MILAN — In the capital of Italy’s northern Lombardy region, those who live near hospitals have started counting ambulance sirens again.
Until a few weeks ago, it seemed Italy might be spared the second wave of coronavirus infections engulfing the Continent. It had successfully rebounded from a devastating spring, earning international praise for its handling of the emergency and successfully reopening its economy in time for the summer tourist season. But the steadily rising numbers, and the government’s decision this week to impose a new set of restrictions to curb the virus, dispersed any illusions Italy might be in the clear.
In Lombardy, the wealthy region that was hit hardest by the first wave of the virus in March, morale is especially low. Of Italy’s current tally of close to 420,000 cases, the largest share — some 98,000 — have been registered in the region, making it by far the most affected. On Tuesday, the government labeled Lombardy a “red zone,” meaning movement in and out of the region is prohibited, except for emergencies, and all shops, bars and restaurants are shuttered for at least two weeks, among other strict measures.
For residents, the spike in cases and the return to lockdown is an uncomfortable flashback to the day in late February when they first started to worry about an unknown virus that would soon overwhelm hospitals and funeral homes.
This time, the region’s capital, Milan — largely spared during the first wave, which devastated the cities of Bergamo, Lodi and Brescia — has emerged as a major infection hub, with some 4,000 new cases registered per day (in a city of around 1.4 million people) and one of the highest reproduction rates in the country.
Exasperated and worried about the tough months ahead, many residents are asking: Why does it still feel like we are groping in the dark? Are Lombardy’s high numbers simply coincidence or the result of mismanagement at the political level?
The answer likely lies somewhere in the middle.
Opposition parties blame the regional government led by Attilio Fontana, a member of the far-right League, for failing to learn the lessons of the first wave.
“The biggest [mistake] was not strengthening the tracking activity,” said Emilia De Biasi, the regional secretary of the Democratic Party (PD) and head of health and welfare. “In the city, the situation is out of control, we have no idea where the new contagion clusters are.”
She added that the government had failed to provide more resources to general practitioners, who should be patients’ first point of contact in order not to overwhelm hospitals.
The region has been struggling to make up for a shortage of doctors. Efforts to create teams of white coats to visit people with symptoms in their homes, to alleviate pressure on hospitals and avoid people spreading the disease further, have fallen flat, not just in Lombardy but across the country. The regional government’s plan to recruit doctors among new medical graduates was met with the criticism that it is too little, too late.
Other preventative measures have also stalled. At the start of the pandemic, there was an abundance of so-called COVID-hotels, places where patients with manageable symptoms could convalesce to prevent them infecting other members of their household. Over the summer, management passed from the Civil Protection Agency to the regions, which are only now launching tenders for agreements with the structures, delaying the use of the spaces.
Testing capacity is also an issue. “Everything is still based on the swab, left to the goodwill of the people,” Massimo De Rosa, group leader of the 5Star Movement in Lombardy, told the outlet Fanpage, citing a lack of rapid tests in schools and for the population at large.
“This is not enough, especially in the region that had the peak of Italian COVID cases. Today we are paying the consequences.”
According to Giulio Gallera, the region’s health chief, Lombardy is making a “titanic effort” to manage the situation, which is complicated by years of cuts to health care.
Speaking on “Che Tempo Fa,” a popular television program, Gallera said the region has “enormous capacity to do test swabs” and will open “20 or 30” new testing centers in the coming 10 days.
Gallera acknowledged that Lombardy has to “manage to lower the curve or in 15 days we will be in pain.” He did not respond to multiple requests for comment from POLITICO.
On the ground, doctors and nurses have started to warn of a return to the nightmare of the spring, when military trucks were called in to help transport the dead out of hospitals in Bergamo — an image that is burned in the mind of many Italians.
Hospital beds are scarce and ambulances carrying new coronavirus patients routinely have to queue outside the entrance to the emergency room. A shortage of flu vaccines — the result of government failure to start tenders on time — also risks exacerbating the situation in coming weeks.
“Gloves, mask, cap, visor, water-repellent coat, boots, second pair of gloves. I am ready to enter the red zone,” Andrea Artoni, a doctor who works in one of the largest hospitals in Milan, wrote in a long Facebook post about the anxieties of health workers returning to the trenches. “I didn’t miss this ritual and it took me a long time to realize that I was back in.”
Beyond those on the front lines and those who fall ill, patients receiving or waiting for treatment for other illnesses are also paying a high price for mistakes made by authorities charged with planning for a return of the virus in the fall and winter.
When Filippo Maraffi, a retired veterinarian who was diagnosed with cancer two years ago, went to Bergamo for a CT scan, “only 1 of 4 rooms was working because there was no staff,” he said. “It was already bad before — with the health emergency, everything got worse.”
According to Maraffi, patients like him are increasingly skipping check-ups and treatment sessions for fear of becoming infected with the coronavirus, which is more likely to cause severe complications in cancer patients and people with compromised immune systems.
“The bureaucracy in recent months has worsened, it is understandable. But if measures such as home nurses were implemented, they would meet the needs of other patients who still exist,” he said.
No one has been left unscathed by the crisis. People are tired, disappointed, angry. Over the past weeks, protests — some of which are led by far-right groups — have erupted in the biggest Italian cities, including Milan. Businesses, and restaurants and bars in particular, are fearful of another total lockdown that they say would decimate their livelihood.
In the hospitals, there is little time to consider the political controversy and heated debates about the economic cost of another lockdown as the number of patients requiring intensive care treatment and the number of deaths start to climb.
“We knew that with the arrival of winter and the cold we could find ourselves facing a situation similar to that of March, but almost no one could imagine that already in October we would have found ourselves with these numbers,” said Francesco Tursi, a pulmonologist and head of the COVID-19 unit at the main hospital in Codogno, the city where the outbreak started in February.
Tursi fell ill himself in March, and still recalls the toll it took on his body — and the fear he, like so many others, felt.
“Seeing those desperate eyes again makes my heart ache,” he said. “We have to hold on and make it through this time too. Today we are better prepared, but until the vaccine and a specific cure arrive, we have to live with COVID.”