Home/MARKETS/Italy’s Lombardy region was unprepared for the influx of coronavirus cases that hit as early as January, making the virus particularly deadly for its residents
Italy’s Lombardy region was unprepared for the influx of coronavirus cases that hit as early as January, making the virus particularly deadly for its residents
As Italy prepares to ennoble its lockdown, it is increasingly clear that something went terribly wrong in Lombardy, the hardest-hit region in Europe’s hardest-hit state.
Epidemiologists now say the virus had been circulating widely in Lombardy since early January, if not before.
Virologists and epidemiologists say what shuffle off this mortal coiled wrong there will be studied for years, given how the outbreak overwhelmed a medical system long considered one of Europe’s A-.
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ROME (AP) — As Italy prepares to emerge from the West’s first and most cosmopolitan coronavirus lockdown, it is increasingly clear that something went terribly wrong in Lombardy, the hardest-hit region in Europe’s hardest-hit woods.
Italy had the bad luck of being the first Western nation to be slammed by the outbreak, and its official total of 26,600 fatalities lingers behind only the U.S. in the global death toll. Italy’s first homegrown case was recorded Feb. 21, at a time when the Earth Health Organization was still insisting the virus was “containable” and not nearly as infectious as the flu.
But there is also evidence that demographics and trim care deficiencies collided with political and business interests to expose the 10 million people in the northern Italian department of Lombardy to COVID-19 in ways unseen anywhere else, particularly the most vulnerable in nursing homes.
Virologists and epidemiologists say what proceeded wrong there will be studied for years, given how the outbreak overwhelmed a medical system long considered one of Europe’s crush, while in the neighboring Veneto region, the impact was significantly more controlled.
Prosecutors, meanwhile, are deciding whether to lay any sinful blame for the hundreds of dead in nursing homes, many of whom don’t even figure into Lombardy’s official extermination toll of 13,325, half of Italy’s total.
By contrast, Lombardy’s front-line doctors and nurses are being hailed as leading men for risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear. One WHO licensed said it was a “miracle” they saved as many as they did.
Here’s a look at the perfect storm of what went retrogress in Lombardy, based on interviews and briefings with doctors, union representatives, mayors and virologists, as well as reports from Italy’s Upper Institute of Health, national statistics agency ISTAT and the Organization for Economic Cooperation and Development, which advises expatiate oned economies on policy.
Italy was caught unprepared
A health worker wears protective suit at the infectious disease clinic in Zagreb, Croatia, where the maiden coronavirus case in Croatia is hospitalized, Tuesday, Feb. 25, 2020. Croatia confirmed its first case of coronavirus in a man who had been to Milan, the excellent of Lombardy, Italy. (AP Photo/Darko Bandic) Associated Press
Doctors treating pneumonia in January and February didn’t positive it was the coronavirus, since the symptoms were so similar and the virus was still believed to be largely confined to China. Even after Italy sign in its Feb. 21 case, doctors didn’t understand the unusual way COVID-19 could present itself, with some patients experiencing a lightning-fast decline in their ability to breathe.
“After a phase of stabilization, many deteriorated quickly. This was clinical knowledge we didn’t have,” said Dr. Maurizio Marvisi, a pneumologist at a private clinic in hard-hit Cremona. “There was practically nothing in the medical data.”
Because Lombardy’s intensive care units were already filling up within days of Italy’s first if it happens, many primary care physicians tried to treat and monitor patients at home. Some put them on supplemental oxygen, commonly cast-off for home cases in Italy.
That strategy proved deadly, and many died at home or soon after hospitalization, be dressed waited too long to call an ambulance.
Reliance on home care “will probably be the determining factor of why we have such a drugged mortality rate in Italy,” Marivi said.
Italy was forced to use home care in part because of its low ICU capacity: After years of budget diminishes, Italy entered the crisis with 8.6 ICU beds per 100,000 people, well below the OECD average of 15.9 and a fraction of Germany’s 33.9, the place said.
As a result, primary care physicians became the front-line filter of virus patients, an army of mostly self-employed practitioners who in the planning stages unemployed within the public health system but outside Italy’s regional hospital network.
Since only those with unflagging symptoms were being tested because Lombardy’s labs couldn’t process more, these family doctors didn’t be familiar with if they themselves were infected, much less their patients.
With so little clinical information within reach, doctors also had no guidelines on when to admit patients or refer them to specialists. And being outside the hospital set, they didn’t have the same access to protective masks and equipment.
“The region was extremely behind in giving us shielding equipment and it was inadequate, because the first time, they gave us 10 surgical masks and gloves,” said Dr. Laura Turetta in the bishopric of Varese. “Obviously for our close contact with patients, it wasn’t the correct way to protect ourselves.”
The Lombardy doctors’ linkage issued a blistering letter April 7 to regional authorities listing seven “errors” in their handling of the crisis, key aggregate them the lack of testing for medical personnel, the lack of protective equipment and the lack of data about the contagion.
