The coronavirus death toll in Italy has risen by nearly 400 in 24 hours, to 1,809 from 1,441, officials have said.

The total number of infections in the country, which is in lockdown, has also gone up, to 24,747, from 21,157, as Europe’s worst outbreak of the virus continued to expand.

Authorities voiced growing concern on Sunday over how much longer the strained health systems in northern regions worst hit could cope with the relentless rise in new cases.

The country’s experience offers an alarming example for other European countries that have begun seeing sharp rises in cases.

The World Health Organization says Europe is the world’s epicentre of the virus, and Italy has the highest number of cases.

One doctor told The Independent how medical staff are being forced to ration care to patients with elderly patients being denied care based on their age and whether they have other conditions.

Lombardy, the heavily populated area around the financial capital Milan, has been Italy‘s worst-affected region, with 966 deaths and 11,685 confirmed cases, more than half the national total.

The health systems there and in other rich northern regions such as Emilia Romagna and Veneto, are considered among the best in Europe, but have been pushed to their limits.

Authorities have been working to set up hundreds of intensive care beds in a specially created facility in an exhibition centre but are waiting for sufficient respirators and qualified staff.

“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 said.

But worries are also looming over the much less well equipped south, where tens of thousands have arrived from the virus-affected regions.

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

“How many other thousands have entered without showing the same sense of responsibility?” he told RAI state television.

The army might have to be deployed to oversee points of arrival, he said.