ROME—Dr. Marcello Natali never left the front line in the northern Italian town of Codogno when the novel coronavirus outbreak exploded more than three weeks ago. And the front line is where the 57-year-old physician died this week from the disease he fought so hard. Natali, whose wife is also a health care worker, had no preexisting conditions, and was far younger than the median age of 80 of most of Italy’s nearly 3,000 COVID-19 dead. But he only agreed to get the intensive care he desperately needed last week after his symptoms overwhelmed him.

He didn’t go in sooner because he didn’t want to take an intensive care unit bed from anyone else. The crisis has put a severe strain on the entire health care system, with some of the best hospitals in Europe using corridors for ICU wards. Natali was taken by ambulance first to a larger facility in nearby Cremona and then to Milan, where he died alone in isolation. And since funerals are prohibited as part of the national lockdown, he will not even receive a hero’s burial.

“Hi Marcello,” Irven Mussi, his close friend and fellow family doctor wrote in a farewell letter published in the Italian press in lieu of a funeral. “They took you to Cremona, then moved you to Milan…. And now you're dead, alone, like everyone else.”

“ At least 2,629 health care workers—roughly 8.3 percent of all cases in Italy—have contracted COVID-19. ”

Natali, who was the head of the region’s Federation of General Practitioners, is the fourth doctor to die in the original red zone, which has been under lockdown since Feb. 23. Just days before he went into intensive care, he gave a radio interview in which he complained that testing was taking too long and that there were many cases that family doctors were taking care of on a house call basis without full protection, exposing them to the virus.

“You in Codogno were the first to enter the war, with fear, but with a superior sense of duty,” Mussi wrote to his friend. “And you've been defeated. We have all been defeated with you. It is absurd, devastating. We are the first barrier and we have no protection, we are getting sick in great numbers and risk making our patients ill.”

As the virus spreads to the United States, health care workers there are watching Italy’s situation closely, and terrified doctors have sounded the alarm repeatedly. But the numbers do not augur well. Italy’s state run health care system is able to provide 3.2 beds per 1,000 people compared to 2.8 beds per 1,000 in the U.S, according to the OECD. On Wednesday, the U.S. State Department confirmed that Italy had sent 500,000 swabs to the U.S. to help complete test kits. The fact that the sick are now helping those perceived to be stronger should be worrying.

COVID-19 was not the first battle Natali fought. For years he had worked to reverse budget cuts to the state health care system that have led in part to the current strain on the system. He was hopeful that new reforms set out before the coronavirus disaster would be put in place, potentially even helping to avert the type of disaster the system is facing now.

“We were joking about when this reform would come into effect,” his friend Mussi wrote. “I claimed that we would first retire, you replied that we would be dead first. I never imagined that, once again, unfortunately, you would have been right.”

At least 2,629 health care workers—roughly 8.3 percent of all cases in Italy—have contracted COVID-19 from working with inadequate equipment or being exposed to asymptomatic carriers, according to the latest results from the Ministry of Health.

In the province of Bergamo alone, another of the most hard-hit regions, 50 doctors have been infected and one has died. Giulio Gallera, the head of the Lombardy Health and Welfare administration, where Bergamo is located, said that the number of infected health workers is 12 percent of all cases in the second most hard hit northern region near where the outbreak began. “If we continue in this way we risk not only that there will not be enough doctors to assist everyone, but also that the same health professionals will become, despite themselves, a vehicle for infection,” Gallera said.

Health workers who suspect they have the virus and showing no symptoms are still working in many areas, others say they are forgoing the testing altogether because as long as they feel strong enough to work, there is no need to stop. After all, if they have the right protective gear on, they won’t likely pass it along. That’s where shortages become an even greater concern.

Across the country, med students and nurses are graduating early to work in the field, and technicians and other medical assistants in training are now on the front line as more health workers fall ill. On Wednesday, the health ministry pleaded for all retired doctors and nurses to come out of retirement and offer their services to relieve the strain on the system. Health workers are putting in double shifts, sometimes working with very few breaks to try to keep up with the burgeoning caseload. On Wednesday, Italy’s total caseload rose to 35,713, up more than 4,000 from the day before.

"New measures are needed to regulate the activity of doctors in clinics, to protect the health of professionals and the whole population," Filippo Anelli, head of the National Federation of Orders of Surgeons said in an open letter to the Italian government. “We doctors are ‘super-spreaders’ of the virus, because we work closely with patients, many of whom are made fragile by age or by pre-existing diseases. If statistically, for COVID-19, any infected person can infect two others, that means when a doctor is ill, he can infect up to 10 people.”

Officials say it may take until March 26 before the curve starts to flatten and the new cases start to go down. Considering how fragile the whole health care system is now, it is hard to imagine how strained it will be by then.