Open this photo in gallery Dr. Sergio Cattaneo and Dr. Paolo Groff are front-line doctors in the Italian cities of Brescia and Perugia, respectively. The Globe and Mail

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.

Italian doctors on the front lines of the novel coronavirus crisis say they feel like they’re living in a war zone, where they have to make quick triage decisions – who to save, who is beyond saving – watch dying patients send their last messages to their family, and deal with their own extreme physical and mental fatigue working in overburdened hospitals.

“Every day is a battle,” says Sergio Cattaneo, 45, a specialist in cardiac surgery anesthesia and resuscitation at the Spedali Civili hospital in Brescia in Northern Italy, one of the Italian cities hardest hit by the outbreak of coronavirus and its resulting COVID-19 disease.

Story continues below advertisement

Farther south, in Perugia, the capital of the central Italian region of Umbria, Paolo Groff, 55, director of the emergency department at Santa Maria della Misericordia hospital, speaks about the sheer sadness of watching gravely ill patients, who are still conscious and aware they are on their way out. "They speak hardly at all because they are paralyzed with fear,” he says. “They are isolated and cannot see their families.”

Dr. Cattaneo and Dr. Groff say their hospitals’ intensive-care units are barely coping. There are not enough doctors and nurses, not enough life-saving ventilators, not enough protective gowns to shield them from the disease that is killing about 9 per cent of infected Italians.

And COVID-19 is killing some of their colleagues, too. By Monday, the death of 19 Italian medics had been confirmed, with almost another 5,000 infected; once infected, they go into quarantine and can no longer work. At Dr. Cattaneo’s hospital, two doctors went into intensive care; both recovered.

The regional health authorities have been begging retired doctors, nurses and medical technicians to report for work again, and many have. A few days ago, Giampiero Giron, an 85-year-old anesthetist, professor emeritus at the University of Padua and a member of the team that performed Italy’s first heart transplant in 1985, became something of a national hero when he once again suited up in green scrubs, well aware that the coronavirus can be merciless for those in their 80s.

“They asked for my availability and I said yes,” he told the Italian media. “When you decide to be a doctor in life, you get involved. I swore an oath. Afraid of getting sick? Then it is better not to be a doctor.”

They remain resolute, even upbeat, despite their fatigue, as Italians pull together to cheer their medical heroes from their balconies and try to prevent their hospitals from collapsing. Manufacturers who were making socks, cars and fashion items are now making, or are about to make, ventilators, face masks and sanitizing hand gel. “I am an optimist,” Dr. Cattaneo says. “We’ve seen a reduction in new patients and deaths in the last few days. But we definitely have a few more weeks of extreme pressure, at least.”

In spite of the fresh fall in cases, the numbers remain grim. Last week, the Italian COVID-19 fatalities surpassed those of China, which has more than 20 times Italy’s population of 60 million. The vast majority of the dead were patients older than 70 with one or more underlying conditions, such as diabetes, hypertension and heart disease.

Story continues below advertisement

Italy’s worst day came last Saturday, when 791 deaths were recorded. The number fell to 651 on Sunday and 602 on Monday, giving Italians some hope that the worst was over. But on Tuesday, the fatalities surged again to 743, the second highest on record, while new cases climbed by 5,249 to 69,176.

The wealthy northern region of Lombardy, whose cities include Milan, Brescia and Bergamo, remain ground zero for the Italian – and European – coronavirus cases. Lombardy alone has recorded more than half of the cases in Italy, which has 20 regions.

Giorgio Gori, the mayor of Bergamo (population 122,000), has said that his “unscientific” guess is that the true number of fatalities in his city and region is as much as four times higher than the official rates because many old people are dying at home or in old-age hospices, where they are not tested for COVID-19.

In Lombardy, and elsewhere in Italy, the ambulances have silenced their sirens so as not to alarm Italians (the empty roads also mean they can make speed without sirens). Dr. Cattaneo says the ICU at his Brescia hospital, similar to all hospitals, was unprepared for the onslaught of patients, which began at the start of March, a few days after Italian Prime Minister Giuseppe Conte placed 11 northern Italian towns into quarantine (the quarantine was extended nationally on March 9).

The enormous Brescia hospital, with 1,000 beds, had just 29 ICU beds. As waves of patients arrived, more space was freed up by sending home patients who were waiting for elective surgery. Today, it has 53 ICU beds for COVID-19 patients, with another 13 coming. But there are just eight beds for non-COVID-19 patients.

The whole hospital has essentially transformed itself into a coronavirus centre. As of Tuesday, it had about 600 COVID-19 patients, half of whom were using oxygen masks. About 100 were using non-invasive ventilators and more than 50 were on invasive ventilators, meaning the patients, in serious or critical condition, required breathing tubes to keep their lungs operating.

Story continues below advertisement

Since the beginning of March, 170 COVID-19 patients have died at the Brescia hospital.

Dr. Cattaneo says the stress on medics is enormous. In normal times, there is one nurse for every two ICU patients. But the rise in patient numbers, which has gone unmatched by a rise in hospital staff, means there is only one nurse for every three patients. “For four weeks, we’ve had no time off,” he says. “We’re exhausted and we see so much death. This is heavy for us. We are very tired physically and mentally.”

He says he was grateful when a batch of Samsung tablets were donated to his hospital’s ICU. The patients use the small computers to record messages to their families, since family members cannot visit them. For some, it is their last message. It’s also a way for family members to see their loved ones who are comatose or have just died. “The families can see them for the last time,” he says. “When the dead leave the hospital, they leave in closed caskets.”

In Umbria, a region with relatively few coronavirus infections (648 by Tuesday), Dr. Groff’s hospital is nonetheless almost overwhelmed by new patients; he says 10 to 20 arrive every day. Almost all are senior citizens, though one patient was in his mid-20s. Seventeen have died in his hospital since the beginning of March, the youngest being 56. “We need more ventilators,” he says. “We need at least 20 more. They are sold out. This is a crisis for us."

Some of the patients arrive in such bad shape, he says, that COVID-19 tests are unnecessary; the doctors know immediately that they would test positive. Triage means that the ones that have no hope of living are not put on ventilators, which would not save them. Dr. Groff feels sorry for them, in spite of their generally advanced years, and their families. “They are isolated and cannot see their families,” he says. “They know they are dying, but we make sure they are not in pain.”

But neither Dr. Groff nor Dr. Cattaneo says the gruelling and heartbreaking work has immobilized them or even slowed them down – they have vital jobs to do.

Story continues below advertisement

“I am not depressed at all,” Dr. Groff says.

“We’re just doing our work,” Dr. Cattaneo says.

The spread of the novel coronavirus that causes COVID-19 continues, with more cases diagnosed in Canada. The Globe offers the dos and don'ts to help slow or stop the spread of the virus in your community.

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters.