The COVID-19 crisis overwhelms Italy’s hospitals again, this time in the south, too

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Southern Italy emerged from the pandemic’s first wave in the spring in relatively good shape. The early lockdowns in northern Italy in late February, followed by the national lockdown in March, slowed the virus’s journey to the south, sparing the generally ill-equipped hospitals in that region from catastrophe.

A horrific amateur video that emerged in mid-November and went viral left no doubt that southern Italy’s luck had run out. The video, shot in the Antonio Cardarelli Hospital in central Naples, shows an unidentified man either dying or dead in the ICU’s washroom. He is slumped against the wall, motionless.

Equally distressing is the pan shot of the ICU itself. The room is packed with patients sprawled on beds. The scene is chaotic, and the video closes in on an elderly woman draped in a blue blanket, her legs dangling over the side of the bed. A voice says: “We don’t know if she’s dead or alive.”

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At the nearby Cotugno infectious-diseases hospital, photos and videos show medics hooking up patients in their cars to oxygen machines and intravenous drips while they wait to be admitted. Media reports said that at least four people died in ambulances parked outside overloaded Naples hospitals.

Foreign Affairs Minister Luigi Di Maio, who is from Naples, said the city’s health services were in crisis. “The situation in Naples and in many areas of Campania [the region that includes Naples] is out of control,” he said.

“You have so many overcrowded hospitals – 50 patients in rooms designed for 20 patients,” said Fernando Schiraldi, a retired critical-care specialist who ran the ICU at the San Paolo hospital in Naples. “Yes, we have more ICU beds now, but we don’t always have enough doctors and nurses to staff them.”

Mayor Leoluca Orlando of Palermo, the Sicilian capital, warned that the island is facing “an inevitable massacre” as COVID-19 infections overwhelm its hospitals.

The scene could not be more different in Rimini, the Adriatic city in the north-central region of Emilia-Romagna, east of Tuscany. There, the hospitals are filling up but are not at breaking point, in good part because the region has a strong public health care system – it resisted the privatizations that weakened public hospitals elsewhere – and had the foresight and resources to plan for a second wave.

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The ICU at the Rimini Hospital doubled its number of beds to 29 over the summer and hired more doctors and nurses. At the moment, COVID-19 patients occupy 23 of the beds, and four others have gone to patients not suffering from the virus, which means the unit still has some spare capacity, even though the infection rate in Emilia-Romagna is high. “I was absolutely sure a second wave was coming, and we prepared ourselves,” said Giuseppe Nardi, the hospital’s ICU director, in an interview. “We prepared ourselves. Campania did not prepare for the second wave.”

He said the situation is nowhere near as grim as it was in the spring, when residents of Rimini brought food to exhausted medics, who worked double shifts for two months, and raised €400,000 to buy ventilators for the ICU. Smaller hospitals in the region were raided for equipment. “We were in a big mess,” Dr. Nardi said. “It’s much better now.”

Italy was the original European epicentre of the pandemic and suffered tremendously, especially in the north, in March and April. Hospitals had critical shortages of medics, ventilators and personal protective equipment. Charities, including the American-Canadian medical charity Samaritan’s Purse, opened emergency field hospitals to take the pressure off some northern hospitals. Cuba, Russia and China supplied equipment and medics.

The numbers of cases and deaths plummeted by the summer, and Italy ended its lockdown. By the end of August, infections climbed again, then soared, triggering a new round of restrictions. By Tuesday, Italy had recorded 52,306 deaths, the second-highest number in Europe after the U.K., and more than 1.45 million infections. The Johns Hopkins University COVID-19 database says Italy has recorded four deaths per 100 infections, the third-highest mortality rate in the world.

Today, about two-thirds of the country is in some form of lockdown. Outdoor mask use and physical distancing are compulsory everywhere, bars and restaurants must close at 6 p.m., and a curfew kicks in at 10 p.m. Italy’s cities are ghost towns once again.

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Now, as in the spring, the fear is that overloaded hospitals will be unable to cope, even though several thousand ICU beds have been added. The Health Ministry has declared that ICUs more than 30-per-cent occupied by COVID-19 patients have reached “critical” status, because that level starts to crowd out patients suffering from other illnesses, such as heart failure.

Statistics carried by the Italian newspaper Il Sole 24 Ore show just two of Italy’s 21 regions are below the 30-per-cent threshold, though several are only slightly over. The ICUs in hospitals in Lombardy, the area around Milan, which has seen Italy’s highest death count, are again close to bursting; at last count, almost 92 per cent of its ICU patients were pandemic victims. ICUs in some smaller regions in the far north, in the central part of the country and in Puglia, in the deep south, have also been hit hard.

The hospital crisis in the north and in some parts of the south is partly due to the diversion of funds from the public health care system to the private, a process that began about 25 years ago and accelerated under Silvio Berlusconi, who was first elected prime minister in 1994 and was last in office in 2011.

In that era, Italy developed a public-private system, in which public hospitals and private clinics competed for government funds. Over time, the private system began to suck up as much government funding as the public one. With the profit motive in play, the private clinics devoted their resources to the most lucrative services and specialties, such as oncology.

Funding for general public health care deteriorated. Crucially, the number of beds in public hospitals plummeted, and equipment such as ventilators became scarce. Private hospitals boosted their capacity, but only slightly.

The gutting of public hospitals was especially apparent in Lombardy. When the pandemic came, Lombardy and a few other regions simply lacked the beds, equipment and medical talent to deal with the rampaging disease. “They stopped investing in the pubic hospitals,” Dr. Schiraldi said. “Politicians cut the number of public beds, equipment and staff because so many financial resources went to the private system.”

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