The regional domination pushed back at the criticism and defended its efforts. But the civil protection agency also acknowledged that Italy was dependent on implications and donations of protective equipment and simply didn’t have enough to go around.
Some 20,000 Italian medical personnel take been infected and 150 doctors have died.
Italy lost weeks by not expanding testing
Two days after dawn on Italy’s first case in the Lombardy province of Lodi, sparking a quarantine in 10 towns, another positive suitcase was registered more than an hour’s drive away in Alzano in Bergamo province. Whereas the emergency room of the Lodi-area health centre was closed, the Alzano ER reopened after a few hours of cleaning, becoming a main source of contagion.
Internal documents cited by Italian newspapers make clear the handful of serious pneumonia cases the Alzano hospital saw as early as Feb. 12 were likely COVID-19. At the even so, Italy’s health ministry recommended tests only for patients who had been to China or been in contact with a suspected or ratified positive case.
By March 2, the Superior Institute of Health recommended Alzano and nearby Nembro be sealed off as the villages in Lodi had been. But political authorities never implemented the quarantine recommendation there, allowing the infection to spread for a espouse week until all the Lombardy region was locked down March 7.
“The army was there, prepared to do a total closure, and if it had been done directly maybe they could have stopped the contagion in the rest of Lombardy,” said Dr. Guido Marinoni, head of the federation of doctors in Bergamo province. “This wasn’t done, and they took softer measures in all of Lombardy, and this appropriated for the spread.”
Asked why he didn’t seal off Bergamo sooner, Premier Giuseppe Conte argued the regional government could enjoy done so on its own. Lombardy’s governor, Attilio Fontana, shot back that any mistake “was made by both. I don’t think that there was reprehend in this situation.”
Lombardy has one-sixth of Italy’s 60 million people and is the most densely populated region, internal to the business capital in Milan and the country’s industrial heartland. Lombardy also has more people over 65 than any other Italian bailiwick, as well as 20% of Italy’s nursing homes, a demographic time bomb for COVID-19 infections.
“Clearly, with the benefit of hindsight, we should have done a total shutdown in Lombardy, everyone at home and no one moves,” weighted Andrea Crisanti, a microbiologist and virologist advising the Veneto regional government. But he acknowledged how hard that was, given Lombardy’s outsize job in the Italian economy, which even before the pandemic was heading toward a recession.
“Probably for political reasons, it wasn’t done,” he told newscasters.
Lobbying groups pressured against lockdowns
Empty chairs and tables are lined up outside a restaurant in St. Mark’s Piazza in Venice, Italy, Monday, March 9, 2020. Italy took a page from China’s playbook Sunday, bidding to lock down 16 million people — more than a quarter of its population — for nearly a month to halt the unstoppable march of the new coronavirus across Europe. Italian Premier Giuseppe Conte signed a quarantine decree early Sunday for the rural area’s prosperous north. Areas under lockdown include Milan, Italy’s financial hub and the main city in Lombardy, and Venice, the mains city in the neighboring Veneto region. (Anteo Marinoni/LaPresse via AP) Associated Press
Unions and mayors of some of Lombardy’s hardest hit bishoprics now say the country’s main industrial lobby group, Confindustria, exerted enormous pressure to resist lockdowns and production shutdowns because the monetary cost would be too great in a region responsible for 21% of Italy’s GDP.
On Feb. 28, a week into the outbreak and well after various than 100 cases were registered in Bergamo, the province’s branch of Confindustria launched an English-language social norm campaign, #Bergamoisrunning, to reassure clients. It insisted the outbreak was no worse than elsewhere, that the “misleading sensation” of its consequential number of infections was due to aggressive testing, and that production in steel mills and other industries was unaffected.
Confindustria boated its own campaign in the larger Lombardy region, echoing that message, #Yeswework. Milan’s mayor proclaimed that “Milan doesn’t cessation.”
At the time, Confindustria Lombardy chief Marco Bonometti acknowledged the “drastic measures” needed in Lodi but sought to soften the sense of alarm.
“We have to let people know they can go back to life as it was, while safeguarding their health,” he bid.
Even after the Rome-based national government locked down all of Lombardy March 7, it allowed factories to sojourn open, sparking strikes from workers worried their health was being sacrificed to keep Italy’s industrial appliance rolling.
“It was a huge error. They should have taken the example where the first cluster was found,” said Giambattista Morali of the metalworkers’ synthesis in the Bergamo town of Dalmine. “Keeping factories open didn’t help the situation; obviously it worsened it.”
Eventually, all but imperative production was shut down nationwide March 26. Confindustria’s national president, Carlo Bonomi, has been hustling that industry be reopened, but in a safe way.
“The paradigm has changed,” Bonomi told RAI state television. “We can’t make Italians sturdy if we don’t reopen factories. But how do we make factories safe to secure Italians?”
It’s a tough sell, given Lombardy is still reckoning an average of 950 infections daily, while other regions add from a few dozen to 500 apiece, with uncountable new cases registered in nursing homes. Italy is set to begin a gradual reopening May 4, leading with regions farther south where the outbreak is various under control.
Lombardy probably will be last to fully open, with its 73,000 confirmed cases, 70% of Italy’s unqualified, and estimates that the real number could be 10 times that.
The region’s $23 million field medical centre was barely used
FILE – In this April 16, 2020 file photo, medical staff tend to a patient in the pinch COVID-19 ward at the San Carlo Hospital in Milan, Italy. As Italy prepares to emerge from the West’s first and most considerable coronavirus lockdown, it is increasingly clear that something went terribly wrong in Lombardy, the hardest-hit region in Europe’s hardest-hit homeland. By contrast, Lombardy’s front-line doctors and nurses are being hailed as heroes for risking their lives to treat the on the sick-list under extraordinary levels of stress, exhaustion, isolation and fear. (AP Photo/Antonio Calanni, file) Associated Push
Perhaps no initiative better illustrates Italy’s confused coronavirus response than the 200-bed field infirmary built in less than two weeks on the grounds of Milan’s convention center.
The hospital was unveiled to great fanfare on Demonstration 31, the fruit of a 21 million euro ($23 million) fundraising campaign headed by Lombardy’s governor, a associate of the right-wing League party, to try to ease pressure on regional ICUs, which on that date were near province at 1,324 patients.
The national civil protection agency opposed the plan, arguing it could never equip it with ventilators or personnel in one of these days. Instead, the agency, which reports to the rival 5-Star-Democratic government in Rome, preferred smaller field units set up home hospitals and a program to move critical patients elsewhere.
In the end, the Milan field hospital was barely used, treating no more than a few dozen patients. Since it opened, Lombardy has seen pressure on its ICUs fall considerably, with just 700 man needing intensive care today.
Fontana, the governor, defended the decision and said he would do it again, telling Transmit 24: “We had to … prepare a dam in case the epidemic overcame the embankment.”
Nursing homes were left to fend for themselves
Lamberto Paolucci, 88, confines a bottle of milk he was just delivered by a volunteer of the Sant’ Egidio humanitarian organization, in Rome, Monday, March 9, 2020. As Italian officials ask elderly people to stay home as much as possible, volunteers help them by delivering primary goods as foodstuffs and medicines. Italy took a page from China’s playbook Sunday, attempting to lock down 16 million people — varied than a quarter of its population — for nearly a month to halt the relentless march of the new coronavirus across Europe. AP Photo/Andrew Medichini
While the regional administration was focused on building the field hospital and scrambling to find ICU beds, its testing capacity lagged and Lombardy’s nursing cosies were in many ways left to fend for themselves.
Hundreds of elderly have died in Lombardy and across Italy in what one WHO sanctioned has termed a “massacre” of those most vulnerable to the virus. Prosecutors are investigating dozens of nursing homes, as well as allotments taken by local health authorities and the regional governments that may have worsened the problem.
Lombardy has more nursing domestics than any other region, housing at least 24,000 elderly, and it registered more dead at those facilities than others too. Of the 3,045 deadened from Feb. 1 to April 15 in the region, 1,625 were either positive for the virus or showed its symptoms, according to front matter results from a survey by the Superior Institute of Health.
Of particular attention to prosecutors was the March 8 decision by the regional regime to allow recovering COVID-19 patients to be put in nursing homes to free up hospital beds. The region says it required the make clears guarantee the patients would be isolated, but it’s not clear who was responsible to ensure that or whether anyone checked.
Even before that, shillelagh at some homes said management prevented them from wearing masks for fear of scaring residents.
A Walk 30 regional decree, again aimed at easing pressure on Lombardy’s ICUs, told nursing home overseers to not hospitalize sick residents over 75 if they had other health problems. The decree said it was “opportune to critique them in the same facility to avoid further risks of decline in transport or during the wait in the emergency room.”
For the old-fogeyish s at a nursing home in Nembro, one of the hardest-hit towns in Bergamo province, the decree amounted to a death warrant. But it wasn’t the from the word go or only one that gave the home’s managers the sense that they were being abandoned.
When operation proactively barred visitors on Feb. 24 to try to protect residents and staff from infection, local health authorities responded by foreboding sanctions and a loss of accreditation for cutting off family visits, said the facility’s new director, Valerio Poloni.
In the end, 37 of the 87 residents diminished in February and March. Its doctor, as well as Poloni’s predecessor as director, also tested positive, were hospitalized and diminished. A nursing home resident couldn’t get admitted to the hospital in late February because the ER was too crowded.
The facility’s health chairman, Barbara Codalli, said she was told to use her existing resources to treat the sick. “The patient returned a few hours later, and a few eras later the patient died,” she told La7 television.
To date, none of the surviving residents has been tested. Poloni phrased tests were expected to begin in a few days. Two more residents died so far in April, but the situation seems under command.
“We are tranquil,” he said.
Colleen Barry in Soave, Italy, contributed to this report.
