Covid-19 patients in Italy's virus epicentre of Lombardy were transferred to nursing homes by an official resolution with catastrophic consequences.
In the early days of March, when northern Italy faced a severe health crisis from the coronavirus outbreak, the scarcity of available hospital beds brought the public health system to its knees.
On March 8, a resolution by Attilio Fontana, president of the Lombardy region – Italy's economic engine and the epicentre of the epidemic with 12,213 deceased - sentenced hundreds of elderly people hosted in nursing homes to death.
The regional resolution offering150 euros ($163) to nursing homes for accepting Covid-19 patients to ease the burden on hospitals, contributed to the uncontrolled spread of the virus among health workers and elderly guests, turning these institutions into virus hotbeds.
Hosting Covid-19 patients in nursing homes was like lighting a match in a haystack.
"We read it twice, we did not want to believe what we read," says Luca Degani, president of UNEBA, the trade association that brings together about 400 rest homes in the region, "the virus affects everyone indistinctly, but its lethality and gravity take a very significant logarithmic curve if people are aged and suffer multiple pathologies."
"The fact that in our facilities we had people at greatest risk was a fact that had to be considered," Degani explains to TRT World, "These structures are made to let the elderly socialise and be provided with adequate care. They are not made to respond to an acute disease caused by a pandemic infection."
At least 1,822 people died in nursing homes in Lombardy, yet it is unknown how many were killed by coronavirus as many were never swabbed.
Italian authorities have started investigations into nursing home deaths during the outbreak and police seized documents related to the Pio Albergo Trivulzio in Milan, a historic nursing home with over 1,000 elderly residents, and 13 other nursing homes in the region.
Coffins have been piling up inside the church at Trivulzio care home where 150 health workers, in a letter, accused the management of being aware of the dangers but not having reacted promptly.
Until March 23, there were no protocols in place, whatsoever. Health workers reportedly assisted residents without personal protection equipment (PPE), and those with symptoms were not even isolated from others.
The relatives of the victims and those still hosted at Trivulzio health facility have come together to ask for justice and are ready to file a class-action lawsuit.
The Public Prosecutor's Office in Milan is investigating the matter. The charge is a culpable epidemic and multiple culpable homicides.
"Besides support statements, I have also received numerous testimonies from family members of patients who, as in my case, have encountered serious and worrying deficiencies in the management of the health emergency that exploded inside the structure," said Alessandro Azzoni, founder and spokesperson of the Justice and Truth Committee for the victims of Trivulzio, where at least 190 resident have died.
"I am very concerned about the health of my mother - still a guest of the facility - whom, like so many other patients, is in a state of current danger," he said.
He expressed hope that the prosecutor will intervene promptly and also consider entrusting the management of the structure to a judicial administrator.
The governor of Lombardy Attilio Fontana and the councillor for Welfare, Giulio Gallera are in the eye of the storm, but they claim that the technicians of the local Health Protection Agencies are the ones responsible for transferring Covid-19 patients from hospitals to care homes.
Meanwhile, over 50,000 signatures have been collected in just a few days to place the regional health administration under 'receivership' (outside management).
A massacre
Last Friday Silvio Brusaferro, chief of the Higher Health Institute (ISS), said that the "carnage" in nursing homes all over Italy had claimed 7,000 victims since February, of which at least 40 percent died due to coronavirus.
"What has happened and is still happening in residences for the elderly is a massacre," says Ranieri Guerra, deputy director of the World Health Organization and a consultant with the Italian Ministry of Health.
"The epidemic arrived in our facility on March 13 – but we were not aware of that - when 17 patients from Sesto San Giovanni hospital (on the outskirts of Milan) were admitted with the aim of easing the pressure on hospitals that no longer had beds," Pietro La Grassa, health worker and trade unionist of Trivulzio in Milan explained to TRT World.
"On the 17 on March we placed them in a non-Covid ward: we were not afraid because we were told by the hospital administration that they were not infected. Since then, the contagion has started spreading among doctors, nurses and health workers. In the blink of an eye, it reached, of course, the residents of the structure: the elderly."
