I n Italy – where the coronavirus death toll recently surpassed China – critical shortages of protective gear have left undertakers in the country’s worst affected region unable to get new face masks, leaving them at acute risk of contagion with some funeral directors too afraid to pick up the deceased.

Undertakers are now rationing their own dwindling reserves of masks and sanitisers to enter the homes of families under quarantine, as the total coronavirus cases in Italy reached 59,138 on Sunday, including 5,476 deceased and 7,024 recoveries. By Monday, the total number of deaths jumped to 6,078 after more than 600 people died in just 24 hours.

The spread of the contagion coupled with the lack of protective gear has already shut the doors of a number of funerary services in Lombardy, the hardest-hit region with 17,885 active cases, and risks further disrupting this essential service.

With Covid-19 claiming thousands of lives, undertaker Mario Giannella says his job has become hasty and perilous – but the repercussions to public health would be too dire for him to give in to fear.

“What will happen when there aren’t enough of us?” the 48-year-old told The Independent. “Who will want to improvise as undertakers?”

The Italian National Federation of Funerary Parlours (FENIOF) sent an appeal to the Civil Protection – the emergency department – and Lombardy’s regional authority, demanding to receive access to protective equipment including filtered face masks and hand sanitiser.

The importation of face masks has been centralised by the government and they are being redistributed by regional authorities to guarantee supplies to hospitals. Over 3,700 healthcare workers have been infected amid surging numbers of intensive care patients requiring long-term hospitalisation.

A spokesperson for Lombardy’s regional authority told The Independent that 300,000 face masks were being distributed every day – but only to hospitals. In a written response to FENIOF’s appeal, the regional authority stated that “at the present time, we can only resupply public workers in the health sector. It will be up to the single companies to cater to their needs.”

However, the centralisation makes it impossible for private companies to acquire filtered face masks and hand sanitiser autonomously. Rome’s cry for help has fallen on deaf ears as countries around the globe scramble to bulk up their mask supplies, with some banning all exports. China has been one of the few countries to respond to Italy’s appeal, sending doctors and medical equipment.

FENIOF was not able to estimate a tally of contagions for undertakers or how many businesses might have been affected so far, but at least four funerary operators have shut their doors in the city of Milan alone, while others worked overtime.

Undertaker Giannella says the situation has left colleagues overburdened and afraid. In Limbiate, a town of 35,000 in the hard-hit Lombardy region, he knows every client by name. As he enters their homes amid a nationwide lockdown, he is greeted by spouses, siblings and offspring who might have Covid-19.

The gut-wrenching feeling of having become the remover of plagued corpses is as difficult to bear as the fear of falling ill, he said.

Some relatives take him by the arm and lean in closer in a bid to stir compassion, imploring him to hold a funeral, despite all religious ceremonies having been banned on 9 March in a bid to halt the spread of the virus.

The risk of contagion appeared to be underplayed by the regional authority, which advised FENIOF in a written response to apply “standard precautions as the deceased ‘does not breathe and therefore does not disperse the virus in the air through respiration’.”

Alessandro Bosi, FENIOF’s secretary general, argued that this is short-sighted.

A body could still exhale liquids and gases that could be infectious, but that is not the biggest concern. Bosi told The Independent: “The risk is posed by the relatives.”

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He estimated one in four deaths occur at home, but numbers may rise as hospitals run out of beds. Those who exhibit symptoms compatible with coronavirus that are not considered life-threatening are often required to self-isolate and wait to be tested at home. But the coronavirus-led steep and rapid downturn means many do not make it to the hospital.

Others may be positive to coronavirus but asymptomatic, leaving undertakers in need for protective gear at all times.

To stay operational, some undertakers say they are having to reuse the same face masks beyond the maximum recommended time limit of four hours.

The gravity of the situation became apparent earlier this month, when an angered man shared a video lamenting not being able to get funerary operators to collect his sister’s body while he was quarantined at home with her.

Luca Franzese, whose sister tested positive to Covid-19, filmed his appeal – which became viral and sparked strong reactions on social media – as the corpse was still visible on the background.

They “refused to come because they were not equipped”, he said, demanding an apology from the authorities, as the 118 health emergency number was not able to provide guidance.

According to FENIOF, funerary operators are also dependent on doctors or medical guards – who ascertain the death of their patient and fill in the legal documents – and cannot intervene if they are not available, or refuse to enter a home without the necessary protective gear.

Italy’s death toll surpassed China’s on Friday, when it reached more than 3,400.

Residents of the northern city of Bergamo ware left aghast on Wednesday as 30 army vehicles were brought in to remove the coffins piling up in the churches and morgues.

Prior to the outbreak of the virus, funerary services in Italy’s worst hit town were handling 1,300 to 1,400 deaths per year. At present, they are managing over 300 per week – 14 times more compared with last year.

This has left morgues and churches full as crematory chambers struggled to respond to the demand.

Army vehicles intervened to move the coffins out of Lombardy towards regions in central Italy where morgues were not operating at full capacity. Following the ministerial decree banning all religious celebrations, bodies are being cremated hastily and without funerals.