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How coronavirus overwhelmed Italy, with 4,000 deaths in one month

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ROME - Police driving through the center of Rome blast loudspeaker messages telling people to stay indoors. The few who venture out are liable to be charged with crimes if their reasons are deemed frivolous. Most Italians have internalized the lockdown with a wartime-level commitment, scolding and shaming those who break the rules.

Still, even that hasn't been enough.

A month after first cases exploded into view in northern Italy, the coronavirus has killed more than 4,000 Italians, including 627 reported on Friday alone. It has sickened tens of thousands more, and swiftly rendered the country unrecognizable - somber, desolate and scared. But for all the life-disrupting measures Italy has taken to slow the virus, it continues to spread and kill at an alarming clip.

The feeling is that battle against the virus, brutal and consuming as it has been, is only beginning.

As the first Western country to deal with a major outbreak, Italy has become a grim symbol of the virus' dangers and the difficulty of contending with it. While other European countries and some U.S. states have borrowed Italy's stay-home strategy, Italy is learning that the strategy does not work quickly, even when broadly adhered to.

Ten days since the beginning of a strict nationwide lockdown, the number of known coronavirus cases continue to rise some 15 percent every day. While that is shy of exponential growth, it is enough to overwhelm hospitals and morgues. More people are getting sick than can be cared for.

The lockdown, which included restrictions on travel and the closure of most stores aside from supermarkets and pharmacies, was initially put in place through April 3. But Prime Minister Giuseppe Conte made it clear in an interview with the Corriere della Sera that the measures would go on longer.

Conte said the "restrictions are working." But even once the pace of transmission starts to wane - hopefully days from now, he said - "we won't be able to immediately resume life as it was."

Some politicians in Italy's northern provinces have pressed for even harsher measures. They want narrower hours for supermarkets, a wider closure of factories and a mass-scale military deployment to keep people off the streets. Several leaders in the north have turned their ire toward people who continue to exercise outdoors, and have called on Conte to place a ban on jogging.

In an interview, the vice governor of the Lombardy region, Fabrizio Sala, said anonymized data provided by telecommunications companies indicated that 60 percent of all movement in the region had stopped, compared to a normal period before the virus. But even so, he said, too many people were leaving the house.

"People should stay at home more," he said.

Polls indicate that the lockdown has wide support, and many of the Italians leaving their homes are doing so for essential work. Still, tens of thousands have been cited by police for breaking the lockdown rules.

In recognition of the limits on how democracies can contend with the virus, Italy has not used some of the more heavy-handed or invasive tools used successfully by China - including sustained monitoring outside apartment complexes and apps that log location and body temperature.

Italy's biggest mistake, virologists say, was not instituting the nationwide lockdown more swiftly.

It is unclear if such a move, made weeks earlier, would have been as widely accepted - because the horrors of the virus had not yet come fully into view. Still, by the time Conte formally made his decree on March 10, the virus's explosive growth had been set in motion.

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"That move should have come from the beginning," said Giorgio Palù, a professor of microbiology and virology at the University of Padova and the former president of the European and Italian Society for Virology.

Instead, when Italy was learning about the first burst of locally transmitted cases, it put only a fraction of the country - 50,000 people, in 11 towns - in strict lockdown. People in those towns were banned from exiting or entering, barring emergencies, and they were tested rigorously.

Experts say the disaster was likely set in motion weeks earlier, with people transmitting the virus well before officials realized there was any problem. The epicenter of the outbreak was Italy's richest region, but also one of the oldest areas in a nation that has the world's second-highest proportion of seniors. Because older people are more vulnerable to the coronavirus, Italy has been hit particularly hard. Among the people who have died, the median age is 80, according to Italy's national health service.

Some initial signs suggest the localized lockdowns may have helped. Ten of those towns were in the Lombardy province of Lodi, where the pace of cases has risen at a rate far below other areas in the region. In a sealed-off town in a separate region further to the east, Vo', the transmission of the illness has nearly stopped.

"You always pay a price for being first," said Giuliano Martini, the Vo' mayor. "But the others had time to act based on our experience, looking at the situation on the ground. They could've predicted it."

Now under nationwide lockdown, all of Italy resembles Vo' from several weeks ago. People stress about the economic cataclysm that is waiting the country, but those fears compete for more foundational concerns: about elderly parents, about the inability to see loved ones. In many neighborhoods across the country, stir-crazy Italians go to their balconies at night and either sing or open their windows and play music. At other times in the day, one of the public radio stations has started playing songs about the locked-down life. ("We are all cooks," one lyric said.)

The moments are levity are fleeting, though, and there is widespread agreement that the country is facing its gravest challenge since at least World War II. This week, Italy surpassed China for the largest number of coronavirus-related deaths. Each of the last six days, the country has announced at least 300 dead. In Bergamo, the hardest-hit cities, military trucks have started lining up outside a hospital, to take the dead away to farther-away crematoriums.

On Friday, Sky News published footage from inside the main public hospital in Bergamo depicting a wrenching crisis: patients on gurneys struggling to breathe, including in the hallways, and exhausted-looking doctors and nurses without proper protective gear. In a public plea posted on the hospital's Facebook page, the director of the department of medicine, Stefano Fagiuoli, said the facility was in "full emergency."

"We are in desperate need of both nurses and physicians, together with ventilators" and protective equipment, he said.

He issued what amounted to an open call for nurses and doctors who wanted to come to Bergamo.

"If you are a health personnel, you are more than welcome to join us in fighting the coronavirus," Fagiuoli said.

The situation is most dire in the north, but cases are increasing rapidly in most parts of the country, and authorities have been responding to a growing number of local hotspots. Some of the cases were transmitted by people who fled Lombardy and returned to their southern hometowns before travel restrictions were put in place. This week, authorities closed off a town of some 40,000 two hours south of Rome, after seeing a spike in cases. A new decree prevents people from leaving even for work purposes.

The spike had reportedly been triggered by a festival three weeks earlier.

Since then, according to the text of the restrictions place on the town, the increase in cases had been "remarkable."

- - -

- Jan. 31: Italy confirms coronavirus in two Chinese tourists visiting Rome. The government declares a six-month state of emergency and becomes the first European country to suspend flights from China.

- Feb. 21: Italy reports its first cases of apparent community transmission and its first coronavirus death, a 78-year-old man from Vo, in the Veneto region.

- Feb. 22: Italy announces a lockdown affecting 50,000 people in the northern Lombardy and Veneto regions.

- March 4: With more than 2,500 cases confirmed, Italy announces closure of schools and universities.

- March 8: With nearly 5,900 cases confirmed, Italy orders a lockdown for 16 million people in the north, while also closing museums and theaters nationally.

- March 10: With nearly 7,400 total cases, the lockdown is extended to the rest of the country, limiting travel abroad and across regions.

- March 11: With nearly 12,500 cases confirmed, the government halts nearly all commercial activity aside from supermarkets and pharmacies.

- March 19: Italy surpassed China as the country with the most reported coronavirus deaths.

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