As virus surges anew, Milan hospitals under pressure again

Coronavirus infections are surging anew in the northern Italian region where the pandemic first took hold in Europe, putting pressure again on hospitals and health care workers.

At Milan’s San Paolo hospital, a ward dedicated to coronavirus patients and outfitted with breathing machines reopened this weekend, a sign that the city and the surrounding area is entering a new emergency phase of the pandemic.

For the medical personnel who fought the virus in Italy's hardest-hit region of Lombardy in the spring, the long-predicted resurgence came too soon.

“On a psychological level, I have to say I still have not recovered,’’ said nurse Cristina Settembrese, referring to last March and April when Lombardy accounted for nearly half of the dead and one-third of the nation’s coronavirus cases.

“In the last five days, I am seeing many people who are hospitalized who need breathing support," Settembrese said. “I am reliving the nightmare, with the difference that the virus is less lethal.”

Months after Italy eased one of the globe’s toughest lockdowns the country is now recording well over 5,000 new infections a day — eerily close to the highs of the spring — as the weather cools and a remarkably relaxed summer of travel and socializing fades into memory. Lombardy is again leading the nation in case numbers, an echo of the trauma of March and April when ambulance sirens pierced the silence of stilled cities.

So far, Italy's death toll remains significantly below the spring heights, hovering recently around 50 per day nationwide, a handful in Lombardy. That compares with over 900 dead nationwide one day in March.

In response to the new surge, Premier Giuseppe Conte’s government twice tightened nationwide restrictions inside a week. Starting Thursday, Italians cannot play casual pickup sports, bars and restaurants face a midnight curfew, and private celebrations in public venues are banned. Masks are mandatory outdoors as of last week.

But there is also growing concern among doctors that Italy squandered the gains it made during its 10-week lockdown and didn’t move quick enough to reimpose restrictions. Concerns persist that the rising stress on hospitals will force scheduled surgeries and screenings to be postponed — creating a parallel health emergency, as happened in the spring.

Italy is not the only European country seeing a resurgence — and, in fact, is faring better than its neighbors this time around. Italy’s cases per 100,000 residents have doubled in the last two weeks to nearly 87 — a rate well below countries like Belgium, the Netherlands, France, Spain and Britain that are seeing between around 300 to around 500 per 100,000. Those countries have also started to impose new restrictions.

This time, Milan is bearing the brunt. With Lombardy recording more than 1,000 cases a day, the regional capital and its surroundings account for as many as half of that total. Bergamo — which was hardest hit last time and has been seared into collective memory by images of army trucks transporting the dead to crematoria — hovers closer to 50.

The resurgence has so far been most strongly linked to vacations, both at home and abroad, as Italians flocked to beaches and crowded islands this summer.

“The lockdown is a treasure that we scraped together with great effort and great sacrifice. We risk losing the results from a summer that in some ways was rather reckless,’’ Massimo Galli, the director of the infection disease ward at Milan’s Sacco Hospital, told The Associated Press. “The whole country acted as if they infections never existed, and was no longer among us.’’

His hospital is on the front lines of the pandemic, but he declined to say how many beds were occupied with coronavirus patients.

Dr. Anna Carla Pozzi, a family physician in a Milan suburb, said she feared that fatigue is weakening the public's response to the virus's resurgence. That's creating a situation similar to the one in January and February, when the virus was circulating undetected in Italy, and nothing was being done, she said.

Dr. Pozzi sees her own patients acting surprisingly casually: Some disregard instructions to only come to her office with an appointment. One high school student called her on Tuesday to get a medical certificate to go back to school, saying she had spent a week at home recovering from flu-like symptoms. “Great that you’re feeling better,” the doctor told her, but she still needed a test before returning to class.

Dr. Pozzi was pleasantly surprised that she was able to book the patient in for one the next day -- something unheard of in the winter and spring.

Testing is helping Italy stay on top of the curve. On Thursday, at least 100 cars were lined up for on-demand drive-through testing at the San Paolo hospital where Settembrese works.

Dr. Guido Marinoni, the head of the association of general practitioners in Bergamo, where 6,000 people died in one month, said people in the province were sufficiently frightened by what happened in the spring to continue to follow the rules. But that may not be so in other parts of Lombardy or the country.

“Six-thousand in one month. Do you know how many dead there were in five years that Milan was bombed during World War II, and it was targeted a lot: 2000,’’ Dr. Marinoni said. “What is worrying to see in other areas is the nightlife, people who are gathering in bars and partying. This is very dangerous."

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Associated Press journalist Luca Bruno contributed to this report.