor Surveillance System (PASSI) data. Methods PASSI 2008-2022 data refer to a sample of 497,223 18-69-year-olds residing in Italy. For each behaviour, from the monthly prevalence data, the 2008-2022 time series was estimated with LOWESS regression and an interrupted time series (ITS) analysis was conducted, using the generalized least squares (gls) model, taking into account autocorrelation (ARMA matrix) and considering March 2020 (start of WHO-declared pandemic) as the month of ‘interruption’ of the series, to show the difference between what was observed and what was expected under the assumption that the pandemic had not happened (‘counterfactual’ scenario). Results In December 2022 the share of people who consume at least 5 servings of fruits and vegetables per day is lower than the counterfactual scenario (6.7% vs 9.1%), while the share of higher-risk alcohol users is significantly higher (19.5% vs 16.9%). In contrast, the share of sedentary people (according to WHO guidelines) is significantly lower than the counterfactual (27.9% vs 31.8%). The pandemic does not seem to have had a significant impact on smoking. Conclusions These results show a worsening impact of the pandemic on alcohol consumption and fruit and vegetable consumption. Sedentariness shows better data at the end of 2022 and smoking remains mostly unchanged. It will be necessary to continue monitoring the impact of the pandemic over longer periods to confirm the findings. Key messages • Understanding changes in lifestyle indicators is critical to design ad hoc interventions to reduce the burden of noncommunicable diseases, and especially during health emergencies such as pandemics. • Through this work it is possible to clearly observe how the pandemic has impacted lifestyle habits.

Unraveling Pneumomediastinum in COVID-19 Patients: Insights from a High-Volume-Center Case-Control Study.

Pneumomediastinum (PNM) is a severe complication in COVID-19 patients, potentially exacerbating morbidity and requiring heightened clinical attention. This study aims to identify risk factors, clinical characteristics, and outcomes associated with PNM in COVID-19 patients hospitalized for respiratory failure in our institution. Among 4513 patients admitted in our institution and testing positive for COVID-19 infection during the peak of the COVID-19 pandemic in Italy (1 March 2020 to 31 July 2020), we conducted a single-center, retrospective case-control study focusing our analysis on those with severe disease (respiratory failure). The cohort included a total of 65 patients (32 with PNM and 33 without PNM in the same period). Data were retrospectively collected from hospital records, including demographics, comorbidities, smoking history, clinical and laboratory findings, and imaging results. Statistical analyses were performed using Fisher's exact test and Student's t-test, with significance set at α = 0.05. Patients with PNM were significantly younger (54.9 ± 18.5 vs. 65.4 ± 14.3 years, p = 0.0214) and exhibited higher inflammatory markers, particularly white blood cells count (WBC) at admission (11.4 ± 5.4 vs. 6.5 ± 4.1, p < 0.0001). Although smoking status, body mass index (BMI), and major comorbidities did not differ significantly between groups, COPD was more prevalent in the PNM group (46.9% vs. 15.1%, p = 0.0148). Radiologically, ground-glass opacities (GGOs) and consolidations were more frequent in PNM patients (93.7% vs. 51.5%, p = 0.0002; 78.1% vs. 42.2%, p = 0.0051, respectively). PNM was associated with longer hospital stays (28.5 ± 14.9 vs. 12.0 ± 7.2 days, p < 0.0001) and a higher need for invasive mechanical ventilation (53.1% vs. 30.3%, p = 0.0619). However, mortality rates did not differ significantly between groups. PNM in patients with severe COVID-19 infection is associated with younger age, elevated inflammatory markers, and extensive lung involvement, contributing to increased morbidity and prolonged hospitalization. Early detection and tailored management strategies, including optimized respiratory support and aggressive anti-inflammatory therapies, are crucial in mitigating the adverse outcomes associated with PNM. Further research is needed to validate these findings and improve clinical protocols for managing this complication.

