“The measures introduced in these days have the aim of avoiding a large epidemic wave,” Italy’s National Health Institute said in a statement explaining its stiffening guidelines, which recommend personal separation as schools closed nationwide until at least March 15.

“In the case of the coronavirus we must take into account, moreover, that Italy has an elderly population, actually much older than the Chinese, and needs to be protected from the contagious,” it said.

About 23 per cent of Italy’s population is 65 or older. The median age is 47.3, compared to 38.3 in the United States, according to the United Nations.

Many of those who have died in Italy already suffered from serious illnesses that put them in grave danger, then the virus “destabilized them,” said Walter Ricciardi, an official at WHO who is advising the Italian health ministry.

Pre-existing conditions

The array of pre-existing conditions suffered by some victims, including cancer, diabetes and heart disease, has complicated efforts to assess the lethality of the virus.

Angelo Borrelli, the head of Italy’s Civil Protection Agency who is coordinating the country’s response to the crisis, said Tuesday that of the people who died, “Most were over 70, and some had pre-existing conditions.’’

‘‘But for the others,’’ he said, ‘‘we still aren’t sure.”

Lombardy’s president, Attilio Fontana, made a similar point in an interview last week. “All the deaths we’ve had are either very old people or very sick people,” he said.

WHO said that the case-fatality ratio was highly fluid and likely to change. Infections have probably been under-reported, it said, given that many are asymptomatic or very mild.


Some experts argued that the aggressive response by Italy’s northern regions had not only slowed the spread of the virus but had also brought down the death rate.

“There was a huge expansion of the intensive care units,” said Fausto Baldanti, a virologist at the San Matteo Hospital in Pavia. “That can make the difference.”

Hit to healthcare system

But the intense focus on the coronavirus in Italy is exacting a cost.

Last week, an old man lost his balance and fell on a sidewalk in Casalpusterlengo, one of the northern towns quarantined to prevent the spread of the coronavirus. A neighbour, Noemi Carelli, called an ambulance, but said the usual emergency hotline automatically diverted to a recorded message about the outbreak.

As the old man bled from his face on the street, she kept trying and finally reached the police, who dispatched an ambulance from a town miles away. “We have to hope that nothing else happens to us besides the coronavirus,” said Carelli, 45.

The spread of the virus and the abundance of elderly patients have worried experts, many of whom are concerned that the outbreak threatens to monopolise the attention and resources of Italy’s public health system.

In the north, many hospitals have suspended all but the most urgent surgeries in order to free medical beds and other resources for acute coronavirus cases. Staff have cancelled vacations and put in overtime.

Lombardy’s president, Attilio Fontana, said that the region is asking retired doctors and nurses to return to work. In Padova, the hospital pitched tents outside in preparation for an influx of cases. And on Wednesday, Italy’s government set aside a space for patients with the virus inside a military hospital.

Raffaele Bruno, director of the infectious disease unit at San Matteo, said that a sudden burst in the number of cases would put an unsustainable strain on operations in the north. “If I have to admit 10 percent of them in the hospital and 2 percent goes to intensive care, I don’t have any more spots to take care of other patients who have other illnesses,” he said.


Mixed expressions

Speaking on Radio1, Alessandro Vergallo, the president of the national association of anesthetists, said that in Lombardy, “we can count the free spots in the hospitals on the fingers of two hands.” The health system can’t long survive under such conditions, he said.

Around Lombardy, elderly Italians expressed a mix of caution, fatalism and nonchalance.

While the men in the bocce club shrugged off the threat, they did so next to empty courts and empty tables. Most of their friends had stayed away.

“I think they’re scared,” said Annalisa Canato, 67, who sat by the bar. “For good reason.”

In Secugnago, a few hundred yards outside a checkpoint blocking the entrance to one of Italy’s locked-down towns, old men shrugged off the threat and said they often drank with friends who slipped out of the quarantined towns via country roads.

“If it comes here and gets me, it gets me,” said Domenico Coppini 79, as he stood outside the Liberty Bar in Secugnago. “Italy is old. And the virus is getting old people.”