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ROME: As Italy prepares to emerge from the West’s first and most extensive coronavirus lockdown, it is increasingly clear that something went terribly wrong in Lombardy, the worst affected region in Europe’s worst hit country.
Italy was unlucky enough to be the first western nation to be hit by the outbreak, and its total of 26,000 deaths is only lagging behind the United States. in the global death toll. Italy’s first homegrown case was recorded on February 21, at a time when the World Health Organization still insisted that the virus was “contagious” and not as infectious as the flu.
But there is also evidence that demographic and health care deficiencies combine with political and commercial interests to expose the 10 million people in Lombardy’s northern Italy region in ways not seen anywhere else, particularly the most vulnerable in nursing homes.
Virologists and epidemiologists say what went wrong will be studied for years, as the outbreak overwhelms a medical system considered one of the best in Europe. In neighboring Veneto, the impact was significantly more controlled.
Prosecutors are deciding whether to criminally blame the hundreds of deaths in nursing homes, many of which are not even counted in Lombardy’s official figure of 13,269 deaths.
By contrast, Lombardy’s frontline doctors and nurses are hailed as heroes for risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear.
Even after Italy recorded its first homegrown case, doctors did not understand the unusual way COVID-19 could present itself, and some patients experienced a rapid decline in their ability to breathe.
“This was clinical information that we did not have,” said Dr. Maurizio Marvisi, a pulmonologist at the private clinic in San Camillo in Cremona.
Because Lombardy intensive care units were filling up a few days after the first cases in Italy, many primary care physicians tried to treat and monitor their patients at home, even giving them supplemental oxygen. That strategy was deadly, as many people died at home or soon after being hospitalized, after waiting too long to call an ambulance.
Italy was forced to rely on home care in part because of its low ICU capacity: After years of budget cuts, Italy entered the emergency with 8.6 ICU beds per 100,000 people, below the average of 15.9 in developed countries of the Organization for the Economy Cooperation and development.
As a result, Italy’s primary care physicians became the front-line filter for patients with COVID-19, an army of mostly self-employed general practitioners working outside of the public hospital system.
Since only those with strong symptoms were being tested because the Lombardy labs couldn’t process any more, these GPs didn’t know if they were positive themselves, let alone their patients.
Doctors also had no guidelines on when to admit patients or refer them to specialists, and they did not have the same access to protective equipment as hospitals.
Some 20,000 Italian doctors have been infected and 150 doctors have died.
Two days after Italy registered its first case in the Lombard province of Lodi, causing a quarantine in 10 cities, another positive case was registered more than an hour by car in Alzano, in the province of Bergamo.
By March 2, the Higher Institute of Health recommended that Alzano and Nembro be closed as the cities of Lodi. But political authorities never implemented that recommendation, allowing the infection to spread for a second week until all of Lombardy was blocked on March 7.
When asked why he did not close the province of Bergamo earlier, Prime Minister Giuseppe Conte argued that the Lombardy regional government could have done it alone. Lombardy Governor Attilio Fontana said that if there was a mistake, “ it was made by both of us. I don’t think there is guilt in this situation. ”
Lombardy has a sixth of Italy’s 60 million inhabitants and is the most densely populated region, home to the commercial capital of Milan and the industrial heart of the country. Lombardy also has more people over the age of 65 than any other region, as well as 20% of Italy’s nursing homes, a population demographic pump for COVID-19 infections.
“Clearly, with the benefit of hindsight, we should have made a complete closure in Lombardy, everyone at home and no one is moving,” said Andrea Crisanti, a microbiologist and virologist who advises the Veneto regional government. But he recognized how difficult it was, given Lombardy’s enormous role in Italy’s economy.
“Probably for political reasons, it was not done,” he told reporters.
Unions and mayors in some of Lombardy’s most affected cities now say the country’s main industrial lobby group, Confindustria, is putting enormous pressure on the authorities to resist production shutdowns, claiming that the economic cost would be too high in a region responsible for 21% of Italy’s GDP. .
On February 28, a week after the Italy outbreak and long after more than 100 cases have been reported in Bergamo, the Confindustria province branch launched a social media campaign aimed at reassuring scary investors. He insisted that the outbreak was no worse than elsewhere and that production in provincial mills and other industries were unaffected.
Even after the national government closed all of Lombardy on March 7, it allowed the factories to remain open, sparking strikes by workers concerned that their health would be sacrificed.
“It was a big mistake. They should have taken the example where the first group was found,” said Giambattista Morali of the metalworkers union in the city of Dalmine in Bergamo.
While the regional government focused on finding new beds in the ICU, its testing capacity was delayed and Lombardy nursing homes had to fend for themselves.
Of particular note to Milan prosecutors who investigated deaths in care facilities was the March 8 regional government’s decision to allow patients recovered from COVID-19 to be housed in nursing homes to free hospital beds.
