The Nightmare of Covid-19
The epidemic that has brought Italy to its knees
In-depth report by Giuseppe De Lorenzo, Andrea Indini

The Nightmare of Covid-19

If anyone in Italy were asked where the nightmare began, no one would have difficulty in indicating a town, Codogno, and a date, 21st February. In fact, when we caught a glimpse of the first flames and started shouting “Fire!” we did not know that we were already in the middle of a fire that was as vast as it was tenacious and hence extremely difficult to extinguish.

The town of Codogno on 22nd February 2020 just after the Coronavirus emergency broke out (LaPresse)

The explosion of the epidemic

It was just after midnight on 20th February when the Welfare Councillor of the Lombardy Region, Giulio Gallera, reported the first infection: a 38-year-old admitted to hospital in Codogno (Lodi) tested positive for Covid-19. During the day the number of people infected in Lombardy rises dramatically to 15. In the same few hours we are faced with having to manage another outbreak: this time in Vo ‘Euganeo, in the province of Padua. The first death occurs, a 78-year-old admitted to hospital in Padua.

 

I carabinieri bloccano gli accessi a Vo' Euganeo, focolaio veneto del Coronavirus (LaPresse)

Codogno, where it all started

It all began on 14th February when Mattia, a young athlete in excellent health, contracted the “usual flu” which did not go away. “On the 18th he came to the accident and emergency department in Codogno and the x-rays showed mild pneumonia – explains anesthetist Annalisa Malara in Codogno in an interview with La Repubblica. The profile did not justify a compulsory admission and he preferred to go home. A matter of just a few hours: during the night of the 19th he returned and the pneumonia was already very serious “. The comings and goings of Matthias from the hospital are probably the cause of the rapid spread of the virus amongst doctors and hospital patients.

By following the government’s protocol, the chain of contagion can in no way be avoided. As revealed by ilGiornale.it, the ministerial circular in force at the time (that of January 27thb) considers to be “suspected cases” only those people with “serious acute respiratory infection” who have also been in “areas at risk in China”, who have worked “in an environment where they are treating patients” struck by Covid-19 or who have had close contact with a “probable or confirmed case of nCoV”.

Un paziente colpito da Covid-19 in un ospedale italiano (LaPresse)

It is only thanks to Malara’s intuition that we can understand what is going on. To do this, however, she must “seek authorisation from the health authority” and take responsibility for carrying out the test because “the Italian protocols did not justify it”.

 

In the meantime, Mattia’s movements are mapped to trace his last contacts. The authorities look for “patient zero”, the one who infected him. The finger is pointed first at a manager who recently returned from China and there is even speculation that there is a link with the closure of a section of a railway line after the derailment of a high speed train in Lodi and the resulting throng of commuters on regional trains.

With the passing of time, however, this line of enquiry appears increasingly devoid of substance and it becomes difficult to find a solution to the puzzle. What is not yet known is that the contagion exploded weeks earlier and the virus has therefore been injected into the tissue of northern Italy. da settimane e che quindi il virus è iniettato nel tessuto del Nord Italia.

Death comes to the valley

The case of Mattia in Codogno is followed by the contagion in the Bergamo hospital of Alzano Lombardo. In a “report on the first phase of the emergency” dated 8th April, the Local Health Authority of East Bergamo explains that “in the period between 13th February and 22nd February some patients arrived at the hospital accident and emergency department and were admitted to the general medicine ward and diagnosed with pneumonia / acute respiratory failure “. Here too “none of the patients (…) presented the conditions set forth by the Ministry of Health for the definition of a suspected case”. It was not until 22nd February, “as a result evidence of an outbreak in the Lodi area, did it become known (…) that this epidemiological criterion was no longer to be considered totally reliable even though it had not yet been modified”.

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A few hours earlier, at around two in the morning, Angiolina dies, an elderly lady who has been hospitalised since 12th February. Her husband Gianfranco died on 13th February and her sister on the 15th. As soon as the news of Codogno arrives they rush to take the first tests and, when on the 23rd the positive results arrive (Franco Orlandi’s and Samuele Acerbis’, both from Nembro and both hospitalised for a week in the same ward as Angelina and now dead from coronavirus), the accident and emergency department is evacuated and reopened after two hours.

L'ospedale Pesenti Fenaroli, ad Alzano lombardo, in provincia di Bergamo (LaPresse)

It is a decision that will be much discussed but, as we will see shortly, it will be dictated by the need to face an emergency that was now ongoing and the fact that now nothing can be done to prevent it apart from immediately closing down the whole country. But “total closure” is still a long way away.

On the other hand, the search for the causes of the spread of the epidemic gets bogged down in a long series of hypotheses that all together can be deemed to be true and that all together have helped to “trigger the atomic bomb”, to use an image used by Gallera.

