Italy’s elderly suffer heavy toll as coronavirus spreads

A table of old men were shooting the breeze next to the bocce ball courts in a Milan recreation centre Wednesday, talking, like seemingly everyone else in northern Italy, about the coronavirus outbreak that had shut down towns, closed all of Italy’s schools and claimed the lives of more than 100 people, almost all of them elderly.

The men, mostly in their 70s and 80s, joked that their wives gave them a hard time for leaving the house (“not even the coronavirus can keep this guy home”), that life’s finish line was too close to get worked up about a contagion, that they had faith in northern Italy’s vaunted health care system.

But the bravado also disguised real concern.

“It’s normal that I’m a little worried.” Antonio Di Furia, the club’s owner, 67, said. “I have heart problems.”

Italy’s mortality rate in the outbreak, about 3.5%, is not much above the global average of 3.4% reported by the World Health Organisation. But the virus is taking a disproportionate toll on the elderly in Italy, which has the oldest population in Europe, and the second-oldest in the world after Japan.

The number of coronavirus cases and deaths spiked again Wednesday in Italy, which has reported 3,089 people infected and 107 deaths overall. Daily jumps have become the new normal.

The increases reflect what is known about the contagion, in which each person is thought to infect about two others. That means that even as Italy locks down towns — two more were added Wednesday, bringing the total to 13 — the virus continues to spread. Italy’s measures have slowed the outbreak, but not enough to allay concerns about the burdens it is placing on the health care system and the threat it poses, especially to older people.

People shop at the a weekly street market at the Piazzale Ferdinando Martini in Milan on Mar 4, 2020. The New York Times

“The measures introduced in these days have the aim of avoiding a large epidemic wave,” Italy’s National Health Institute said in a statement explaining its stiffening guidelines, which recommend personal separation as schools closed nationwide until at least March 15.

“In the case of the coronavirus we must take into account, moreover, that Italy has an elderly population, actually much older than the Chinese, and needs to be protected from the contagious,” it said.

About 23% of Italy’s population is 65 or older. The median age is 47.3, compared to 38.3 in the United States, according to the United Nations.

Many of those who have died in Italy already suffered from serious illnesses that put them in grave danger, then the virus “destabilised them,” said Walter Ricciardi, an official at the World Health Organisation who is advising the Italian health ministry.

The array of preexisting conditions suffered by some victims, including cancer, diabetes and heart disease, has complicated efforts to assess the lethality of the virus.

Angelo Borrelli, the head of Italy’s Civil Protection Agency who is coordinating the country’s response to the crisis, said Tuesday that of the people who died, “Most were over 70, and some had preexisting conditions.’’

‘‘But for the others,’’ he said, ‘‘we still aren’t sure.”

Lombardy’s president, Attilio Fontana, made a similar point in an interview last week. “All the deaths we’ve had are either very old people or very sick people,” he said.

The World Health Organisation said that the case-fatality ratio was highly fluid and likely to change. Infections have probably been underreported, it said, given that many are asymptomatic or very mild.

Some experts argued that the aggressive response by Italy’s northern regions had not only slowed the spread of the virus but had also brought down the death rate.

“There was a huge expansion of the intensive care units,” said Fausto Baldanti, a virologist at the San Matteo Hospital in Pavia. “That can make the difference.”

But the intense focus on coronavirus in Italy is exacting a cost.

A woman wears a protective mask at a street market in Milan on Mar 4, 2020. The New York Times

Last week, an old man lost his balance and fell on a sidewalk in Casalpusterlengo, one of the northern towns quarantined to prevent the spread of the coronavirus. A neighbour, Noemi Carelli, called an ambulance, but said the usual emergency hotline automatically diverted to a recorded message about the outbreak.

As the old man bled from his face on the street, she kept trying and finally reached the police, who dispatched an ambulance from a town miles away. “We have to hope that nothing else happens to us besides the coronavirus,” said Carelli, 45.

The spread of the virus and the abundance of elderly patients have worried experts, many of whom are concerned that the outbreak threatens to monopolise the attention and resources of Italy’s public health system.

In the north, many hospitals have suspended all but the most urgent surgeries in order to free medical beds and other resources for acute coronavirus cases. Staff have cancelled vacations and put in overtime.

Fontana said that Lombardy is asking retired doctors and nurses to return to work. In Padova, the hospital pitched tents outside in preparation for an influx of cases. And on Wednesday, Italy’s government set aside a space for patients with the virus inside a military hospital.

Raffaele Bruno, director of the infectious disease unit at San Matteo, said that a sudden burst in the number of cases would put an unsustainable strain on operations in the north. “If I have to admit 10% of them in the hospital and 2% goes to intensive care, I don’t have any more spots to take care of other patients who have other illnesses,” he said.

Speaking on Radio1, Alessandro Vergallo, the president of the national association of anesthetists, said that in Lombardy, “we can count the free spots in the hospitals on the fingers of two hands.” The health system can’t long survive under such conditions, he said.

Around Lombardy, elderly Italians expressed a mix of caution, fatalism and nonchalance.

While the men in the bocce club shrugged off the threat, they did so next to empty courts and empty tables. Most of their friends had stayed away.

“I think they’re scared,” said Annalisa Canato, 67, who sat by the bar. “For good reason.”

A man walks through the town of Secugnago, just outside a quarantined red zone, in Lombardy, Italy on Feb 23, 2020. The New York Times

In Secugnago, a few hundred yards outside a checkpoint blocking the entrance to one of Italy’s locked-down towns, old men shrugged off the threat and said they often drank with friends who slipped out of the quarantined towns via country roads.

“If it comes here and gets me, it gets me,” said Domenico Coppini 79, as he stood outside the Liberty Bar in Secugnago. “Italy is old. And the virus is getting old people.”

In Milan, others were more cautious.

Lucia Franceschini, 84, shopped for vegetables at a market and said it was important not to be “excessively worried” but to keep up normal routines and good hygiene and to maintain “the appropriate distance” when talking to people.

Still, she had not failed to notice that the vast majority of Italians who died were elderly.

“You become fragile,” she said, and lamented that Italy, was “maybe more vulnerable.”

“We’re all little old people now,” she said.

© 2020 New York Times News Service