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Italian authorities voiced growing concern on Sunday over how much longer strained health systems could cope with the coronavirus outbreak, as thousands of new cases were recorded over the past 24 hours and several hundred more people died.

While the virus has begun spreading rapidly across Europe, Italy remains the second most heavily affected country after China, where the illness first emerged, and the outbreak has shown no signs of slowing.

The government is working urgently on procuring more protective equipment, Prime Minister Giuseppe Conte said, adding there was maximum attention on helping Lombardy, the northern region where the virus emerged three weeks ago.

“Our priority is to keep doctors, nurses and all our health personnel safe,” Conte said in a statement.

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A week ago, his government, which is expected to confirm a 25 billion euro (US$27.68 billion) package of measures to support businesses and workers hit by the crisis, imposed a virtual lockdown across the country.

With 24,747 cases and 1,809 deaths by Sunday – a rise of 368 in the death toll in just 24 hours – Italy’s experience has offered an alarming example for other European countries which have begun seeing sharp rises in cases over recent days.

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Lombardy, the heavily populated area around the financial capital Milan, has been the worst-affected region with 1,218 deaths. Of those, 252 were recorded in the last 24 hours.

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Italy has the most elderly population in Europe, with almost a quarter of the population aged 65 and over, rendering it especially vulnerable to a disease that has predominantly killed older people.

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PUSHED TO THE LIMITS

The head of the civil protection authority, Angelo Borelli, said that Lombardy had been able to transfer some patients to other regions. He also said he was so far unaware of any cases of patients dying because of a lack of intensive care facilities.

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But the health systems in Lombardy and in other regions like Emilia Romagna and Veneto at the epicenter of the Italian outbreak have been pushed to their limits.

“The numbers have continued to grow. We’re close to the moment where we will have no more intensive care beds,” Lombardy governor Attilio Fontana told SkyTG24 television.

Italy was the first government in Europe to impose country-wide restrictions to try to control the spread of the virus, closing schools, shops and sporting events and ordering people to stay in their homes for all but essential travel.

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Most cases in Lombardy have been in small towns in areas like Bergamo and Brescia, but there have been fears of a major spread into Milan itself, which could overwhelm hospitals.

“The big challenge will be to see how far we can succeed in keeping Milan, the metropolitan area, away from a mass phenomenon with the disease,” said Massimo Galli, head of the infectious diseases unit at the city’s Sacco hospital.

Authorities have been working to set up hundreds of intensive care beds in a specially created facility in the Fiera Milano exhibition center but are still waiting for sufficient respirators and qualified personnel.

Behind the concern for the north, where intensive care and assisted breathing units were at saturation point, there was also a looming worry over the much less well-equipped south, where tens of thousands of people have arrived from the affected regions.

Nello Musumeci, president of the Sicily region, said at least 31,000 people had arrived from northern and central areas in the past 10 to 12 days and registered with authorities but the real number was much higher.

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“How many other thousands have entered without showing the same sense of responsibility?” he told RAI state television, adding that the army might have to be deployed to oversee points of arrival.

($1 = 0.9033 euros) (Reporting by James Mackenzie Editing by Jan Harvey and Frances Kerry)