Friday, March 20, 2020

Italy’s Coronavirus Victims Face Death Alone, With Funerals Postponed

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Italy’s Coronavirus Victims Face Death Alone, With Funerals Postponed

As morgues are inundated, coffins pile up and mourners grieve in isolation: ‘‘This is the bitterest part.’’
Credit...Claudio Furlan/LaPresse, via Associated Press
ROME — At around midnight on Wednesday, Renzo Carlo Testa, 85, died from the coronavirus in a hospital in the northern Italian town of Bergamo. Five days later, his body was still sitting in a coffin, one of scores lined head-to-toe in the church of the local cemetery, which is itself closed to the public.
His wife of 50 years, Franca Stefanelli, would like to give him a proper funeral. But traditional funeral services are illegal throughout Italy now, part of the national restrictions against gatherings and going out that have been put in place to try to stem the spread of Europe’s worst outbreak of the coronavirus. In any case, she and her sons could not attend anyway, because they are themselves sick and in quarantine.
“It’s a strange thing,” Ms. Stefanelli, 70, said, struggling to explain what she was going through. “It’s not anger. It’s impotence in the face of this virus.”
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The coronavirus epidemic raging through Italy has already left streets empty and shops shuttered as 60 million Italians are essentially under house arrest. There are the exhausted doctors and nurses toiling day and night to keep people alive. There are children hanging drawings of rainbows from their windows and families singing from their balconies.
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Credit...L’Eco di Bergamo
But the ultimate metric of pandemics and plagues is the bodies they leave behind. In Italy, with the oldest population in Europe, the toll has been heavy, with more than 2,100 deaths, the most outside of China. On Monday alone, more than 300 people died.
And the bodies are piling up in the northern region of Lombardy, especially in the province of Bergamo. With 3,760 total cases reported on Monday, an increase of 344 cases from the day before, according to officials, it is at the center of the outbreak.
Hospital morgues there are inundated. Bergamo’s mayor, Giorgio Gori, issued an ordinance that closed the local cemetery this week for the first time since World War II, though he guaranteed that its mortuary would still accept coffins. Many of them had been sent to the Church of All Saints in Bergamo, located in the closed cemetery, where scores of waxed wooden coffins form a macabre line for cremations.
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“Unfortunately, we don’t know where to put them,” said Brother Marco Bergamelli, one of the priests at the church. He said that with hundreds dying each day, and with each body taking more than an hour to cremate, there was an awful backlog. “It takes time and the dead are many.”
An emergency national law issued last week banned civil and religious ceremonies, including funerals, to prevent the spread of the virus. Officials have allowed priests to say a prayer at burials attended by just a few of the bereaved. In his brief prayers to family members, who often wore masks, Brother Marco said that he tried to give consolation and hope and urged people to be close, if permitted, to those who were alone. “This tragedy reminds us to love life,” he said.
In the nearby village of Zogno, the local priest has decided to ring the death knell just once a day, to keep from ringing it all day long. In another town, Casalpusterlengo, the Rev. Pierluigi Leva said believers were taking the “absence” of funerals especially hard.
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Credit...Spedali Civili di Brescia

Listen to ‘The Daily’: ‘It’s Like a War’

We spoke to an doctor triaging care at the heart of the coronavirus crisis in Italy about what may lie ahead for the U.S.
0:00/24:23

Listen to ‘The Daily’: ‘It’s Like a War’

Hosted by Michael Barbaro, produced by Lynsea Garrison, Annie Brown, Clare Toeniskoetter and Kelly Prime, and edited by Lisa Chow

We spoke to an doctor triaging care at the heart of the coronavirus crisis in Italy about what may lie ahead for the U.S.

Dr. Fabiano Di Marco
Can you see me? No, I think.
Michael Barbaro
I cannot see you, but I can hear you. And I think I can hear you — ah, now I can see you.
Dr. Fabiano Di Marco
OK. Sorry for my English. I don’t know if my English will be adequate for a podcast. But then you will decide, OK?