On the weekend when it all began, according to an Espresso investigation, a hypermarket on the outskirts of Bergamo is literally “looted”: the shelves are completely emptied and almost Euro 800,000 is collected. Another investigation, published by La Repubblica, sees the Champions League match between Atalanta and Valencia played on 19th February in San Siro as the threat that caused the province of Bergamo to explode.

Secondo alcuni virologi, la partita Atalanta-Valencia avrebbe innescato la bomba che, 15 giorni dopo, avrebbe messo in ginocchio la Bergamasca (LaPresse)

Just a week earlier, in the Valencia region, Spain confirmed the first death from Covid-19. 45,000 Atalanta fans flock to Meazza: many arrive by car, but there are also about thirty buses.

However, according to Massimo Galli, head of the infectious diseases department at the Sacco Hospital in Milan, the epidemic “started earlier, in the countryside, during agricultural fairs and in country bars”.

Nembro, uno dei comuni più colpiti nella Bergamasca (LaPresse)

Nembro, uno dei comuni più colpiti nella Bergamasca (LaPresse)

The Piacenza case

On 22nd February, on the same day that the doctors in Alzano Lombardo find out that a tsunami is about to hit, the Piacenza Hospital finds the first positive case.
It is an 82-year-old lady who lives in Codogno. By the time she tests positive it is too late to do anything: two doctors and a nurse were also infected the next day. And while Codogno, which is only 16 kilometers away, is already cordoned off, the government prefers to wait to extend the restrictions to Emilia Romagna. This will not come until 8th March by which time, in what is the most affected province in the Region with 528 infected (out of the 1180 cases in the region), 24 deaths have already been recorded.

Tensostruttura davanti al Pronto Soccorso dell'Ospedale di Piacenza per far fronte all'emergenza Coronavirus (LaPresse)

Tensostruttura davanti al Pronto Soccorso dell'Ospedale di Piacenza per far fronte all'emergenza Coronavirus (LaPresse)

The day before, on 7th March, four men and a woman pass away in Piacenza hospital: “Until 24 February people reporting fever and cough, and others with different ailments, arrived without distinction at the accident and emergency department – says a nurse at the hospital who asked to remain anonymous – there have been infections both among the medical and nursing staff and among those who had been to the accident and emergency department and in many cases there have been fatalities”.

However, the Region in any case decides to keep the hospital open and it is not until 5th March that the one in Fiorenzuola d’Arda, another coronavirus epicentre, closes. This is because, just like in Alzano, the epidemic had already broken out and it was essential to keep hospitals open in order to treat the infected.

To understand this, it is necessary to look at the figures of 9th April: Alzano Lombardo and Fiorenzuola, which have about the same number of inhabitants, also have a similar number of infected people. The same result is obtained by way of a comparison between the cities of Piacenza and Bergamo. Furthermore, if you look at the incidence per thousand inhabitants, the province of Emilia exceeds that of Lombardy. In absolute numbers Bergamo obviously appears more affected, but because it has 1.1 million inhabitants. Piacenza has only 287,000.

The Orzinuovi outbreak

There are however two images that make up our picture of Brescia. The first is the trend of the contagions of the Lombard provinces, the graph that by now everyone has learned about. For days the curves of Bergamo and Brescia border each other just like the two territories and grow at the same rate. Then on 8th April they touch each other and Brèsa, as they call it in dialect, reaches Bèrghem. And then overtakes it. The other photograph is that of two refrigerated containers parked in front of the crematorium in the city. The procession of coffins reaches the cemetery of Sant’Eufemia but the ovens are no longer able to keep up with the death rate of the coronavirus. Before being enveloped in flames, the bodies must wait two weeks in the deposits. Too long with the sultry heat coming. So the coffins are crammed into those refrigerator cells that are so reminiscent of the Bergamo caravan. Also because the numbers are those of a massacre.

Un sacerdote cammina all'interno del cimitero monumentale di Brescia, detto Vantiniano, dopo aver benedetto le bare di alcune vittime di Covid-19 (LaPresse)

Un sacerdote cammina all'interno del cimitero monumentale di Brescia, detto Vantiniano, dopo aver benedetto le bare di alcune vittime di Covid-19 (LaPresse)

According to a calculation based on a finding by ISTAT (the National Statistics Office), deaths in the city compared to the previous year have more than doubled, from 134 in 2015-2019 to 381 in 2020. In the whole province, in the Municipalities included in the statistics, there were 466 deaths in March 2019 compared to 1,345 in 2020. Villages that usually saw only one person die per month suffered 11, 12, 20 deaths. In Corte Franca the increase is 1,900%.