Another regional decree of March 30 told nursing home directors not to hospitalize sick residents over the age of 75 if they had other health problems and to avoid risking their health during transportation.
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Italy was unlucky enough to be the first western nation to be hit by the outbreak, and its total of 26,000 deaths is only lagging behind the United States. in the global death toll. Italy’s first homegrown case was recorded on February 21, at a time when the World Health Organization still insisted that the virus was “contagious” and not as infectious as the flu.
But there is also evidence that demographic and health care deficiencies combine with political and commercial interests to expose the 10 million people in Lombardy’s northern Italy region in ways not seen anywhere else, particularly the most vulnerable in nursing homes.
Virologists and epidemiologists say what went wrong will be studied for years, as the outbreak overwhelms a medical system considered one of the best in Europe. In neighboring Veneto, the impact was significantly more controlled.
Prosecutors are deciding whether to criminally blame the hundreds of deaths in nursing homes, many of which are not even counted in Lombardy’s official figure of 13,269 deaths.
By contrast, Lombardy’s frontline doctors and nurses are hailed as heroes for risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear.
Even after Italy recorded its first homegrown case, doctors did not understand the unusual way COVID-19 could present itself, and some patients experienced a rapid decline in their ability to breathe.
“This was clinical information that we did not have,” said Dr. Maurizio Marvisi, a pulmonologist at the private clinic in San Camillo in Cremona.
Because Lombardy intensive care units were filling up a few days after the first cases in Italy, many primary care physicians tried to treat and monitor their patients at home, even giving them supplemental oxygen. That strategy was deadly, as many people died at home or soon after being hospitalized, after waiting too long to call an ambulance.
Italy was forced to rely on home care in part because of its low ICU capacity: After years of budget cuts, Italy entered the emergency with 8.6 ICU beds per 100,000 people, below the average of 15.9 in developed countries of the Organization for the Economy Cooperation and development.
As a result, Italy’s primary care physicians became the front-line filter for patients with COVID-19, an army of mostly self-employed general practitioners working outside of the public hospital system.
Since only those with strong symptoms were being tested because the Lombardy labs couldn’t process any more, these GPs didn’t know if they were positive themselves, let alone their patients.
Doctors also had no guidelines on when to admit patients or refer them to specialists, and they did not have the same access to protective equipment as hospitals.
Some 20,000 Italian doctors have been infected and 150 doctors have died.
Two days after Italy registered its first case in the Lombard province of Lodi, causing a quarantine in 10 cities, another positive case was registered more than an hour by car in Alzano, in the province of Bergamo.
By March 2, the Higher Institute of Health recommended that Alzano and Nembro be closed as the cities of Lodi. But political authorities never implemented that recommendation, allowing the infection to spread for a second week until all of Lombardy was blocked on March 7.
When asked why he did not close the province of Bergamo earlier, Prime Minister Giuseppe Conte argued that the Lombardy regional government could have done it alone. Lombardy Governor Attilio Fontana said that if there was a mistake, “ it was made by both of us. I don’t think there is guilt in this situation. ”
Lombardy has a sixth of Italy’s 60 million inhabitants and is the most densely populated region, home to the commercial capital of Milan and the industrial heart of the country. Lombardy also has more people over the age of 65 than any other region, as well as 20% of Italy’s nursing homes, a population demographic pump for COVID-19 infections.
“Clearly, with the benefit of hindsight, we should have made a complete closure in Lombardy, everyone at home and no one is moving,” said Andrea Crisanti, a microbiologist and virologist who advises the Veneto regional government. But he recognized how difficult it was, given Lombardy’s enormous role in Italy’s economy.
“Probably for political reasons, it was not done,” he told reporters.
Unions and mayors in some of Lombardy’s most affected cities now say the country’s main industrial lobby group, Confindustria, is putting enormous pressure on the authorities to resist production shutdowns, claiming that the economic cost would be too high in a region responsible for 21% of Italy’s GDP. .
On February 28, a week after the Italy outbreak and long after more than 100 cases have been reported in Bergamo, the Confindustria province branch launched a social media campaign aimed at reassuring scary investors. He insisted that the outbreak was no worse than elsewhere and that production in provincial mills and other industries were unaffected.
Even after the national government closed all of Lombardy on March 7, it allowed the factories to remain open, sparking strikes by workers concerned that their health would be sacrificed.
“It was a big mistake. They should have taken the example where the first group was found,” said Giambattista Morali of the metalworkers union in the city of Dalmine in Bergamo.
While the regional government focused on finding new beds in the ICU, its testing capacity was delayed and Lombardy nursing homes had to fend for themselves.
Of particular note to Milan prosecutors who investigated deaths in care facilities was the March 8 regional government’s decision to allow patients recovered from COVID-19 to be housed in nursing homes to free hospital beds.
Another regional decree of March 30 told nursing home directors not to hospitalize sick residents over the age of 75 if they had other health problems and to avoid risking their health during transportation.
