ROME—As least six inmates have died, and at least 50 others have escaped from an Italian prison in the southern region of Puglia on Monday amid extensive rioting in 27 prisons across the country after visitation rights were curtailed due to the rapid spread of the novel coronavirus.

Riots broke out Sunday afternoon in half a dozen prisons after the Italian government enacted a draconian decree that has locked down 16 million people and curtailed movement across the entire country to try to contain the spread of COVID-19. By Monday, the riots had spread to nearly 30 detention facilities.

The number of coronavirus cases in Italy reached 9,172 on Monday, the highest number outside of China. At least 463 people have died in Italy with the virus, the second highest number of fatalities after China.

In Modena, now part of the extended outbreak red zone designated by the government, prisoners were able to take two guards hostage Sunday and steal keys before climbing a barrier fence to try to escape. They were eventually pushed back by riot police, but the prison had been so damaged that all inmates had to be moved to temporary facilities.

In a prison in Pavia, inmates lit mattresses on fire, causing a wing of the facility to be evacuated Sunday. Flames coming from the prison could be seen more than a half-mile away.

On Monday, prisoners were seen on top of the San Vittore Prison in Milan, at the heart of the outbreak. There, fires were burning in some areas after all visitation rights were banned after the city was put on lockdown Sunday. During morning recreational time, inmates charged guards and gained access to the roof.

In Rome, where nearly 90 people have tested positive for the disease across the province, prisoners have been prohibited from congregating in open areas for recreation. In the Regina Coeli prison in central Rome, inmates could be heard yelling and banging objects in their cells on Monday. Prisoners in the city’s Rebibbia prison also set that facility on fire on Monday afternoon, after which around 30 prisoners escaped. Helicopters were flying low over the city center, and sirens wailed for most of the afternoon as the inmates were apprehended.

Most criminal trials that have not been suspended across the country will be held in closed courtrooms without prisoners present—out of fear of them contracting the virus in court and spreading it to other inmates. The murder trial involving American teens Finnegan Elder and Gabe Natale for the stabbing death of an Italian police officer last July was in session behind closed doors Monday, but the suspects were not allowed to leave the prison to attend the hearing.

Italian prisons are severely overcrowded, with 61,230 inmates in detention centers meant to hold a capacity of no more than 50,950.

Inmate-rights groups have complained that testing is not being conducted inside prisons across the country and that a lack of confirmed cases among the incarcerated is not reflective of the current situation.