Italy's COVID-19 outbreak is more devastating than war, with patients dying alone and hugs becoming a luxury

Ambulances line up in long queues in front of the hospital, their flashing warning lights unsettling the mind. Military trucks carrying coffins crawl forward like pythons slithering through the dark night, stirring unease in the deepest reaches of the soul.

In the past two weeks, death has claimed more than five hundred lives in the Province of Bergamo (Provincia di Bergamo). The crematorium operates 24 hours a day, working overtime on weekends and Sundays, yet coffins still fill the hospital mortuaries, funeral homes and cemetery chapels. Funeral homes are overwhelmed. To let the dead rest in peace as soon as possible, the government dispatched the military to transport coffins to neighboring cities for cremation.

Death has lingered for a long time, and the death toll has soared

As the novel coronavirus (Covid-19) rages, the figures released by Italy's Civil Protection Department every evening are alarming, with the national death toll crossing the five thousand mark. Lombardia (Lombardia), where Bergamo is located, has a severe outbreak, with more than three thousand deaths and still climbing.

People walk toward death's door in fear, while spring sunshine remains as bright as ever, caring nothing for human suffering. The spring goddess arrives with birdsong and blooming flowers as messengers, yet death comes silently. Only after seeing relatives and friends die one after another did the people of Bergamo wake up to the fact that death had been lingering by their side for a long time.

On February 20, Italy discovered its first case of locally transmitted novel coronavirus, unveiling an outbreak that had been spreading outside the epidemic prevention net for several weeks. The "Patient No. 1" in Codogno (Codogno), a small town on the Po Plain, drew global attention, as authorities traced the marathon he ran, the soccer games he played, and the gatherings he attended. The government urgently designated surrounding cities as red alert zones, hoping to stop the virus.

Too late. The virus had already spread from the plain to the valleys. After one month, Italy's confirmed cases approached sixty thousand (including more than seven thousand recoveries), nearly half of them from Lombardia. The administrative level of the Province of Bergamo is like a "county" in Taiwan, China, governing 243 municipalities including the capital city of Bergamo, with a total population of 1.1 million and an area of 2,700 sq km. From the edge of the Po Plain to the valleys of the Alpine foothills, it has become the hardest-hit area in Italy, with about six thousand confirmed cases and nearly one thousand deaths from the novel coronavirus.

Official figures are alarming, but the actual death toll is even higher

The official figures are alarming, but the actual number of infections and deaths is even higher. "These figures are just the tip of the iceberg. Unfortunately, many elderly people died at home or in care homes without being tested for the novel coronavirus," pointed out Bergamo Mayor Giorgio Gori.

Nembro (Nembro) in the Val Seriana (Val Seriana) was the first city in the Province of Bergamo to report the novel coronavirus. Among its more than ten thousand residents, about 120 have died from early March to now, compared with only 14 deaths during the same period last year.

Not only did the mayor in charge of death registration realize the extraordinary number of deaths, but the obituary section of the local newspaper L'Eco di Bergamo (L'Eco di Bergamo) also rapidly expanded from the usual two or three pages to 10 or 12 pages. Some of the deceased were centenarians, many were elderly over eighty, but the virus did not spare younger adults either.

Claudio Polzoni (Claudio Polzoni) was a carabiniere in Bergamo. Earlier he had taken leave to stay home and care for his father-in-law who had contracted the novel coronavirus. Unfortunately, after his father-in-law passed away, he too contracted the virus and died. Having lost two family members, Polzoni's wife said: "When my father fell ill, I was mentally prepared to accept his death because he had severe heart disease. But my husband was only 46, strong and without any illness, and I did not even have the chance to say goodbye to him."

Many elderly people with chronic diseases contracted the virus, driving up the fatality rate

Italy's COVID-19 fatality rate is as high as 9%, far exceeding the 3.8% estimated by the World Health Organization (WHO). One reason is that after initially testing asymptomatic and mild cases as well, facing a surge in cases, Italy now mainly tests severe cases. However, this also underestimates the number of infections; when estimating the fatality rate, the denominator becomes smaller, pushing the mortality rate higher, and these confirmed severe cases also have a relatively high probability of death.

According to the latest statistics from the National Institute of Health (ISS), the average age of Italy's COVID-19 deceased is nearly 80, and half of the deceased already had three or more diseases, with the novel coronavirus not being the sole cause of death. Moreover, research indicates that some hypertension medications reduce patients' immunity, making it hard to resist the novel coronavirus.

"France and Spain, which have high death tolls, adopt the same statistical method as us: as long as the deceased tests positive, they are counted as a COVID-19 death. By contrast, in Germany, the novel coronavirus must be confirmed as the sole cause of death to be counted. By that standard, Italy's COVID-19 death toll might also drop to a few hundred." Public health expert Carlo Signorelli (Carlo Signorelli) explained.

In any case, since the outbreak began, Italy has conducted nearly 260,000 tests, almost second only to South Korea in the world. In one month, about five thousand deaths related to the novel coronavirus remain a cruel fact.

With 23% of the population over 65, Italy faces a major test

There are various hypotheses about the high mortality rate, but in the face of a volatile virus, there is still too little evidence. What is undeniable is that Italy, where those over 65 account for 23% of the total population, has an aging demographic structure that is extremely vulnerable to the virus. However, compared with South Korea, China and Japan, Italy's proportion of infected elderly people is relatively high, which may be related to close family relationships and social habits: parents live with adult children, grandparents often help care for grandchildren, and young, able-bodied people may unintentionally become spreaders of the virus.

Most of Italy's deceased are elderly men, and many were heavy smokers; degraded lung function also made it harder for them to cope with the novel coronavirus's attack. According to genetic sequence analysis, the novel coronavirus mutated in Italy. Some doctors speculate that this made the virus more deadly, but more research is needed to confirm this.

More devastating than war: the novel coronavirus kills ordinary civilians without blinking

Page after page of obituaries in the newspaper reads like a list of war martyrs, but compared with blades and ammunition, this invisible killer, the virus, is even more cruel, slaughtering ordinary civilians without blinking an eye.

Brothers Karim Rachedi (Karim Rachedi) and Nadir Rachedi (Nadir Rachedi) are both military surgeons. They have respectively been deployed to battlefields in Afghanistan, Libya and Lebanon, and were also responsible for going to Wuhan to bring back febrile Italian students in bio-containment pods. The two brothers were subsequently dispatched to hospitals in Italy's epidemic zones to support the crumbling healthcare system.

One hour after arriving, they called relatives and friends, urging everyone not to go out unless absolutely necessary: "You may find it hard to understand, but even in Afghanistan, we have never seen a situation like this. Overseas, we dealt with military missions, but here, a devastating enemy targets civilians specifically. Patients deteriorate, doctors and nurses are exhausted, yet fortunately everyone is still full of a spirit of mutual help."

The people and businesses of Bergamo, besides donating money to support medical workers fighting on the front lines, some also deliver hot pizza every day. Nadir said: "A few people even went to the Netherlands to buy a CT scanner