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Europe’s largest coronavirus outbreak is putting unprecedented strain on the Italian health-care system, with hospitals in the worst-affected areas close to the breaking point.

Italy went from having a handful of cases to the second-largest death toll after China in less than three weeks, flooding intensive-care units with hundreds of patients. If the government’s efforts to contain the spread are unsuccessful — and the lax enforcement of a travel ban bodes ill — experts warn that a new influx would be nearly impossible to manage.

Lombardy, the region around Milan that accounts for more than a fifth of Italy’s economic output, is by far the worst-affected part of the country. It had 5,469 cases, including 440 in intensive care, as of Monday afternoon.

Finding more acute care beds is a “race against time,” Lombardy’s top health official, Giulio Gallera, said in a phone interview. “As of now the region’s health-care system is holding up well, but if the increase in the number of infected people in need of intensive care doesn’t slow down we could have issues.”

More than 80% of the region’s 1,123 acute care beds are dedicated to coronavirus, after many other patients have been moved elsewhere and 223 extra places have been opened to cope with the emergency. About half of those are occupied, Gallera said.

Newspapers and WhatsApp groups are rife with personal accounts from doctors on the front lines of the epidemic. When new patients come in with pneumonia, a symptom of advanced coronavirus infections, doctors have little time to decide whether to assign them intensive-care beds, ventilation machines or respirators that could make the difference between life and death.

Some doctors have said that they sometimes make the call on who gets treatment based on the age of the patient. In some areas, hospitals are suspending other treatments to focus personnel on the contagion.

Specialists Conscripted

A doctor who asked not to be named because of potential repercussions painted a dire picture of the situation in a hospital in Milan. While the coronavirus is best known for causing severe disease in elderly patients, even some young people are affected, the doctor said, and without sufficient beds and ventilators, some can’t be treated.

The hundreds of patients needing treatment for pneumonia have swamped the supply of available specialists, the Milan doctor said. Physicians such as gastroenterologists, who normally focus on the digestive system, have been conscripted to help out with lung patients, and they’re still not enough, the doctor said.

Gallera said about 150 more acute care places will open up in the next week. Whether this will be enough to keep up with the spread of the contagion depends on how effective the government’s containment measures prove to be.

System ‘Overwhelmed’

“The best we can do with the quarantines is slow down the number of cases,” said Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Italy right now from a health-care standpoint has overwhelmed its health-care system.”

On Sunday, the government ordered sweeping travel restrictions for most of the north of the country, with movement allowed only for demonstrable work reasons or medical emergencies.

While checks appeared to be slowly getting stricter, initially enforcement seemed almost nonexistent, with airports open and thousands of people traveling from their workplaces in the north to their native towns in the south. Late Monday, Italy moved to extend the lockdown throughout the country.

The fear is that those who left the north before the restrictions were expanded have taken the contagion with them, risking new outbreaks in areas where the health-care system is weaker. An Italian health ministry report from 2017 said the overall level of care in some southern regions — including Campania, where Naples is located, and Calabria — was sub-standard.

“We have a health-care system in southern regions, especially south of Naples, where we actually have very few facilities,” said Prisco Piscitelli, an epidemiologist and vice president of the Italian Society of Environmental Medicine. Their ability to cope may be “even worse with the increased number of occupied beds in hospitals and intensive-care units.”

Hospital berths are only part of the answer. Italy is also suffering from a shortage of doctors. As many as 1,500 leave the country every year after finishing their specialization, according to doctors’ association Fnomceo.

New Doctors

The government last week announced a plan to hire 20,000 new doctors, nurses and hospital employees. In the meantime, medical authorities are avoiding quarantining doctors who have come in contact with coronavirus patients, telling them to keep working unless they show symptoms of the infection or test positive.

The rest of Europe is watching closely. Maurizio Cecconi, a professor at Humanitas University in Milan and incoming president of the European Society of Intensive Care Medicine, told his fellow doctors to stock up on equipment like face masks and establish criteria for dealing with suspected cases.

“We are seeing a high percentage of positive cases being admitted to our intensive-care units — in the range of 10% of all positive patients,” he wrote in a letter to a professional organization signed along with two colleagues. “We wish to convey a strong message: Get ready!”

Cecconi said he hasn’t seen his family in two weeks as he’s been working non-stop. Getting the public to comply with the government restrictions is more important than anything doctors can do, he said.

“If people stay at home, we will avoid a catastrophe,” he said in an interview. “As doctors, we are begging you.”