First in, last out: Why Lombardy is still Italy’s coronavirus hotspot

MILAN — Since the start of the coronavirus pandemic, the Italian region of Lombardy has made headlines for all the wrong reasons: overwhelmed hospitals, health care workers performing wartime-like triage, caretakers struggling to bury the dead.

The richest region in Italy, vaunted for its state-of-the-art health care system, has recorded more than 15,500 deaths within its borders since February 21 — half the number of total fatalities country-wide.

And now, as the country starts lifting lockdown restrictions, it still counts the highest number of cases per capita.

Why has the region performed so badly in comparison to others? The question of what went wrong — and continues to go wrong — in Lombardy has become a source of major political controversy and a potential stumbling block on the way to opening the entire country back up to a new normal.

Faced with mounting criticism, regional governor Attilio Fontana insists there is nothing he would have done differently.

“Those who irresponsibly celebrate nightlife are betraying the sacrifices made by millions of Italians.” — Francesco Boccia, Italy’s minister for regional affairs

“I got thrown into a hurricane that no one had prepared us for, and made choices aimed at securing our citizens’ health,” Fontana said in an interview.

“Unlike other places, we had an immediate exponential increase — after 10 days we had almost 1,000 positive cases, of which about half were hospitalized.”

The public health catastrophe and human tragedy that followed could not have been avoided, according to Fontana, a member of the far-right League party.

Critics disagree, saying a difficult situation was made worse by poor decision-making. In recent days, a series of political gaffes have exacerbated the lack of trust in the regional government’s abilities and increased fears that official incompetence could lead to a second wave of infections and undermine efforts to contain the virus elsewhere.

Over the weekend, the region’s health and welfare minister Giulio Gallera attracted widespread mockery after claiming in an interview that — with the virus’ reproduction rate now at 0.5 in Italy — a person would need to come into contact with two infected people at the same time to fall ill themselves. “It’s not that easy,” he said.

Gallera’s lack of understanding of the so-called R rate prompted a flurry of criticism on social media from people concerned that the official coordinating the region’s health response did not grasp the science behind the virus’ transmission.

On Sunday, Fontana added fuel to the fire when he announced there were no new COVID-19 deaths, but it later emerged his report was flawed as a result of a miscommunication between hospitals and regional authorities.

Meanwhile, images of the streets of Milan and other cities full of people flouting social distancing rules as they gathered outside bars and restaurants also drew condemnation.

“If this continues, we risk not being able to open the borders between regions,” Francesco Boccia, Italy’s minister for regional affairs, said in an interview with La Stampa.

“We must not forget that we are still in the COVID-19 pandemic, and those who irresponsibly celebrate nightlife are betraying the sacrifices made by millions of Italians.”

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There’s no easy answer for why Lombardy became a hotspot of the coronavirus in Italy. Some have pointed to factors that may have made it particularly vulnerable: It is densely populated (with more than 10 million inhabitants) and its high level of economic activity means residents — who also skew older than in the rest of the country — are exceptionally mobile.

Still, critics argue that the catastrophe that struck the region could have been avoided had it not been for errors of judgment, government incompetence and failures in the health care system.

The biggest mistake was Lombardy’s management of health care resources, said Massimo Galli, the head of the infectious diseases department of the Sacco hospital in Milan.

“All attention was focused on hospitals, which became breeding grounds for the virus, and primary care physicians were left behind without proper help to treat people at home,” he said. That meant that many people died at home without being tested, as the virus spread through families uncontroled.

Health care is a regional competency in Italy, meaning there is no unified system. In Lombardy, which has been governed for the past 25 years by either the far-right League or the center-right Forza Italia, authorities focused on building private health care institutions that deliver profitable services such as complex surgical operations and specialist treatments.

Less attention was paid to the broader public health system, which dealt with the unprofitable side of things: emergency services, general care and geriatrics.

Weakened by years of cuts and staff shortages, the public system was quickly overwhelmed by the treatment required for COVID-19 patients, which fell under “standard administration,” rather than specialized services offered at the region’s wealthy clinics.

To Stefania Carrara, whose stepfather died of COVID-19 in hospital in March, the region’s reputation for “excellence” in health care increasingly seems like a bad joke.

“We are so excellent that almost two months after Carlo’s death, I am the only one in my family that has had a serological test, and that’s thanks to my employer,” according to Carrara, who said that although everyone in her family fell ill, nobody was able to get tested for the virus.

In Bergamo, one of the cities hardest hit by the health crisis, a Facebook page for families of deceased COVID-19 patients called “Noi denunceremo” (“We will sue you”) garnered likes from some 54,000 people.

A lack of testing has been a persistent problem. In the region of Veneto, authorities were successful in slowing the spread of the virus by rolling out blanket testing, which enabled them to better trace infections.

Lombardy started at a disadvantage — with a higher population density and more initial cases than in Veneto — Galli conceded, but its lack of testing at the start of the epidemic had a substantial effect on the virus’ spread.

“The problem with the swab tests is that the government sent us 3.5 million, but it did not send the necessary chemicals to process them,” said Fontana.

The region has increased its number of laboratories able to process the tests from three to 45 since the start of the epidemic, according to Fontana. But even so, “it is not possible to process more than 15,000-16,000 a day, due to the lack of chemical supplies.”

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The dramatic course the virus took in Lombardy and the mixed messages coming from governor’s office has made people fearful of plans to reopen the region to economic activity.

“It hit us very hard here,” said Chiara Filicetti, who owns a bistro in Treviglio, a town in the province of Bergamo, one of the hardest hit parts of Lombardy. “Many of our customers have lost their parents and grandparents. We’re not in sunny skies yet.”

Milan, the region’s economic center, is eager to reopen, Giuseppe Sala, the city’s mayor said. He expects authorities to shed light on what happened in nursing homes and to issue clear guidance on swab tests and antibody tests in order to make sure the region can resume economic activity safely, he said.

The biggest mistake, according to Sala, was “an initial lack of clarity” that has to be corrected if the region is going to resume its activities along with the rest of Italy.

“It led to all of us, including myself, to underestimate the danger and created a lot of confusion, which helped fuel the pandemic.”

Fontana, in response to the criticism that followed images of people gathering in Milan, insisted he was ready to tighten the rules again if need be.

In the meantime, the rest of Italy is watching the region nervously. The southern regions, starting with Sicily and Sardinia, have pushed for a health passport for those who want to travel to the islands this summer, aimed mainly at tourists from northern Italy.

Unless numbers improve, people in Lombardy — along with residents of Piedmont and possibly Emilia-Romagna — also risk finding themselves confined to their home turf beyond June 3, when the government is set to allow travel between regions.

A postponed reopening would be yet another headache for the beleaguered local government, already straining under heavy criticism from residents increasingly worried about the future — and how they’ll rejoin the rest of Italy on its road to recovery.