Why Brescia has been affected to such an extent is not yet known but epidemiological research is now a waste of time. It is an incontrovertible fact, however, that the province is always among the top three in the Lombard ranking by number of weekly infections. And by number of deaths (over 1,900) it exceeds a metropolis like Milan and its hinterland. “We were unable to stem the outbreaks,” admits Mayor Emilio Del Bono. The first case certified at the Civil Hospital is on 24th February, two days after Alzano Lombardo. The victim is a 51 year old man from Pontevico, a small town on the plain to the south of Brescia. It is here that the epidemic seems to have started and then struck at the entire province.

Triage degli Spedali Civili di Brescia allestito per l'emergenza coronavirus (LaPresse)

The first great outbreak occurs in Orzinuovi, a town of 12 thousand souls and too many infections. The mayor Gianpietro Maffoni, a senator in the Brothers of Italy party, submitted a question to the Minister of Health to find out why the government has not set up a “red zone” around in his town. The controversy follows that of the Val Seriana but is less intense. To explain the reason for the rapid spread across the area, some focus on the San Faustino and Giovita fair as a possible source of transmission, a little like the Atalanta game for Bergamo. On 15th February over 250 thousand people poured into the narrow streets full of stalls in Brescia city centre. Fourteen days later, i.e. the incubation period of the virus, 14 people had already been infected.

The state of emergency

The first real measure against coronavirus dates back to the now distant 31st January, a few hours after the hospitalisation of the two Chinese tourists at Spallanzani in Rome. The Italian cabinet declares a state of national emergency and appoints Angelo Borrelli as commissioner. Just three days earlier, Conte had gone on television to say that Italy was “fully prepared” to face the virus without knowing that the facts would contradict him. What is surprising is that despite the “state of emergency” both the executive and Borrelli do practically nothing of any substance for 15 days, until the Codogno train hits the Palazzo Chigi and the Civil Defence Department.

The government says nothing about the legislative measures it intends to take until 23th February when, with the crisis now ongoing, it orders the first red zones in the Lodi area. It was not until 21st February, after the discovery of “patient 1”, that Borrelli allocates Euro 4.6 million to increase the number of medical personnel by a “maximum of 77 units” (not many, given how things will go). A few days later, Italy will find itself without ventilators, masks and protective equipment for doctors.

But to get the measure that will allow the Civil Protection Department to purchase the PPE with “absolute priority over any other order”, it will be necessary to wait until 25th February. Almost a month after the “state of emergency”. And it will take another three days for “acquisition of invasive and non-invasive instruments and ventilators” to have the same degree of urgency or to allocate the masks “as a priority to health personnel”.

Il reparto di terapia intensiva di Brescia (LaPresse)

Il reparto di terapia intensiva di Brescia (LaPresse)

A string of decrees

If initially Italy pays for the excessive delay in carrying out the tests on the sick who rush to the hospitals it must then pay for the complete inexperience of the government which gets confused and approves a series of decrees that delay by too many weeks the only measure that can stop the epidemic: total closure. On 22nd February there are already 79 infected people and the number of dead rises to two. The first measure comes during the night but is limited to eleven municipalities: the areas around Lodi where outbreaks have occurred (Bertonico; Casalpusterlengo; Castelgerundo; Castiglione D’Adda; Codogno; Fombio; Maleo; San Fiorano; Somaglia; Terranova dei Passerini) and Vo ’Euganeo.

On the same day, the Ministry of Health, “in view of the evolution of the epidemiological situation” and “the new scientific evidence”, changes the definition of a “suspect” case issued on 27th January, 2020. The goal is to avoid a new case like Codogno and to seek to diagnose the infected first. It is the first of a (long) series of provisions that doctors and nurses will have to deal with, with constant tweaks and adjustments. Suffice to think that a new circular will arrive on 25th February and another two days later, when a change is made to the definition of “suspected case of Covid-19 requiring a diagnostic test”. Previously the test had to be carried out only on those people who had been in China, in close contact with a case of Sars-CoV-2 infection or work in frontline hospitals; then it suffices “to have been in areas with presumed community transmission”. A further change will also be made on 3rd March.


On 25th February the epidemic spreads to other regions, the number of people infected reaches 328 and there are now 11 victims. The government therefore decides to enact a second decree that extends to Emilia Romagna, Friuli Venezia Giulia, Lombardy, Veneto, Piedmont and Liguria the measures that are in force in the eleven municipalities where outbreaks have occurred. In the same few hours, however, the first major political rift opens up between the executive and local institutions.

After governor Attilio Fontana closed all the schools in the region of Lombardy, the President Luca Ceriscioli signed an order to do the same in the Marche. In that region there are still no infections, but the Democratic Party politician wants to be far-sighted.

