When her hospital in the northern Italian city of Cremona had its first case of coronavirus three weeks ago, Francesca Mangiatordi was on a night shift.

Since then, as dozens of new cases poured in, the emergency-room doctor has been faced with heart-rending choices, such as how to allocate scarce oxygen supplies among critically ill patients.

“These are the choices I would have never wanted to make,” she said. “It’s somewhat like being in war.”

The outbreak of the virus has pushed Italy’s health care system in the worst-affected areas to the brink. In just weeks, the number of confirmed infections in Italy has soared from a handful to more than 12,000, with 827 dead, the highest rate outside of China, where the virus originated.

Lombardy, the wealthy northern region that is home to Milan, has had 7,280 cases, about 58% of Italy’s total. Across the country, about 6.6% of those infected have died, but in Lombardy, that rate is 8.5%. Three-quarters of the overall deaths have been in Lombardy. The global mortality rate for the virus is about 3.6%, according to World Health Organization data.


The soaring number of cases in Italy’s north influenced the Italian government to lock down the entire country. On Wednesday night, authorities tightened the quarantine, decreeing the closure of all shops except for food shops and pharmacies. Bars, restaurants, hairdressers, and other service-sector outlets where people meet are now closed until April 3. The government is trying to drastically reduce social interactions to slow virus infections and relieve the pressure on hospitals.

A health-care worker outside a hospital in Codogno, near Milan, in northern Italy. Photo: miguel medina/Agence France-Presse/Getty Images

Authorities are especially concerned that a surge in cases in Italy’s poorer southern regions, where hospitals are less prepared than the north for such crises, would cause hospitals to buckle. Italy’s health-care system has been weakened by cuts in funding over the last decade, according to Fondazione Gimbe, a medical research firm foundation.

Even in Lombardy, intensive care units are almost at full capacity despite authorities’ efforts to add beds and provide equipment.

“There are no more ICU beds,” said Bergamo Mayor Giorgio Gori in a tweet Tuesday. Mr. Gori said efforts to reorganize hospital facilities and add intensive-care beds may not be enough to cope with a continued sharp rise in cases.


The main hospital in hard-hit Cremona, a town about 50 miles outside Milan, has more than tripled the number of intensive care beds but they are filling up quickly, with about 35 new cases arriving daily, said Dr. Mangiatordi.

In early March, Marco Resta, an intensive care doctor in Milan, volunteered to help at a hospital in Lodi, a city about 25 miles outside Milan that was at the center of Italy’s first major outbreak. He found doctors struggling to improvise to stretch resources to meet the needs of a wave of critically ill patients, including equipping normal units to handle such cases.

“The terms that I use when friends ask me how I am doing are ‘Afghanistan’ and ‘Vietnam’,” said Dr. Resta. “We had to improvise as it was something we were not prepared for.”

A coffin is brought out of a hospital in Venice. Funerals and other religious ceremonies are being canceled across Italy. Photo: Marco Di Lauro/Getty Images

The northern region has scrambled to add intensive-care units, reorganizing wards and postponing nonessential surgery. Most of the region’s roughly 150 hospitals now focus on coronavirus cases. In the past several weeks, over 230 intensive-care spots, including breathing equipment, have been added and more will be created in coming days, according to regional authorities.


“We are navigating the perfect storm,” said Alberto Zangrillo, chief of intensive care at San Raffaele Hospital in Milan. “But the system has held up so far.”

Violent revolts have erupted in several Italian prisons after authorities suspended visits to curb the spread of the coronavirus. Late Monday, the government locked down the entire country, restricting travel and banning public gatherings. Photo: Antonio Calanni/Associated Press

The volume of patients at San Raffaele has in about three weeks reached levels comparable to those typically seen over the course of five or six months, said Dr. Zangrillo. The hospital has responded by cutting routine operations by 80% and expanding the intensive care unit, which has been at full capacity for at least two weeks.

Strained by marathon working hours, a number of doctors and nurses have drawn wide public attention for their social media posts.

“I never was at war, but that’s how I imagine it,” said Federica Brena, a medical oncologist at a hospital in Bergamo, another hard-hit area in northern Italy, on Facebook. “The health-care system risks collapse.”

Dr. Mangiatordi posted this photo on social media of a nurse taking a few minutes to rest while still wearing protective gear after a 10-hour-long shift treating coronavirus patients at Ospedale Maggiore of Cremona, Italy. Photo: Francesca Mangiatordi

A photo showing a sleeping nurse slumped over a computer while still wearing protective gear was widely shared on social media, becoming a symbol of the emergency and the strain the epidemic has put on medical personnel.


“We are doing everything humanly possible,” said Dr. Mangiatordi, who took the photo. “But sometimes I feel powerless.”

Medical staff risk getting the infection themselves. Despite protective equipment—double gloves, tightened face masks and scrubs—medical personnel account for about 12% of those infected in Lombardy.

“The staff is exhausted and a growing number of workers are in quarantine, making it more difficult to organize shifts,” said Stefano Magnone, a surgeon at a hospital in Bergamo. He is among the medical professionals with other specializations who are set to be trained to treat coronavirus-affected patients.

Doctors and nurses have joined the national campaign to encourage Italians to comply with the governmental quarantine and slow the spread of the deadly virus.

“It’s an extreme situation and everybody has to help us,” Dr. Mangiatordi said. “Please stay home and prevent the virus from spreading.”

Write to Pietro Lombardi at Pietro.Lombardi@dowjones.com