Purpose:The COVID-19 death-rate in Italy continues to climb, surpassing that in every other country. We implement one of the first nationally representative surveys about this unprecedented public health crisis and use it to evaluate the Italian government' public health efforts and citizen responses. Findings: (1) Public health messaging is being heard. Except for slightly lower compliance among young adults, all subgroups we studied understand how to keep themselves and others safe from the SARS-Cov-2 virus. Remarkably, even those who do not trust the government , or think the government has been untruthful about the crisis believe the messaging and claim to be acting in accordance. (2) The quarantine is beginning to have serious negative effects on the population's mental health. Policy Recommendations: Communications should move from explaining to citizens that they should stay at home to what they can do there. We need interventions that make staying following public health protocols more desirable, such as virtual social interactions, online social reading activities, classes, exercise routines, etc. -all designed to reduce the boredom of long term social isolation and to increase the attractiveness of following public health recommendations. Interventions like these will grow in importance as the crisis wears on around the world, and staying inside wears on people. 1 Roma Capitale (Municipality of Rome) convened our "COVID-19 International Behavioral Science Working Group" to (i) strengthen its public health policies and guidance, (ii) suggest new policies and guidance based on rigorous behavioral science, and (iii) develop empirical evidence about behavioral change. We report here empirical results and policy interventions aimed at achieving the objectives of the national Italian Government concerning the containment of the pandemic. Thanks to TIM S.p.A., Fastweb S.p.A., and Indra Italia S.p.A. for financial support. The current version of this paper is at GaryKing.org/covid-italy .

ObjectiveThis study aims to estimate the technical efficiency of health systems in Asia.SettingsThe study was conducted in Asian countries.MethodsWe applied an output-oriented data envelopment analysis (DEA) approach to estimate the technical efficiency of the health systems in Asian countries. The DEA model used per-capita health expenditure (all healthcare resources as a proxy) as input variable and cross-country comparable health outcome indicators (eg, healthy life expectancy at birth and infant mortality per 1000 live births) as output variables. Censored Tobit regression and smoothed bootstrap models were used to observe the associated factors with the efficiency scores. A sensitivity analysis was performed to assess the consistency of these efficiency scores.ResultsThe main findings of this paper demonstrate that about 91.3% (42 of 46 countries) of the studied Asian countries were inefficient with respect to using healthcare system resources. Most of the efficient countries belonged to the high-income group (Cyprus, Japan, and Singapore) and only one country belonged to the lower middle-income group (Bangladesh). Through improving health system efficiency, the studied high-income, upper middle-income, low-income and lower middle-income countries can improve health system outcomes by 6.6%, 8.6% and 8.7%, respectively, using the existing level of resources. Population density, bed density, and primary education completion rate significantly influenced the efficiency score.ConclusionThe results of this analysis showed inefficiency of the health systems in most of the Asian countries and imply that many countries may improve their health system efficiency using the current level of resources. The identified inefficient countries could pay attention to benchmarking their health systems within their income group or other within similar types of health systems.

Bill & Melinda Gates Foundation and Dalla Lana School of Public Health.