COVID-19 pandemic in Italy: a brief overview of the role and response of primary care

COVID-19 pandemic in Italy: a brief overview of the role and response of primary care

Educational Poverty and Deprivation: Attitudes and the Role of Teachers during the Pandemic

Educational poverty is widespread in compulsory education in terms of poor learning and socio-cultural disadvantages; it affects students with disabilities, students with learning difficulties, and those with an immigrant background. During the pandemic crisis, students with special educational needs (SENs) mostly suffered the risk of an additional deprivation. Within an advanced inclusive model during school closure, the Italian State guaranteed access to schools only to students with disabilities. What effects did this “equalizing” measure produce? What kinds of attitudes have teachers adopted and what roles have they played (active vs. passive) in order to make it sustainable? What was their acknowledgement of the educational poverty and deprivation? To what extent were their attitudes differentiated? This article explores the roles and attitudes of teachers during periods of lockdown as a result of the COVID-19 pandemic in Italy. We assume that the teachers’ attitudes were differentiated on the basis of five cultural dimensions (auto/hetero-referencing; vision of remote teaching; relationship with bureaucracy, relationships with students; teaching as performance or relation), and two functions (classroom teachers/ SENs teachers). The study is based on 42 semi-structured interviews conducted with teachers, principals, and parents in six lower secondary public schools with high rates of SENs students and multi-ethnicity (Northern Italy), and focused on the organisational, teaching, and relational aspects. Results seem to confirm that not all teachers agreed with the Ministry line and adopted a range of responses to the challenge of maintaining inclusivity, from the inert/impatient to the creative/active ones. Their attitudes changed during the post-pandemic period from atomistic to more collaborative, and their preoccupation with the fragile “uncertified students” increased. The article closes with recommendations on teacher training.

From lockdown to cradle: Navigating the psychological challenges of childbirth during the COVID-19 pandemic in Italy– Evidence from a 3-year analysis

From lockdown to cradle: Navigating the psychological challenges of childbirth during the COVID-19 pandemic in Italy– Evidence from a 3-year analysis

Essential Factors on Effective Response at the Onset of the COVID-19 Pandemic; Comment on "Experiences and Implications of the First Wave of the COVID-19 Emergency in Italy: A Social Science Perspective"

The COVID-19 pandemic in Italy is a stark reminder of the necessity of incorporating the social, economic, and political context in planning responses to public health emergencies. During the ongoing global COVID-19 crisis, it's not just crucial but a shared responsibility to supplement epidemiological approaches with insights from the social sciences. This ensures effective and equitable policies, and it's a responsibility that each of us in the field shares. This discussion is relevant and timely, relating directly to the current global crisis and its potential implications for future public health strategies. This comment underscores the key points of Masino and Enria's paper (2023), illuminating the importance of integrating social sciences into public health strategies, the pivotal role of inequalities in shaping pandemic experiences, and, most importantly, the profound and urgent implications for future epidemic preparedness and response. The urgency of these implications cannot be overstated, and we must act on them swiftly and decisively.

Hospital-Based Influenza and Pneumococcal Vaccination for Cancer Patients on Active Treatment and Their Family Members during the COVID-19 Pandemic in Italy: A Single-Center Experience

In patients with cancer, tumor- and treatment-induced immunosuppression are responsible for a four-fold increase in morbidity and mortality caused by influenza and invasive Streptococcus pneumoniae infections compared to the general population. The main oncology societies strongly recommend vaccination in patients with cancer to prevent these infections. However, vaccine hesitancy is a main concern in this population. The aim of this study was to assess the feasibility of in-hospital vaccination for patients under anticancer treatment and their family members (FMs) against influenza and pneumococcal infections during the COVID-19 pandemic in order to increase vaccine coverage. This was a single-center, prospective, observational study conducted at the Department of Oncology of Luigi Sacco University Hospital (Milan, Italy) between October 2020 and April 2021. The main primary outcome was the incidence of influenza-like illness (ILI) and pneumococcal infections. The main secondary outcome was safety. A total of 341 subjects were enrolled, including 194 patients with cancer and 147 FMs. The incidence of ILI was higher among patients than among FMs (9% vs. 2.7%, OR 3.92, p = 0.02). Moreover, two subjects were diagnosed with pneumococcal pneumonia. The most frequent vaccine-related AEs were pain in the injection site (31%) and fatigue (8.7%). In conclusion, this hospital-based vaccination strategy was feasible during the COVID-19 pandemic, representing a potential model to maximize vaccine coverage during a public health emergency.