Michael Barbaro
It’s exceptional. And I’m really grateful that you’re making time for us.
Dr. Fabiano Di Marco
Thank you. Thank you.
Michael Barbaro
So, where are you right now?
Dr. Fabiano Di Marco
Now, I’m at home. After three weeks, today, in the afternoon, I am at home, because I have a big family with three children. And I decide to come back at home one day.
Michael Barbaro
So you have not been home in three weeks?
Dr. Fabiano Di Marco
Three weeks, yes. I have been in my hospital every day, start of the crisis, Friday the 21st of February. And since then, it was a total mess. It’s like a war, to be honest.
Michael Barbaro
From the New York Times, I’m Michael Barbaro. This is “The Daily.”
[Music]
Archived Recording
This is how Italy’s cases have grown now for the last month — slowly at first, but now more rapidly. It’s a textbook epidemic curve.
Michael Barbaro
Italy has quickly become the new epicenter of the pandemic, with nearly 30,000 infections and more than 2,000 deaths, numbers that are soaring by the day, even after the government there took extreme measures to lock down much of the country.
Archived Recording (Dr. Jerome Adams)
We are at a critical inflection point in this country.
Michael Barbaro
On Monday, the U.S. surgeon general warned that the United States is now on a strikingly similar path.
Archived Recording (Dr. Jerome Adams)
People, we are where Italy was two weeks ago in terms of our numbers. And we have a choice to make as a nation. Do we want to go the direction of South Korea and really be aggressive and lower our mortality rates? Or do we want to go the direction of Italy?
Michael Barbaro
Today, a conversation with a doctor in Bergamo, north of Milan, one of Italy’s hardest hit areas.
[Music]
It’s Tuesday, March 17.
Michael Barbaro
Could I just ask you to just say your full name for me?
Dr. Fabiano Di Marco
OK. My name is Fabiano Di Marco. I’m a professor of the University of Milan and the head of the respiratory unit of the Hospital Papa Giovanni XXIII of Bergamo, which is a town close to Milan.
Michael Barbaro
Can you give me a sense, and maybe paint the picture, of what it’s like in the hospital right now, what you’re dealing with?
Dr. Fabiano Di Marco
I have now — my ward has been totally transformed. Nothing is as before. I’ve been in my hospital every single day for 14 hours or 15 hours a day —
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
— to try to deal with the outbreak of coronavirus infection.
Michael Barbaro
What has been the story of what has happened in your hospital these past few weeks? Because I think people in the United States are desperate to understand what you have seen, and what people have said to you, and what it has looked like. You described it as a war. So we want to understand what you mean.
Dr. Fabiano Di Marco
OK. Every day we receive, on average, between 50 to 70 patients with severe respiratory failure due to coronavirus infection. Every single day. And to describe my reality, my hospital is, at least in Europe, a huge hospital with 1,000 beds. But to receive every day between 50 and 70 patients with severe pneumonia due to coronavirus, it’s impossible. You have to change your organization day by day.
Michael Barbaro
And tell me what you mean. How do you have to change your organization to deal with people who are in such severe respiratory condition?
Dr. Fabiano Di Marco
So we change it, the normal ward, mainly surgery wards, because the activity of surgery has been reduced off at least 80 percent. And we transform it, so far five wards of surgery for patients with coronavirus. Now we have, between the five wards and the emergency room, at least 350 patients with respiratory failure due to coronavirus infection.
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
Today is the first day in which we have more than 50 percent of the hospital dedicated to coronavirus patients. To organize these, we had to teach cardiologists, dermatologists, rheumatologists — specialists of something very different from respiratory failure — how to treat this patient. You try to find a solution. But day by day, it’s no longer enough. So I can tell you that my colleagues, both physicians and nurses, they cry every day.
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
I’m 47. I’m not so, so old to be the head of a ward, at least in Italy. But I have with me 20 colleagues who are respiratory physician, with many fellow. They are 27, 30. So for me, it’s a huge responsibility. And I was scared they can be sick. OK? But we cry every day. And now, we have today, 460 nurse at home because they are sick. And I think we have —
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
Yes. It’s a very huge number.