Last Thursday, Corrado Formigli, a well-known TV investigative journalist in Italy, in his "Piazza Pulita" a prime-time television broadcast, openly referred to a "massacre going on in nursing homes".
He aired mobile videos shot by health workers where elderly residents are seen dyeing suffocated, alone, in the beds of the Milanese care home.
The images were grotesque.
"We were forbidden to wear masks because they told us we would have frightened the guests of the structure," continues Pietro La Grassa, "our hosts saw their relatives with masks, on television they heard that the epidemic kills them above all, yet health workers were forbidden to wear protection."
According to Luca Degani, orders for PPE were seized and diverted from nursing homes to hospitals.
The result is that today in Trivulzio some 220 workers out of just over 600 are on sick leave with symptoms, fever or cough and some with pneumonia.
For a long time, Covid-19 patients were not isolated and coexisted with others, the elderly. Until April 16, swabs were not available, so residents fell ill without knowing whether they had been infected or not. Their dead simply slipped off the official figures.
At least 87 elderly have died in Trivulzio just since the beginning of this month.
"Due to the ineptitude of someone, we have become a hotbed of the disease," says La Grassa, "while it was immediately clear that elderly with pre-existing pathologies were the most vulnerable subjects in this epidemic, it was decided to turn care homes into Covid houses. We do not have intensive care and emergency rooms; what care could we provide?"
"An absolutely unjustifiable conduct," comments Vittorio Agnoletto, a former member of the European Parliament and occupational doctor.
"As early as March 8, in addition to having identified the virus and its transmission pattern, we knew quite clearly how it affects fragile people and mainly kills those over 70 years old. We knew exactly that nursing homes' guests were the ideal victims of Covid-19," he tells TRT World.
A viral wave crashed on the most vulnerable
Agnoletto contextualises this debacle within a series of others triggered by the Lombardy administration.
"The entire health model that delegates 40 percent of public health expenses to the private sector must be questioned. These private structures work on treatment, not on prevention because the former brings gains and the latter does not," he says.
"Besides, they work on specific care fields: cardiology, oncology, surgery, neglecting emergency and intensive care. This system needs people to be sick to keep on running."
Military metaphors are routinely abused these days.
"We had a frontline protection network that is made of our general practitioners, a prevention and control form that the world envied. For every citizen or migrant - regular or irregular – there is a doctor to establish a direct relationship with," he says.
According to Agnoletto, general practitioners were not provided with adequate protections until recently and were not informed of procedures and protocols to be adopted.
“There was a systemic error in such an advanced health system: attention was focused only on the hospital dimension,” agrees Luca Degani, “Pandemics are fought with prevention on the territory.”
Which is what general practitioners should do: have control of the territory, swab the people and take care of those most at risk.
“This network is like the breakwater supposed to cushion the impact of the wave. Yet, the virus wave arrived and crashed on the hospitals that could not cope with the load because, over the years, we have progressively cut beds reaching the lowest European average,” says Agnoletto, “We channelled the wave exactly on the most fragile subjects, creating clusters.”
But, above all, according to Agnoletto, official figures are a farce.
“National numbers are a joke, insignificant and unusable for any statistical purpose: they lack any forecasting logic. Summing up every day the newly infected to the total Covid cases makes the percentage of course smaller – he says - calculations are to be made on the number of the dead instead.”
Considering that the number of swabs is negligible and is not done on a given sample, the only reliable parameter of comparison is the account of total deaths over the same period in previous years.
“Only so we could have reliable data on the progress of the epidemic,” claims the doctor.
Throughout Italy, homes for the elderly have become critical hotspots during the Covid-19 outbreak. The same happened in other countries in Europe: in Spain out of 350, 000 people housed in care homes, 10,000 elderly have died, half of the total deaths due to the epidemic.
In France, deaths in the residences for the elderly reached 40 percent of the total deaths. In Belgium, in a few days, deaths in care homes for the elderly make up the majority of the deceased. But in Lombardy - where care homes have been picked to hospitalise Covid-19 patients – it just added to the ongoing tragedy.