When Milan resident Antonia Mortensen was pulled over by police while driving recently, it wasn’t for a traffic offence. It was to instruct her fellow passenger to sit in the back of the car and to check that both were wearing face masks.

“We were told we cannot both sit in the front,” said the CNN journalist, who was on her way to hospital with her husband to visit a sick relative.

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“We have a special certificate giving us permission to go to the hospital,” she said, adding that the relative does not have coronavirus.

Such are the tight restrictions on Italians now living in the deadliest hotspot of the global coronavirus pandemic.

Italy’s death toll is now the highest in the world at 10,023.

Fatalities passed the grim milestone on Saturday, with an increase of 889 since the last figures were released on Friday, according to Italy’s Civil Protection Agency.

A red cross volunteer checks the temperature of a homeless man in Rome. Credit: Andrew Medichini / AP

With 92,472 confirmed cases, Italy appears to have the highest death rate on the planet. Compare it to China, the epicentre of the pandemic, which has a roughly similar number of confirmed cases at 81,997, but under a third as many deaths, at 3,299, according to Johns Hopkins University and Medicine.

Indeed Italy now has the second-highest number of confirmed cases in the world after the United States, which stands at 105,470. But the US has a fraction of the deaths, at just over 1,700.

As Italy enters its sixth week of restrictions, many are asking: why does its death rate seem so much higher than in other countries?

The San Matteo hospital Intensive Care Unit in Pavia during the coronavirus emergency. Credit: Claudio Furlan / AP

Experts say it’s down to a combination of factors, like the country’s large elderly population which is more susceptible to the virus, and the method of testing that’s not giving the full picture about infections.

Italy’s number of confirmed cases is “not representative of the entire infected population,” said Dr. Massimo Galli, head of the infectious disease unit at Sacco Hospital in Milan. The real figure was “much much more.”

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Only the most severe cases are being tested, added Galli, and not the entire population - which in turn, skews the death rate.

In the northern Lombardy region, which has the majority of cases, about 5,000 swabs are being carried out daily, said Galli. He added this was “much lower than needed, with “thousands of people waiting for diagnosis at their home.”

A red rose lays on top of a row of caskets in Italy. Credit: Claudio Furlan / AP

A major obstacle for health workers carrying out tests was limited protective gear available, he said.

In a stark warning to other countries, Galli said: “We have a national healthcare system that works very well, especially in Lombardy - but even our system has been hit by this.

“Miracles have been done in multiplying the numbers of beds in hospitals,” said the health expert. But medicine “has been lacking - and this is a big problem that will be felt by other countries.”