Michael Barbaro
You have 460 nurses who are in a hospital in the middle of this crisis who are home because they’re sick?
Dr. Fabiano Di Marco
Yeah, today. This is the outcome of today.
Michael Barbaro
And is that because they are sick with the coronavirus?
Dr. Fabiano Di Marco
There are some who are sick, some with a total burnout for the situation, and other who are contact of patients, so they stay in quarantine at home.
Michael Barbaro
Doctor, you said you are upset, that you maybe even cry every day. And I wonder if there is an experience, maybe one story or one patient, that made you upset?
Dr. Fabiano Di Marco
The main problem for us is to treat our colleagues. As doctor, we are used to treat patients. And for us it’s normal. There is not so emotional, luckily, because we are used to treat other people. But this is difficult when the patient is your colleague. And we have now admitted tens of colleagues or nurse, people who you will meet every day in your life.
Michael Barbaro
Your colleagues are now your patients because they have contracted the virus.
Dr. Fabiano Di Marco
Absolutely. For example, yesterday, the chief of my department come to the emergency room to be with a low level of oxygenation. He has a bilateral pneumonia due to coronavirus.
Michael Barbaro
Wow. I’m sorry.
Dr. Fabiano Di Marco
Not very severe. But he was someone who tried to organize the hospital to deal with this infection three days ago. And we went to have a dinner with my wife and his wife one week ago.
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
I don’t know. We are scared because on Friday, only in my hospital, we had 20 deaths.
Michael Barbaro
20 deaths.
Dr. Fabiano Di Marco
Yeah. For coronavirus. In one day.
Michael Barbaro
That’s extraordinary.
Dr. Fabiano Di Marco
Yeah. So another important thing, we have not had the opportunity to allow the relative to come to the hospital for two reasons. First, it’s a danger for them and for other people, evidently, because in 80 percent of the cases, they are infected. The second reason, which is not easy to understand if you are not in this situation, is that we do not have enough personal protective equipment — the mask in case of infection, something to cover the shoes, and the gown. It’s impossible to find these now Europe, not only in Italy.
Michael Barbaro
So you’re running out of those and you can’t get them anywhere, in the region or anywhere in Europe. You just can’t get them.
Dr. Fabiano Di Marco
Yeah. Impossible to find.
Michael Barbaro
Wow.
Dr. Fabiano Di Marco
If I allow one or two relative to come to the hospital, I have to give them these. But we do not have this for us.
Michael Barbaro
Right. You need them for doctors.
Dr. Fabiano Di Marco
Yeah. They cannot receive the relative in hospital. So the patients are alone. And they die alone. We — this is difficult for us. We try to call, every day, the relative. But I have to tell you that sometimes, in the confusion of this new organization with a dermatologist who is trying to treat a patient with severe respiratory failure, and probably the doctors cry, and the — no one remember to call the relative. So it’s happened that the relative call the hospital —
Michael Barbaro
And the person’s already dead.
Dr. Fabiano Di Marco
Yeah.
[Music]
Michael Barbaro
We’ll be right back.
Doctor, you’ve mentioned a lot of the choices that you and your staff have to make now that this is such a terrible situation. And I wonder how you make decisions about who gets which treatment, and who has the best chance to survive. How do you make those decisions?
Dr. Fabiano Di Marco
This is, for us, a crucial point, because we have hundreds of very sick patients. But we have tens of I.C.U. beds.
Michael Barbaro
Right.
Dr. Fabiano Di Marco
The problem is that you can find many scores of gravity. But these scores of gravity have been thought for another reason. OK?
Michael Barbaro
And when you say score of gravity, you mean, basically, kind of a calculation of who is in greatest need?
Dr. Fabiano Di Marco
Absolutely. So for instance, if you are 80, you have a severe respiratory failure, and I don’t know, you have also renal failure, I have to admit you in the I.C.U. because you are very severe. And you have a probability to die very high. OK. I have to admit you in the I.C.U.. But now we need another score, which is a score which help us to understand your probability to benefit of the I.C.U. bed. And we do not have this score. OK?