Relationship between Environmental Conditions and Utilisation of Community-Based Mental Health Care: A Comparative Study before and during the COVID-19 Pandemic in Italy.

(1) Background: Lower socioeconomic status increases psychiatric service use, exacerbated during the COVID-19 pandemic by environmental stressors like air pollution and limited green spaces. This study aims to assess the influence of sociodemographic and environmental factors on mental health service utilisation. (2) Methods: This retrospective study uses an administrative database focusing on community mental health services in Northeast Italy. Spatial and temporal analyses were used to address space-time dependencies. (3) Results: Findings showed that sociodemographic factors like living in rented apartments and lower education levels predicted higher mental health service use. Environmental factors, such as elevated NO2 levels and, before the pandemic, lower solar radiation and tree cover, correlated with increased service utilisation. COVID-19 reduced most of the pre-existing differences associated with these factors across census blocks with a different composition of sociodemographic and environmental factors. (4) Conclusions: These findings contribute to a better understanding of the impact of the environment on public mental health.

Exploring the interplay between individual and family functioning during the COVID-19 pandemic: a cross-sectional study

AbstractFamily relationships are central to an individual’s development and influence their emotional, relational, and social trajectories. Optimal family functioning, encompassing emotional connections, communication patterns, and coping mechanisms, is pivotal to the well-being of individual family members, especially during challenging periods such as the COVID-19 pandemic. From this perspective, this study, conducted during the second wave of the COVID-19 pandemic in Italy, assessed the interplay between individual and family functioning. Utilizing Hill's ABC-X model, we explored how the pandemic (stressor) impacted family dynamics (resources), perceived individual affectivity and family efficacy (perception), thereby influencing family quality of life (outcome). Four hundred and four participants completed a battery of standardized questionnaires to evaluate perceived individual affectivity during the pandemic, family quality of life, family dynamics (cohesion, flexibility, and communication), family conflict, family efficacy, and family coping strategies. Positive affectivity was associated with better family quality of life and more adaptive family coping strategies. The sample reported a low family quality of life and low family cohesion, flexibility, and communication during the pandemic. A positive sense of family cohesion, flexibility, and communication was associated with better individual well-being, better family quality of life and efficacy, and less conflict. Family communication was the strongest predictor of family quality of life in the study sample. In conclusion, our results emphasize the importance of strengthening family and individual resilience in transforming post-pandemic challenges into psychological and familial growth opportunities.

Gender and Beyond: Employment Patterns during the COVID-19 Pandemic in Italy

This paper investigates employment changes during the COVID-19 pandemic for women and men in a country characterized by notoriously low female employment: Italy. The paper explores to what extent previously existing inequalities in employment were further exacerbated during the pandemic. Using data from the Italian Labor Force Surveys from 2018 to 2020, we find evidence of a limited decline in employment, but a steep increase in the number of individuals working zero hours during the lockdown periods. This result holds for both men and women. The pandemic highlighted how gender inequalities in employment intersect with other socioeconomic disadvantages: single mothers and lower-educated women were more affected than their male counterparts, while single men without children and foreign men were hit stronger than women with the same characteristics in the immediate aftermath of the pandemic. The pandemic thus came with differentiated consequences, generally affecting those already in less advantaged situations harder. At the same time, the results support the idea that women’s employment was crucial to counteract job loss in the family, and some became the only breadwinner for their families. This also exposed them to risks by working during the pandemic. Overall, the pandemic greatly accentuated preexisting social inequalities in the Italian labor market, yet with an apparently transitory effect at least regarding employment participation.

