At the national health institute in Rome, which logs Italy’s coronavirus toll, the medical records of the dead arrive in a dropbox one after the next — hundreds of victims every day, and still more coming the next morning, as the researcher who handles the files turns on her computer.
“The number just jumped again,” said Cinzia Lo Noce, the researcher, when 10 more victims’ medical records arrived.
At the outset of the pandemic, Italy’s immense daily death tolls — 919 at the peak — froze the country in fear and put much of the world on alert. But as the tolls again approach those heights, Italy is becoming emblematic of a far different point of the pandemic, when the dangers continue unabated even as so many are desensitized, fatigued and preoccupied with economic survival.
In Italy, the scale of death no longer registers as a consuming national tragedy. But the tragedy is there nonetheless — playing out more quietly, in specific nursing homes, hospitals and living rooms. Some 10,000 people have died of the coronavirus in Italy this month — a per capita rate more than double that of the United States.
During a week when somebody in Europe has died of covid-19 every 17 seconds, according to the World Health Organization, Italy has recorded the highest tolls on the continent: 731 people one day, 753 the next. A recent report from the country’s Health Ministry showed how recorded deaths — for the second time this year — were racing far above seasonal norms, including in the poorer south, which was largely spared from the first wave.
In the countryside of Sicily, Calogero Bontempo, 73, contracted the virus and at first seemed mainly fatigued. But then he complained of blurred vision. And his breathing worsened. His pacemaker seemed to be having problems, too. A relative called the medics, a team arrived in body suits, and soon Bontempo was on his way to the closest coronavirus hospital — 90 minutes away.
He died just after being given a room.
“I am still psychologically shaken,” said Vanessa Carcione, 24, his granddaughter, who took the call from the hospital.
Bontempo’s burial was live-streamed, just a quick blessing with no in-person guests. Before his casket was placed in the ground, the hearse drove past his home, where his wife, who was also positive, watched through the glass pane of the front door.
“She was screaming,” Carcione said.
'Unbroken sound of ambulances'
For those who aren’t direct victims, there are reasons aside from the decreased shock value that the second wave has not registered with the same degree of alarm. The sense of national solidarity has eroded as the country falls deeper into economic distress. And unlike in the first wave, the deaths have been spread geographically, such that the images of crisis aren’t nearly as acute: no military trucks outside hospitals, no 11-page local obituaries.
Even hospitals in the harder-hit areas say they can avoid rationing treatment and choosing who lives and dies, in part by transferring patients to other regional hospitals with available beds. The death rate for patients with severe cases is lower as well, thanks to improved treatments and understanding of the disease.
But Paolo Bonfanti, director of the infectious-disease department at the San Gerardo Hospital in Monza, one of the epicenters of this second wave, said the sensation of the emergency is no different from the first wave.
“I refer to the unbroken sound of ambulances, the lack of oxygen in our covid-19 patients and, above all, the bewilderment and fear in our patients’ eyes, which I can barely describe,” Bonfanti wrote in an email.
The coronavirus has been especially deadly in Italy because of its demographics: The country has the world’s second-highest proportion of seniors. According to the national health institute, the average coronavirus victim is 80 years old. Nearly all have some kind of preexisting condition, and often more than one. Only 1.1 percent of the dead have been under the age of 50.
Lo Noce, who sees the files of the victims arrive by the hour, said she is used to working with medical data but sometimes freezes — and even says a quiet prayer — when looking at the names, the dates of birth and death. Occasionally, a file sent from a nursing home includes a headshot.
“You can see their frailty,” she said.
Even though the health institute has some two dozen people who sort through the data, it can’t keep pace with the second wave. The backlog of deaths to catalogue is 16,000 and growing.
“We are evaluating the clinical features of the dead,” said Graziano Onder, who coordinates the research. Meaning: What health risks did they have? What treatments did they receive? And what led up to their death?
'He was no longer there'
The chain of events that led to the death of Cesare Agostini, 83, began with a birthday lunch for his 14-year-old grandson. The family knew there was some risk. But they’d seen one another many times since the spring lockdown — first outdoors, then indoors — and it had always gone well. Cesare’s wife, Angela, was especially sociable and said she couldn’t bear to not see her grandchildren. So, for the 14-year-old’s birthday, she offered to use the big table, the one usually reserved for Christmas. Everybody could sit at a distance.
That was the idea, at least. Once they settled in, they relaxed into the rhythms of a family birthday party. There were hugs and kisses.
Six of the eight people at the lunch ended up positive.
At first, it was hard to tell who had it worse, Cesare or Angela. They both had fevers. They were both terrified of going to a hospital and being separated. After several days, they got into the ambulance together, with Angela framing it to Cesare as one more unforeseen adventure after 53 years of marriage. But in the hospital — sharing the same room — Angela started getting better. Cesare did not.
He was transferred to another ward and fitted with a mechanical breathing device. Even that scarcely worked for his faltering lungs. On the phone, he struggled to speak. The calls from the hospital staff became more dire. One doctor said Cesare was confused, trying to pull off his mask, and then another called to say there was “no way back.”
So many people have died lonely hospital deaths during the coronavirus pandemic, and Cesare’s daughters knew the rules. But they went to the hospital anyway. They found a nurse who turned a blind eye, set them up with protective gear — goggles, a body suit, two sets of gloves — and all of a sudden, they were in a room with two patients. One was a stranger, in his 40s. The other was their father.
This was what passed for a goodbye during the pandemic: While the other patient ate mashed potatoes, Elena looked at her father. He was no longer moving. He had one eye half-shut. One of his legs looked swollen “four times beyond normal.” The breathing machine was whirring, pumping air in and out, and his pacemaker was helping his heart to keep beating.
To Elena, it seemed that her father was only alive because of the machinery.
“I understood that he was no longer there,” Elena said. “That body was not my dad.”
A more senior hospital manager soon saw them there and hurried them out, angry about the violation, but Elena felt it was worth it — to see her father the day before he died.
In her city of Bologna, she said, life is far from normal, but unlike during March’s lockdown, children are going to school. Parents meet and talk behind masks. Sometimes Elena sees people smile, and to her, it is encouraging that people are no longer as paralyzed by the virus. “It means the human race can adapt,” she said.
But it is clear to her that, even as that version of life goes on, she is the one who can be stopped at any moment by grief. It happened twice in recent days — once when she burst into sobs while picking up her daughter from school, another time when she stepped into her father’s home office for the first time since his death. His office was the place he’d written books about his Roman archaeological findings, and she saw Post-its with names, numbers, lists of all the things he’d been planning to do.
“I touched them, I read them,” Elena said. “I wondered what was in his mind.”