At Palazzo Chigi, however, they are not convinced of the need for a lockdown and even decide to appeal the order which will then be suspended by the Regional Administrative Court. “It will be an opportunity to see who did the right thing, us or the government that opposes it,” commented Ceriscioli in a very polemical manner and renews the order first on 27th February and then on 3rd March. The news will prove him right. Today the Marche region, which has almost 5,000 cases and 669 deaths, is one of the most affected regions in central and southern Italy. But above all it is most in difficulty due to the risk of running out intensive care beds. “Ordering the closure of schools creates problems for parents. It has only negative and no positive effects, ”said Conte at the time. He will change his mind on 4th March when he performs a volte-face and closes down schools across Italy.

The clash between the Prime Minister and the Marche Region can only be understood by recalling the climate that prevailed in late February. Many, even among the ranks of infectious disease specialists, consider Covid-19 a virus that is not much more harmful than normal seasonal flu. Politicians are no different.

In the Lombard capital, the mayor Beppe Sala puts his face on the “Milan does not stop” initiative. The leader of the Democratic Party Nicola Zingaretti raises a toast in company and sends tweets like: “I agree with Sala’s call, let’s not lose our habits, we can’t stop Milan and Italy”. A few days later, however, he announces, again on social networks, that he has contracted coronavirus. In those same few hours reports issued by the Lombardy Region mark Nembro as the fourth most affected Municipality, on a par with Casalpusterlengo which, however, is one of the “red zones”. And two days later, on 29th February, while Conte is being asked for more restrictive measures, Bergamo Employers’ Confederation publishes the video “Bergamo is running” and mayor Giorgio Gori relaunches it.

La zona rossa di Casalpusterlengo (LaPresse)

The result of all this hesitation? On 4th March the number of victims reaches the 100 mark. Conte therefore signs a new decree that closes down universities and schools throughout Italy until 15th March but still nothing is being done for the outbreaks that flare up in Lombardy. Alarming figures come in from the region, especially in relation to Alzano and Nembro but the Prime Minister asks for “further evidence in order to decide whether to extend the ‘red zone’ to those two municipalities”. On 5th March, the President of the National Institute of Health, Silvio Brusaferro, responds positively, but the following day the premier reiterated the line that the distinction between “red zone”, “orange zone” and the rest of the country must be overcome. So much so that, on the night of 7th and 8th March, he issues another decree prohibiting movement in Lombardy and in fourteen provinces in Veneto, Emilia Romagna, Piedmont, Marche.

During the night, the Prime Minister’s improvised live speech on Facebook to announce the new measures, triggers the “flight” to Southern Italy. Trains are stormed in the stations of the main cities in the north. An exodus that exposes the whole country to a contagion that until now has been mainly confined to the central and northern regions. Another factor contributing to the spike in cases which will be reflected in the curve for the next two weeks. The closure of the schools decided a few days earlier triggers another exodus: on the weekend of 7th-8th March many Italians flock to the ski resorts in Trentino and Valle d’Aosta.

A country in disarray

In the morning of the 9th the inmates of the Foggia prison set fire to sheets and mattresses: it is the beginning of hell. 200 of them pour into the courtyards, break through the gate and escape into the street. The police hunt 72 escaped prisoners while riots multiply across Italy and images of the devastation shock Italy (watch the video). The official reason for the protests is the reduction of visits by relatives and the fear that the virus will get into the prisons but mafia maneuvers and the hope of winning an amnesty also lie behind them. In five days the prisons of Treviso, Turin, Rovigo, Potenza, Modena and Naples are set on fire. Then it’s the turn of San Vittore, Foggia, Bologna, Bari and so on. Final bulletin: nearly 50 institutions involved, 14 prisoners dead and dozens of injured policemen.

La protesta dei carcerati di san Vittore (LaPresse)

Minister Bonafede decides to give way to the rioters: to reduce the overcrowding of prisons, he decides to grant house arrest to those serving sentences of less than 18 months. In the meantime, Conte decides to extend the ‘red areas’ to the whole of the country. Italy is closed. The umpteenth decree, with the slogan “I’m staying at home“, comes when there are 463 dead and 9,172 cases in Italy. Lombardy, left to its own devices, has 333 dead and 5469 cases.

As the days go by, the consequences of all this bad behaviour make themselves felt. On 12th March the number of deaths reaches the 1,000 mark and Lombardy is still worst affected with a tragic 744 deaths and 8,725 cases. If the closure of the Lodi has paid off, the problem is now Bergamo and Brescia. The numbers are becoming increasingly dramatic and the hospitals do not know how to manage the large number of corpses. Not even the cemeteries can keep up with all the burials. Thus, during the night of 18th March army trucks pass through Bergamo to transport the bodies to other regions where they will be cremated.

On 19th March, with 3,405 Italians dead, we overtake China and achieve the tragic world record. The bulletin of the count of victims of coronavirus, which is provided every evening at 6pm by the National Institute of Health and the Civil Protection Department, is a dramatic appointment for all citizens of the country. Finally, one month after the first infection, the government passed the “close Italy” decree.