The development and cross-cultural validation of a Student Online Learning Experience Scale

ABSTRACT A growing body of research has explored the effects of Covid-19-induced online learning on students’ experiences. However, there is a lack of validated tools that measure the perceived online learning experiences of domestic and international students in various national and cultural contexts. To address this gap, this article aims to develop the Student Online Learning Experience Scale (SOLE-S). We conceptualised four potential dimensions of students’ perceptions of their online learning experiences: online interactions with students, teachers, university, and technology (i.e. students’ capacity to participate in online learning). Confirmatory factor analysis determined three distinct factors: online interactions with students, the university (including teachers), and technology. Based on multiple validation studies reported in this article, the 10-item SOLE-S demonstrated sound internal consistency, discriminant validity, and convergent validity. Multigroup confirmatory factor analysis on data from domestic and international students transitioning from conventional classroom learning to online learning during the COVID-19 pandemic in Italy, France, Poland, and the UK showed a stable factor structure across different cultural contexts. Bivariate and point-biserial correlation analyses revealed that the SOLE-S is associated with students’ adjustment, performance, satisfaction, and loyalty to the university. This tool will assist higher education institutions in monitoring students’ online learning experiences and developing relevant support structures to enhance their academic experience and well-being during the pandemic and post-pandemic online learning.

Epidemicity indices and reproduction numbers from infectious disease data in connected human populations

We focus on distinctive data-driven measures of the fate of ongoing epidemics. The relevance of our pursuit is suggested by recent results proving that the short-term temporal evolution of infection spread is described by an epidemicity index related to the maximum instantaneous growth rate of new infections, echoing concepts and tools developed to study the reactivity of ecosystems. Suitable epidemicity indices can showcase the dynamics of infections, together with commonly employed effective reproduction numbers, especially when the latter assume values less than 1. In particular, epidemicity evaluates the short-term reactivity to perturbations of a disease-free equilibrium. Here, we show that sufficient epidemicity thresholds to prevent transient epidemic outbreaks in a spatially connected setting can be estimated by generalizing existing analogues derived when spatial effects are neglected. We specifically account for the discrete nature, in both space and time, of surveillance data of the type typically employed to estimate effective reproduction numbers that formed the bulk of the communication of the state of the COVID-19 pandemic and its controls. After analyzing the effects of spatial heterogeneity on the considered prognostic indicators, we perform a short- and long-term analysis on the COVID-19 pandemic in Italy, showing that endemic conditions were maintained throughout the duration of our simulation despite stringent control measures. Our method provides a portfolio of prognostic indices that are essential to pinpoint the ongoing pandemic in both a qualitative and quantitative manner, as our results demonstrate. We base our conclusions on extended investigations of the effects of spatial fragmentation of communities of different sizes owing to connectivity by human mobility and contact scenarios, within real geographic contexts and synthetic setups designed to test our framework.

The role of income inequality as an ecological determinant of mental health: A nation-wide multilevel analysis on an Italian sample.

Income inequality, a pivotal determinant of general and mental health, operates through intricate mechanisms at various geographical scales. While established at country or region levels, the impact of lower-level (municipal or neighborhood) inequality remains inconsistent. This study explores the influence of regional- and municipal-level income inequality on individual psychological distress during the COVID-19 pandemic in Italy, employing a multilevel data analysis. In a post hoc analysis of data from the first wave of the pandemic (March to April 2020), three hierarchical levels were considered: individual participants, municipalities, and regions. Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7 scales, while the Gini coefficient gauged income inequality at municipal and regional levels. The analysis incorporated demographic variables as potential confounders. The study encompassed 21 regions, 3,900 municipalities, and 21,477 subjects. Income inequality at both regional and municipal levels exhibited associations with distress scores, suggesting independent effects. Notably, higher distress scores were identified in southern regions with elevated inequality, despite a more substantial COVID-19 impact in the north. Findings contribute to existing literature by emphasizing the independent impact of lower-level (municipal) and higher-level (regional) income inequality on population psychopathology. The study supports theories suggesting diverse pathways through which inequality at different levels influences health, such as potential associations with healthcare system dysfunction at the regional level and welfare dysfunction at the municipal level. The observed north-south gradient in distress scores highlights the need for psychosocial interventions to alleviate income inequality, especially in historically disadvantaged southern regions. Future research should explore the nuanced interplay between income inequality and various ecological variables to provide a comprehensive understanding of its health impact.

