Italy’s prime minister has narrowly survived a crunch vote of confidence in his fragile coalition government as the country grapples with twin health and economic crises.

Giuseppe Conte won 156 out of 296 votes in the Italian Senate on Tuesday, short of the 161 senators he would need for an absolute majority but enough to pass because of 16 abstentions.

While the result will preserve Mr Conte’s coalition of the one-time populist Five Star Movement and centre-left Democratic party, it leaves the government severely weakened at a time of national emergency.

The confidence votes were triggered when Italia Viva, a small party led by former prime minister Matteo Renzi, quit the coalition last week over criticisms of its handling of the coronavirus pandemic.

If Mr Conte had lost the Senate vote, he would have been forced to hand in his resignation to the president, Sergio Mattarella, plunging Italy into a full political crisis.

Italy has suffered more than 82,000 deaths during the Covid-19 pandemic, the second-highest toll in Europe. This month, the government announced a further increase to its planned budget deficit for this year to allow for more spending to fight a brutal recession.

Ahead of the vote, Mr Conte had pledged to introduce greater proportional representation in elections, a move interpreted as an attempt to woo lawmakers from the smaller parties that would benefit.

Mr Renzi’s Italia Viva ultimately opted to abstain from the Senate vote, meaning Mr Conte needed the approval of fewer lawmakers to survive than if his predecessor had opposed the government.

On Monday, Mr Conte easily won a vote in the Italian lower house but he had been scrambling over the weekend to win over enough senators to scrape though in the upper chamber, where the exit of Mr Renzi’s party deprived the coalition of its majority.

With Mr Conte’s unconvincing survival, attention in Rome will now swing to how his weakened coalition will move forward in spending around €200bn in EU pandemic recovery money.

Paolo Gentiloni, a former Italian prime minister and the current EU commissioner for economic and monetary affairs, said on Monday that Italy’s recovery plans needed “to be discussed and strengthened”, but he did not single out the country for criticism.

Yet without an absolute majority in Italy’s upper house, Mr Conte’s coalition faces an uphill battle to pass meaningful reforms as the country faces its worst economic crisis since the second world war. Italian governments require a Senate majority to pass significant legislation, including annual budgets.

“He risks being a lame-duck prime minister from now on,” said Francesco Galietti, founder of the risk consultancy Policy Sonar. “Conte will try to make it look like a victory but the whole house of cards could easily collapse further down the line.”

Both Mr Conte and Mr Renzi had earlier in the day exchanged strong words in speeches to the Senate. Mr Conte accused the ex-prime minster of causing instability during “a challenge of epochal proportions” and defended his coalition government’s record fighting the pandemic.

“The whole political class risks losing contact with reality,” Mr Conte said. “Was there really a need to open a political crisis at this stage?”

Mr Renzi responded that, instead of being irresponsible for bringing the country to the brink of a political crisis, the departure of Italia Viva from the coalition was meant to avert a further escalation of “a health and economic crisis”.

“We have been asking for a turnround for months,” the former prime minister told the Senate. “It is not true that we have been irresponsible, we have been far too patient.”