Michael Barbaro
Because it has not been created.
Dr. Fabiano Di Marco
Absolutely. We are trying to do this now, because for example, the age, for all of the stage of severity, higher is the age, higher is the score. But when you have few beds for many people, the age is absolutely the opposite. If you are 85, I give the bed to another one who is 45.
Michael Barbaro
Because 45-year-old is more likely to benefit from the I.C.U. bed than the 80-year-old. So you’re saying all the normal rules have to be thrown out the window.
Dr. Fabiano Di Marco
Absolutely. We need a new tool we do not have, because so far, the difference between the number of patients, number or bed, is something totally new for us. OK? And not only for us, all the country will have to deal with this. But it’s difficult to tell people that if you are 80, you will never have the I.C.U. bed.
Michael Barbaro
Of course.
Dr. Fabiano Di Marco
But so far, if you have not the opportunity to build a new hospital with 1,000 bed, such as in China, we need this terrible tool, because this is a tool of selection.
Michael Barbaro
Right — of who lives and who dies.
Dr. Fabiano Di Marco
Yeah. And this is why it’s important. If you do not reduce the number of patients who are sick, it’s impossible to deal with this disease. Impossible. You have to reduce the rate of infection. And the only way to reduce the rate of infection is to change totally the life of people. Now, in Italy, everyone is at home. This is a tragedy for economy. No one is working. No one is working. But it’s the only way. There is not something in between.
Michael Barbaro
It sounds like you’re saying that once you are in a hospital as a doctor, looking at a room full of people with this virus, overwhelmed, it’s too late. That the role of countries who are not yet at the place Italy is in is to make sure they don’t ever get to that place, don’t ever get to the point that your hospital is at. And to do whatever it takes to not get there.
Dr. Fabiano Di Marco
Absolutely. You have two choices. You decide to not close all the activities, close the people in their home, and you will accept thousand of beds. Or, you have to close all the activity. There is not a choice in between. I know this is difficult to have this approach, because also in Italy, if you speak with my colleague in another town, it’s quite difficult to understand this. Because many people, including many physicians, have not this perception of this. Because in your reality, all is normal. It’s difficult to be scared for something you have not the perception. OK? So I can understand that in other countries, it’s the same. But trust us, or, such as in Bergamo, each family will have a relative or a friend who dies. This is the situation in Bergamo. This is not a disease that you can discuss on TV, or you will have the perception of this in your family, in your relative, in your town. It’s something very aggressive, very aggressive.
Michael Barbaro
I wonder, as a doctor, what advice you would give to doctors in the United States who may have to do what you have to do and make the kind of difficult decisions that you have to make now.
Dr. Fabiano Di Marco
I think that the best is to speak with us to analyze the situation of Italy. It could be something important. Because you have to be prepared for this. This is the only thing I would suggest to my colleague. Because also in Italy, I have some colleague in the other part of Italy who are not prepared. And I speak with them. They are doing the same thing we did three weeks ago. This is incredible. This new reality we are living started the 23rd of February, not three years ago. OK? Three weeks ago. After three weeks, we are living in another dimension. For me, it’s difficult to think to my life before this.
No one can be prepared for this — impossible.
Michael Barbaro
I wonder, just a final question here. At the beginning of our conversation, you said you were finally home after three weeks. And I wonder what it was like to come home to your family. What are you telling them? And how are you feeling?
Dr. Fabiano Di Marco
My children are at home now for three weeks. The schools are closed. Luckily there are three, so they can stay together. But we try to create a normal situation at home. For me, it’s difficult, because evidently, I have a risk of infection which is higher than compared to other people. So I had to decide what to do at home. If stay with a mask —
sorry. And I decide to stay normal, without the mask.
Michael Barbaro
It sounds like this was a tough decision.