Impact of Benzodiazepines and Illness Duration on Obsessive-Compulsive Disorder during COVID-19 in Italy: Exploring Symptoms' Evolutionary Benefits.

Obsessive-compulsive disorder (OCD) is believed to follow a waxing and waning course, often according to environmental stressors. During the COVID-19 pandemic, pre-existing OCD symptoms were reported to increase and to change from checking to washing behaviors, while new-onset symptoms were predominantly of the hoarding type. In the present study, we followed the evolution of OCD symptoms, anxiety, depression, and insights of illness in forty-six OCD patients throughout the pandemic. Clinical measures were collected at four different time points before and during the COVID-19 pandemic in Italy. Within-subject comparisons were used to compare clinical scale scores across time, and correlations were examined between patients' baseline characteristics and changes in clinical scores. We found that all clinical measures increased during the first Italian lockdown with respect to the pre-pandemic values. Anxiety decreased during the temporary elimination of restriction provisions, whereas the severity of OCD symptoms and insight returned to pre-pandemic values during the second mandatory lockdown. These results were observed only in two sub-groups of patients: those taking benzodiazepines and those with shorter illness duration. Our findings suggest the need for additional clinical attention to these specific sub-groups of OCD patients in case of particularly distressing circumstances while pointing to a possible adaptive role of their OCD symptoms when the environment requires a higher care of hygiene and an extraordinary supply of essential resources.

Impact of Stress during COVID-19 Pandemic in Italy: A Study on Dispositional and Behavioral Dimensions for Supporting Evidence-Based Targeted Strategies.

The COVID-19 pandemic caused critical mental health issues and lifestyle disruptions. The aim of this study was to explore, during the lockdown of second-wave contagions in Italy, how stress was affected by dispositional (personality factors and intolerance to uncertainty) and behavioral (coping strategies) dimensions, how these variables differed among sex, age, educational, professional, and health groups, and how the various changes in work and daily routine intervened in the psychological impact of the emergency. Our results highlight that women, the youngs, students/trainees, those with chronic diseases, those who stopped their jobs due to restrictions, and those who left home less than twice a week were more stressed, while health professionals showed lower levels of the same construct. Those with higher levels of stress used more coping strategies based on avoidance, which positively correlated with age, agreeableness, conscientiousness, and intolerance to uncertainty, and negatively with openness. Stress levels also positively correlated with agreeableness, conscientiousness, intolerance to uncertainty, and seeking of social support, and negatively with openness, a positive attitude, and a transcendent orientation. Finally, stress was predicted mainly by behavioral dimensions. Our results are discussed and framed within the literature, as important insights for targeted intervention strategies to promote health even in emergencies.

