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The Covid-19 pandemic has been a stress-test on Health Care Systems across Europe, but particularly in Italy, that has been the first European country hit by the outbreak in 2020. This fact triggered the need for learning a management of the crisis because of the lack of resources, the long-time policy of spending cuts and a shortage of doctors and nurses, specifically due to a short-sighted education policy over a long time. Territorial health services suffered a lack of investment more than hospitals. That's why primary has been completely unable to cope with the outbreak. Front-line actors (doctors, managers and local authorities) were consequently called for managing emergency by inventing extemporaneous solutions in steering capacity and instrument selection. Several scientific contributions have recently explained the pandemic outbreak in Italy looking at the national governance of the health system and its specific institutional framework that decentralizes tasks and functions to the Regions, also with a certain degree of managerial autonomy for local authorities. It means that the most part of the capacity of steering and coordinating the emergency was transferred to local level and to the capabilities of the street level bureaucrats. Indeed, although the National Health system had a National Pandemic Plan since 2006 (while only some Regions enacted a regional one since 2009-2010), pandemic strategies both at clinical and at managerial level were completely missing. When territorial health services, including hospitals, were hit by the first wave in March 2020, they were lacking tools, staffs and knowledge, but were simultaneously forced to steer (alone and quickly) an ‘ad hoc’ governance of emergency by adopting new plans and new instruments. Then, when the second wave came in November 2020, the local capacity to cope with the emergency was improved thanks to the practice learnt during the first one. It means that beyond the institutional frame, the loc