Dr. Fabiano Di Marco
Yeah, because I have to find the solution between to protect the best, uh, my wife and do not scare my children. OK? The only good news is that children and young boys or girls are not affected. This is the only consolation for us. And I decide that I changed my approach to my children. OK? I pay attention to my hands. I pay attention to my towel. OK? But I decide to not wear a mask because it will be difficult for them to see the father who is a respiratory physician in Bergamo with those kind of cases, hundreds of that. So also for these, it’s really difficult to decide what is the best. And then I spoke with my wife. And we decided to do this.
Michael Barbaro
It sounds like on top of all the difficult decisions you’ve had to make, you had to go home and make one more difficult decision, which was this mask.
Dr. Fabiano Di Marco
Yeah. Absolutely.
[Music]
Michael Barbaro
Doctor, I really want to thank you so much for giving us your time. And I want to wish you the best of luck, you and all your colleagues, doctors and nurses at the hospital. We’re going to be thinking about you a lot in the coming days.
Dr. Fabiano Di Marco
Thank you. Thank you. It has been a privilege. I hope, indeed, to be useful for some of my colleagues and for you.
[Music]
Michael Barbaro
We’ll be right back.
Here’s what else you need to know today.
Archived Recording (Donald Trump)
This afternoon, we’re announcing new guidelines for every American to follow over the next 15 days. As we combat the virus, each and every one of us has a critical role to play in stopping —
Michael Barbaro
On Monday, President Trump issued sweeping new health guidelines for Americans, encouraging them to work from home, avoid restaurants, bars, and food courts, and discretionary travel, and limit gatherings to 10 people or fewer.
Archived Recording (Donald Trump)
If everyone makes this change or these critical changes and sacrifices now, we will rally together as one nation. And we will defeat the virus. And we’re going to have a big celebration all together.
Michael Barbaro
But the guidelines are not mandatory. And the president stopped short of explicitly ordering Americans to stay home, as several countries in Europe and a handful of U.S. counties are now doing. On Monday, health officials in the Bay Area of California instructed nearly 7 million people to remain in their homes, with few exceptions, to slow the virus’s spread.
Archived Recording
These new orders direct all individuals to shelter at their place of residence and maintain social distancing of at least 6 feet from any other person when outside their residence. We know we need to do this. And we know we need a regional approach.
Michael Barbaro
American health officials now predict that the U.S. outbreak is likely to last for months.
That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.
Listen 24:23
Family members are spirited away and, because of the danger of contagion, often die in the hospital isolation without any family or friends around. Local associations in the northern city of Brescia have started collecting donations of tablet devices to give to hospitals so that coronavirus patients can stay in touch — or say goodbye — to their families back home.
Mr. Testa’s death notice appeared on Friday in a local paper, L’Eco di Bergamo. The paper usually has a single page of death notices. On Friday there were 10 pages, and the rest was dedicated to the virus devastating Bergamo.
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“For us, it’s a trauma, an emotional trauma,” said Alberto Ceresoli, who edits the paper. “These are people who die alone and who are buried alone. They didn’t have someone hold their hand and the funerals have to be tiny, with a quick prayer from the priest. Many of the close relatives are in quarantine.”
Giorgio Valoti, the mayor of nearby Cene, died last Friday. He was 70. His son, Alessandro, said that 90 people died the same day in Bergamo’s main hospital. The virus “is massacring this valley, every family is losing someone dear to them,” he said. “In Bergamo, so many bodies are piling up they don’t know what to do with them.”
In Fiobbio, a small village outside Bergamo, an ambulance came to collect Luca Carrara’s father, 86, on Saturday. On Sunday, another one came for his mother, 82. Mr. Carrara, 52, couldn’t visit them in hospital and stayed home in quarantine, where he has begun showing symptoms of the virus. On Tuesday, his parents died. Their bodies are held in the hospital morgue awaiting cremation.
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Credit...Flavio Lo Scalzo/Reuters
“I am sorry that they are still there,” he said. “Still alone.”