Synchronies and asynchronies in the development of COVID-19 pandemic in Italy

the study of the possible determinants of the rise and fall of infections can be of great relevance, as was experienced during the COVID-19 pandemic. One of the methods to understand whether determinants are simultaneous or develop through contiguity between different areas is the study of the diagnostic replication index RDt among regions. to introduce the analysis of RDt variability and the subsequent application of a recently introduced functional clustering method as highly useful procedures for recognizing the presence of clusters with similar trends in epidemic curves. within the considered period, trends in regional RDt are analyzed in detail over four different time intervals. to exemplify this methodology, the study of variability in the period from the end of 2021 to the beginning of 2022 may be of interest. the variability in the regional RDt indices is assessed by means of the correlation coefficient weighted with respect to the populations of the individual regions. The clustering procedure is applied to the time series of absolute RDt values. it emerges that the periods of increasing variability in the RDt correspond to the initial growth or decrease in the number of infections, while functional clustering identifies macro-areas in which the epidemic curves have had similar trends. What caused contagions to increase seems to relate to a factor that is not specific to certain areas, with the contribution in some cases of a contagion dynamic between adjacent areas. the variability in the trend of regional diagnostic replication indices, which are calculated with only a few days delay, is a further indicator for the early detection of major changes in the trend of epidemic curves. The clustering of epidemic index curves may be useful to determine whether determinants act simultaneously or by contiguity between adjacent areas.

Yes, I will do it! Factors promoting the intention to volunteer after COVID-19 pandemic in Italy.

This cross-sectional study assessed the extent to which the intention to volunteer after the COVID-19 pandemic is associated with resilience, post-traumatic growth, and community service self-efficacy in a representative Italian sample (N = 295; Mage = 44.77; SD = 14.79; range = 18-83 years; 53.22% men). The model tested through a path analysis revealed a positive association between community service self-efficacy and intention to continue volunteering. Multi-group comparisons revealed that this relationship was maintained in participants who were active volunteers, while in the group of former volunteers, only a positive association between post-traumatic growth and intention to volunteer was found. This study contributed to highlight the importance of community service self-efficacy and post-traumatic growth in the volunteering experience and the intention to continue volunteering in the future.

Human-Computer Interaction in Times of Grief: Unveiling Support Processes Among COVID-19 Bereaved Users in a Facebook Group Through Netnography

During the early waves of the COVID-19 pandemic in Italy, social distancing hindered mourners in their help-seeking. A netnographic approach was employed to investigate grief and empathy expressions on a Facebook support group, created for the purpose and moderated by a psychologist. Participants (23 Females, 2 Males) knew about the research and co-participated in the improvement of the group experience. The virtual space was used by group members with two different purposes: some mainly vented their anger but others created a new and coherent narration of their loss. Differently from other peer-to-peer support groups, users supported each other continuously and in some cases took up the role of moderators. The results shed light on continuous peer support and user-driven moderation dynamics, advancing our understanding of online groups moderated by professionals. The study also prompts reflection on distinct aspects of grieving on social media during the initial 2 years of the pandemic.

Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy.

This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient's skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool.

An unintended consequence of COVID-19 immunity passports-quasi-experimental evidence of moral hazard observed after implementing the domestic Green Pass policy during the second wave of the COVID-19 pandemic in Italy.

Amidst the second wave of the COVID-19 pandemic, Italian policymakers mandated to exhibit evidence of vaccination or immunity (the Green Pass) as a condition to access retail premises and public offices. This study aims to offer evidence, in a quasi-experimental setting, suggesting that an unintended consequence of this policy was the emergence of moral hazard. Google visit duration data measured the time customers typically spend on retail premises or public offices. A pairwise comparison of median visit time per premise was performed at a six-week interval before and after the introduction of the Green Pass. This study is the first to provide evidence of "ex-post" moral hazard associated with introducing a domestic Green Pass policy. The median visiting time on premises that required digital immunity control significantly increased after introducing the domestic Green Pass policy, contrary to other public premises where access remained free of limitations. The increase in median visit time in premises with faster customer turnaround, such as coffee shops (+49%) and fast-food restaurants (+45%), was lower than the increase observed for fine-dining restaurants (+74%) and pizzerias (+163%). No significant increase in median visit time was observed in premises where the Green Pass was not required, such as food supermarkets, retail non-food shops, post offices, banks, pharmacies, and gas stations. The evidence of moral hazard highlights the critical issue of unintended consequences stemming from public health policies. This discovery is pivotal for policymakers, indicating that unforeseen behavioral adjustments could offset the intended benefits despite the intent to reduce risk through measures like the Green Pass.