Bologna: Coronavirus victims in Italy could be left to die if they are aged 80 or more, or in poor health, under draft plans drawn up for the next phase of the crisis.

The victims will be denied access to intensive care should pressure on beds increase, according to a new regional protocol, seen by The Telegraph, London, from the government's crisis management unit in Turin.

The coronavirus outbreak it set to cause some difficult decisions by Italian doctors. iStock

The document lays out in cold detail which patients receive treatment in intensive care and which do not if there are insufficient spaces - triggering concerns for the elderly in other countries if the infection rate follows suit.

Italy now has more than 17,000 positive cases and more than 1200 dead, second only to China. But the rate of death is far higher due to Italy's large elderly population.

Inside the Bergamo cemetery, the epicentre of the outbreak in the north, dozens of coffins fill the Ognissanti church, now an emergency mortuary storing corpses after the region's two hospitals could hold no more.

Italians have filled the deserted streets with music by singing and playing instruments from their windows and balconies while in quarantine.

With funerals banned under Italy's lockdown decree, the city crematorium is set to begin operating on a new 24-hour schedule this weekend to keep up.

Officials had to close the cemetery to stop the elderly from coming by bus to say last respects to fellow friends, neighbours and relatives dying at an alarming rate.

"To see entire generation of Bergamo residents taken in this way - it is unthinkable," said one doctor working inside the Hospital Pope John XXIII, where nearly 150 people have died in recent days.

The small town of Medicina, just outside Bologna, is mourning the death of three men,all friends, who frequented the same social-recreation centre. Francesco Nanni, 77, was the club's vice-president, Oddone Tolomelli, was the centre's cook, known for the excellent ragu sauce he made, while Luigi Balduini was the club's handyman and a passionate card player with a fixed seat at the corner table.

All died of coronavirus complications and more than a dozen others have fallen ill. In the Tuscan city of Prato, at least eight elderly have been infected in a senior home.

Since the more stringent lockdown measures were passed, 9,000 senior centres across the country have been closed, leaving thousands of elderly isolated in their homes.

Some have been abandoned by caregivers who no longer want to take public transport. Others have been approached by fraudsters posing as healthcare workers saying they need to do COVID-19 testing or disinfect their homes.

Of the country's 13 million elderly, approximately five million live alone. For them, the shutdown of their recreational centres and inability to see their grandchildren and extended family has created a new level of anxiety and solitude. "They are alone, being bombarded all day by information on television - we're not talking about anything but this outbreak - and they are not seeing their grandchildren, so there is less contact with one of the things that gives them the most joy," Eleonora Selvi, spokesman for the Senior Italia Federanziani association for the elderly, told The Sunday Telegraph.

In both the Lodi province and in Bergamo province, elderly couples both became infected and died within hours of one another in the last week.

Severa Belotti, 82 and Luigi Carrara, 86, died in hospital after being confined for days at home with fevers. They had been married 60 years.

"The psychological impact on the elderly population has been dramatic," Selvi said. "To say 'you will be sacrificed in ICU because there are more elderly victims and you have less of a chance of making it', well that is an alarming situation."

Pressure on the intensive care capacity in Bergamo increased after 71 of the region's doctors, nurses and healthcare workers tested positive for the virus. Many of them now lie in crowded intensive care wards with oxygen helmets hooked up to respiration tubes.

One exasperated anaesthesiologist revealed this week that the lack of available breathing machines and beds were already forcing doctors to make devastating decisions about who to save and who to let die, based on age and health conditions.

"We decide depending on their age and the condition of their health. That is not me saying that, but the medical procedure manuals," Christian Salaroli, 48, told Corriere della Sera, the Milan daily. "If a patient aged 80-95 has massive respiratory problems, plus organ failure, then its all over." Salaroli added that Lombardy's strained hospitals were also taking a devastating emotional toll on his colleagues. Experienced nurses are breaking down in tears and doctors with nerves of steel now trembling.

The government has scrambled to respond, striking an urgent deal with China to ship 30 tons of emergency equipment, including breathing machines, oxygen helmets and masks, which arrived in Rome on Friday from Shanghai, along with nine Chinese COVID-19 medical experts.

In Milan, plans are under way to transform - in a week's time - an unused trade fair pavilion into a dedicated COVID-19 field hospital with 600 ICU beds.

The new protocol for treating the elderly was produced by the civil protection department of the Piedmont region, one of those hardest hit, and was signed by Mario Raviolo, the director of the regional crisis unit.

The document, which sources said was expected to be applied throughout Italy, says: "The growth of the current epidemic makes it likely that a point of imbalance between the clinical needs of patients with COVID-19 and the effective availability of intensive resources will be reached.

"Should it become impossible to provide all patients with intensive care services, it will be necessary to apply criteria for access to intensive treatment, which depends on the limited resources available."

One doctor said: "[Who lives and who dies] is decided by age and by the [patient's] health conditions. This is how it is in a war."

The Telegraph, London