Luca di Palma, 49, said his father, Vittorio, 79, died on Wednesday night, and that the funeral home he called told him that they had no space for the body. Instead, they delivered to his house a coffin, some candles, a cross and a mortuary refrigerator so that he could lay his father out in the living room. He said nobody came to pay respects, out of fear of contagion, though his father had died before he could be confirmed as a coronavirus case, and doctors had refused to perform a post-mortem swab test.
On Saturday, Mr. di Palma followed a hearse carrying his father’s body to a cemetery in Bergamo, where a caretaker let them in and locked the gates behind. A priest arrived to offer a brief prayer over the hearse, its trunk lifted. Mr. di Palma said his father wanted to be cremated, but the wait was long. “Painful,” he said.
In a country where many learn in school about the dreaded Monatti who, preceded by the ringing of a little bell, retrieved corpses on carts during the 17th-century Milan plague, the amassing of dead bodies seems out of another time.
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Alessandro Bosi, secretary of the National Federation of Funeral Homes, said that the virus had also caught the mortuary industry by surprise, with those who handle the dead not having sufficient masks or gloves. While health authorities say they do not believe that the virus can be transmitted posthumously, Mr. Bosi said that a corpse’s lungs often released air when being moved.
“We have to consider them in the way we would treat infectious individuals, and take the same care,” he said.
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Credit...Alessandro Grassani for The New York Times
“If we’re not the ones taking away the dead,” he added, “then they’d have to call in the army.”
In some parts of southern Italy, where Roman Catholic traditions are particularly strong, the funeral rite has been too important for some to let go.
In the Sicilian town of Porto Empedocle, the local authorities said that they had cited 48 mourners last week for taking part in a funeral procession in defiance of national restrictions. The mourners risk three months of jail.
The Rev. Leopoldo Argento, 59, a priest there, said, “Funerals are part of our anthropology.” He said he understood the impulse of the mourners to congregate but thought it was necessary to suspend the funerals. Normally, 600 to 1,000 people might attend. “In Sicily, the death of our loved ones is a very strong moment and a very important one in our social life,” he noted.
All of Italian social life has been transformed by the virus, most acutely in Lombardy.
Giacomo Grasselli, who is coordinating the intensive care unit response in Lombardy hospitals, attributed the high number of deaths in part to the advanced age of Italy’s population. The average age of death, he pointed out, was about 80.
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He said medical workers were more frequently forced to decide whether or not to take invasive measures to assist the breathing of the very old and sick but that, for now, every patient had received care.
But, “This will not last forever,” he warned, adding that the capacity to extend care to everyone depended on whether the containment measures worked. He said he took encouragement from the steep drop in new infections in the original quarantined towns of the region. “It is the only way to survive this.”
Costantino Pesatori, the mayor of Castiglione D’Adda, one of those formerly quarantined towns, said that 47 people had died there since Feb. 21, compared with about 50 in all of 2019. He said that despite some of his residents having received a diagnosis of pneumonia, hospital officials “sent them home without testing them for coronavirus.”
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Credit...Nadia Shira Cohen for The New York Times
In Bergamo last week, when an ambulance arrived at Ms. Stefanelli’s apartment for her husband, both were in bed with fevers. Three nurses entered and took Mr. Testa to the hospital and left her. That was the last time she saw him. Four days later, he was dead.
She said that she hoped his body could be kept in the Bergamo church until she and her children were released from quarantine and able to attend a funeral. She said the thought of her husband being buried without her there or having to choose who could go was unbearable.
“How can you choose among family members? The children shouldn’t be there? The wife shouldn’t be there?” she said. “This is the bitterest part.”
Elisabetta Povoledo contributed reporting from Rome.
Jason Horowitz is the Rome bureau chief, covering Italy, the Vatican, Greece and other parts of Southern Europe. He previously covered the 2016 presidential campaign, the Obama administration and Congress, with an emphasis on political profiles and features. @jasondhorowitz
A version of this article appears in print on , Section A, Page 1 of the New York edition with the headline: Lonely Deaths and Funerals As the Bodies Pile Up in ItalyOrder Reprints | Today’s Paper | Subscribe

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