Hospitals in the locked-down Italian region of Lombardy are beginning to run out of beds as the country recorded its highest day-on-day rise in deaths from coronavirus.

Twenty days into its outbreak, Italy is grappling to contain the spread of the virus and find space and beds in intensive care units, which are dwindling day by day. To manage the emergency, the sick are being placed in operating rooms or in hospital corridors.

“I am very concerned,” said Prof Massimo Galli, the director of infectious diseases at Sacco hospital in Milan. “The pressure on hospitals in Lombardy these days is enormous. I am very, very worried about the impact the virus will have on our health system.”

The whole of Lombardy, including Milan, Italy’s financial capital, and 14 provinces across the worst-affected northern regions encompassing more than 15 million people, have been shut down until 3 April, under measures not seen since the second world war.

Police checks are under way at railway stations, toll booths, roads entering and leaving internal cities, and airports. Those who have to leave the region out of serious necessity can do so only if they have self-certification stating that they must cross the Lombardy border for compelling business reasons, health reasons and or because they have to return to their homes.

The prime minister, Giuseppe Conte, gloomily cited Winston Churchill as evidence that great nations persevere when the going gets tough. “These days, I have been thinking about the old speeches of Churchill – it is our darkest hour but we will make it,” Conte told La Repubblica newspaper.

The number of deaths from coronavirus in Italy rose from 366 to 463 on Monday, according to the head of the civil protection agency. The total number of cases in Italy rose by 24% to 9,172, and of those originally infected, 724 had fully recovered. Some 733 people were in intensive care against a previous total of 650.

There are about 500 available beds for intensive care in Lombardy’s public health sphere, with another 160 in private care facilities. Despite a massive effort to locate additional space there are still not enough.

The emergency commissioner and civil protection chief, Angelo Borrelli, announced that 13 patients had been transferred or were on the way to neighbouring regions for their care.

Negative-pressure isolation rooms, designed to contain airborne contaminants, are needed to treat coronavirus properly, to protect doctors and medical technicians from contracting the virus from the patients in their care.

“Just a small portion of the patients affected by Covid-19 in Lombardy are hospitalised in negative pressure rooms,” said Galli. “The majority is not, and this is a dangerous problem because it can lead to transmission to other patients and medical staff throughout an entire hospital.”

Authorities in Lombardy are attempting to free up beds as quickly as possible. According to new guidelines, if a patient infected with Covid-19 has been without a fever for three days and appears to be getting better, then he or she will be released from intensive care and placed in a dedicated rehabilitative pulmonary ward for coronavirus patients.

“Beds in intensive care units and in hospitals in general must be freed quickly to make room for more patients,” the health minister for the Lombardy region, Angelo Garra, told the Corriere della Sera.

Dozens of doctors have contracted the virus. The government has allocated €600m (£522m) to recruit 20,000 doctors and nurses.

There is a risk that the kind of pressure on hospitals experienced in Lombardy will spread to the south of the country after thousands of panic-stricken people travelled there on trains, buses and in their cars as news of spread of the impending government lockdown in the north.

In southern Italy dozens of police officers and medics wearing masks and hazmat suits waited in Salerno, Campania for passengers who had boarded overnight trains from Lombardy.

“This flight en masse is causing the opposite effect of the measures put in place in the north,” warned Roberto Burioni, a professor of microbiology and virology at Vita-Salute San Raffaele University in Milan. “Unfortunately, some of those who fled carry the disease.”

More than 9,000 people have arrived in Puglia from the north of the country in the last two days. The authorities have already registered them and placed many in quarantine.

Q&A How can I protect myself and others from the coronavirus outbreak? Show Hide The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus, for which there is no specific cure or vaccine. The UN agency advises people to: Frequently wash their hands with an alcohol-based hand rub or warm water and soap

Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing

Avoid close contact with anyone who has a fever or cough

Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers

Advice about face masks varies. Wearing them while out and about may offer some protection against both spreading and catching the virus via coughs and sneezes, but it is not a cast-iron guarantee of protection Many countries are now enforcing or recommending curfews or lockdowns. Check with your local authorities for up-to-date information about the situation in your area. In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

Michele Emiliano, the president of Puglia, signed an order on Sunday obliging all those arriving from the north in the coming hours to go into quarantine.

“Do not bring the Lombardy, Veneto and Emilia epidemic to your Puglia,” he wrote on Facebook, mostly addressing people from the region who live in the north. “You are carrying the virus into the lungs of your brothers and sisters, your grandparents, uncles, cousins and parents.”

“People arriving in Sicily from the north must take care not to spread the disease,” said Tullio Prestileo, a doctor in infectious diseases at Palermo’s Benfratelli hospital. “If we want to avoid that the emergency affecting Lombardy reaches us, we all must be very responsible.”

Sicily is preparing for the worst, and the authorities have already doubled the number of beds in intensive care and infectious disease units in anticipation of a rise in patients affected with Covid-19.