In early March, as deaths from the virus spiked and the number of confirmed cases swelled, Italy’s government needed to take decisive steps to slow the lightning-fast rate of infection.

On March 8, Prime Minister Giuseppe Conte issued a lockdown of Italy’s Lombardy region, effectively quarantining around 16 million people in the north. Two days later, Conte expanded the quarantine order to include the entire country. The decrees came just over a month after similar quarantines went into effect in parts of China where the virus first emerged.

Overnight, the normally bustling streets of cities like Milan and Venice were deserted, their sprawling piazzas and picturesque walkways silent and devoid of people.

But this tranquility betrayed a very different reality for Italians at the front lines of the pandemic.

“It seems relaxed because everyone is staying inside and people are cooking and looking at old photos and doing work at home,” said Francesco Longo, director of the Centre for Research on Health and Social Care Management at Bocconi University in Milan. “But in the hospitals, it’s like a war.”

At his hospital, D’Antiga said almost half of the 1,000 beds are dedicated to treating patients with COVID-19, the disease caused by the coronavirus. Most other operations at the hospital have either scaled back significantly or ground to a halt.

“In the gastroenterology ward, internal medicine and other wards, they have to send away patients and only admit those with COVID-19 — even in the neurology ward,” D’Antiga said. “We have 20 to 30 patients coming in every day requiring admission, but we’ve run out of beds. It’s a really difficult situation.”

What makes the situation even worse is that some of those beds are being used to treat medical personnel themselves.

“Here, probably 20 to 30 percent of healthcare professionals got infected,” D’Antiga said. “In my department, I have 25 pediatricians and currently 10 are off sick. This is the same in other departments, and it’s a major challenge.”

March 17, 202003:13

Though the majority of those who have tested positive for the coronavirus so far have experienced mild symptoms, the most serious cases can result in respiratory failure. Nearly 13,000 of Italy’s total coronavirus patients are currently hospitalized with symptoms, and of those, more than 2,000 are under intensive medical care, straining hospitals’ resources.

D’Antiga said 80 out of the 100 beds in his hospital’s ICU are occupied by coronavirus patients hooked up to ventilators to breathe, but hospitals are rapidly running out of beds and the equipment needed to keep patients alive.

These limited resources are forcing doctors to make excruciating decisions about who to treat — and who may be beyond help.

Though cases vary, doctors typically take into account the patient’s age and their condition, which is standard practice even without being in the midst of a pandemic, according to D’Antiga. So far, he said doctors are mostly heeding the same criteria when they do have to make tough choices.

“Outside of an epidemic, if a 90-year-old person comes in with severe pneumonia, we likely wouldn’t admit the patient into intensive care and intubate them,” D’Antiga said. “We do have to select, unfortunately, but at the moment, at least we don’t have to select among those who would have been treated in normal times.”

But that could change, he added. And as the virus spreads the heart wrenching situation in Lombardy could be intensified in other regions of Italy and in other countries.

“What we’re seeing in Italy is what we’re likely to start seeing in hospitals around the world in the coming weeks and months,” said Yascha Mounk, a political scientist at Johns Hopkins University in Baltimore. “One of the characteristics of this disease is it has a very long incubation period. It takes a long time for it to start overburdening the health care system, but once it starts, the increase is very rapid.”

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