This study aims to analyze the pressure on the Italian public hospitals from the additional demand created by COVID-19.

Starting from the analysis of regulatory interventions ordered by the Central Government in response to the emergency, this paper illustrates the trend of hospital and ICU beds from the beginning of the pandemic until November 2020.

Hospital efficiency in the various Italian regions is measured by analyzing input variables, in terms of beds and health personnel, and output variables, in terms of hospital admissions.

The results reveal a critical situation in the system for meeting this potential demand, with numerous regions operating beyond their capacity. The study presents two relevant messages. First, it is necessary to slow the spread of COVID-19 in the Italian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system.

Another suggestion regards the regionalized organization of health services: the design may be adequate in situations of routine demand but suffers important challenges during pandemics.