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Italy questions what went wrong as coronavirus measures begin to ease

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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 hardest-hit region in Europe’s hardest-hit country.

Italy had the bad luck of being the first Western nation to be slammed by the outbreak, and its total of 26,600 fatalities lags behind only the U.S. in the global death toll. Italy’s first homegrown case was recorded Feb. 21, at a time when the World Health Organization was still insisting the virus was “containable” and not nearly as infectious as the flu.

But there’s also evidence that demographics and health care deficiencies combined with political and business interests to expose the 10 million people in the northern Italian region of Lombardy in ways unseen anywhere else, particularly the most vulnerable in nursing homes.

Virologists and epidemiologists say what went wrong there will be studied for years, given how the outbreak overwhelmed a medical system considered one of Europe’s best. In neighbouring Veneto, the impact was significantly more controlled.

Prosecutors are deciding whether to lay any criminal blame for the hundreds of dead in nursing homes, many of whom aren’t even counted in Lombardy’s official death toll of 13,325.

By contrast, Lombardy’s front-line doctors and nurses are being hailed as heroes for risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear.

Even after Italy registered its first homegrown case, doctors didn’t understand the unusual way COVID-19 could present itself, with some patients experiencing a rapid decline in their ability to breathe.

“This was clinical information we didn’t have,” said Dr. Maurizio Marvisi, a pneumologist at the San Camillo private clinic in hard-hit Cremona.

Because Lombardy’s intensive care units were filling up within days of Italy’s first cases, many primary care physicians tried to treat and monitor their patients at home, even putting them on supplemental oxygen. That strategy proved deadly, since many people died at home or soon after being hospitalized, having waited too long to call an ambulance.

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Italy was forced to rely on home care in part because of its low ICU capacity: After years of budget cuts, Italy went into the emergency with 8.6 ICU beds per 100,000 people, below the average of 15.9 within the developed countries of the Organization for Economic Cooperation and Development.

As a result, Italy’s primary care physicians became the front-line filter of COVID-19 patients, an army of mostly self-employed general practitioners who work outside the public hospital system.

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