Southern Italy emerged from the first wave of the pandemic in the spring in relatively good shape. An initial lockdown in northern Italy in late February, followed by a nationwide lockdown in March, slowed the virus’s journey south, saving the region’s generally incomplete hospital from disaster.

The gruesome amateur video that emerged in mid-November and went viral leaves no doubt that southern Italy’s fortunes are running out. The video, taken at the Antonio Cardarelli Hospital in central Naples, shows an unidentified man dying or dying in an ICU restroom. He slumped against the wall, motionless.

What’s also sad is the pan shot from the ICU itself. The room was full of bedridden patients. The scene is chaotic, and the video approaches an old woman wrapped in a blue blanket, her legs dangling over the side of the bed. A voice said: “We don’t know if he is alive or dead.”

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At the nearby Cotugno infectious disease hospital, photos and videos show medics connecting patients in their cars to oxygen and IV machines while they wait to be treated. Media reports said that at least four people died in an ambulance parked outside an overloaded Naples hospital.

Foreign Minister Luigi Di Maio, who is from Naples, said the city’s health services were in crisis. “The situation in Napoli and in many areas of Campania [the region that includes Naples] out of control, “he said.

“You have so many hospitals overcrowded – 50 patients in rooms designed for 20 patients,” said Fernando Schiraldi, a retired critical care specialist who runs the ICU at San Paolo hospital in Naples. “Yes, we have more ICU beds now, but we don’t always have enough doctors and nurses to manage them.”

The mayor of Leoluca Orlando of Palermo, the capital of Sicily, warned that the island was facing “inevitable carnage” as COVID-19 infections flooded his hospitals.

The scene is very different in Rimini, an Adriatic city in the north-central region of Emilia-Romagna, east of Tuscany. There, hospitals are full but not at their breaking point, partly because the region has a strong public health care system – resists the privatization that is undermining public hospitals elsewhere – and has the foresight and resources to plan a second wave.

The ICU at Rimini Hospital doubled its number of beds to 29 over the summer and is employing more doctors and nurses. Currently, COVID-19 patients occupy 23 beds, and four others have gone to patients who do not have the virus, which means the unit still has spare capacity, even though the infection rate in Emilia-Romagna is high. “I firmly believe the second batch is coming, and we are preparing,” Giuseppe Nardi, the hospital’s ICU director, said in an interview. “We are preparing ourselves. Campania is not preparing for the second wave. “

He said the situation is not as grim as it was in the spring, when residents of Rimini bring food to exhausted medics, who work two shifts for two months, and raise € 400,000 to buy ventilators for the ICU. Smaller hospitals in the area were raided for equipment. “We are in a big mess,” said Dr. Nardi. “It’s much better now.”

Italy is the epicenter of the original European pandemic and has suffered greatly, especially in the north, in March and April. Hospitals are experiencing shortages of medical personnel, ventilators and personal protective equipment. Charities, including the American-Canadian medical charity Samaritan’s Purse, opened a field emergency hospital to relieve pressure from some northern hospitals. Cuba, Russia and China supply medical equipment and personnel.

The number of cases and deaths plunged in the summer, and Italy ended its lockdown. In late August, infections spiked again, then spiked, sparking a new round of restrictions. As of Tuesday, Italy has recorded 52,306 deaths, the second highest number in Europe after Britain, and more than 1.45 million infections. The Johns Hopkins University COVID-19 database says Italy has recorded four deaths per 100 infections, the third-highest death rate in the world.

Currently, about two-thirds of the country is in some form of lockdown. The use of masks outdoors and physical distancing is mandatory everywhere, bars and restaurants must close at 6pm, and curfews come into effect at 10pm. Italian cities are again ghost towns.

Now, like in spring, the worry is that overloaded hospitals can’t handle it, even though several thousand ICU beds have been added. The Ministry of Health has stated that more than 30 percent of the ICUs occupied by COVID-19 patients have reached “critical” status, as that level starts to exclude patients suffering from other diseases, such as heart failure.

Statistics published by the Italian newspaper Il Sole 24 Ore show only two of Italy’s 21 regions are below the 30 percent threshold, although some are only slightly above. The ICU in a hospital in Lombardy, the area around Milan, which has the highest number of deaths in Italy, is again on the verge of exploding; at last count, nearly 92 percent of ICU patients were victims of the pandemic. ICUs in several smaller regions in the far north, in the central part of the country and in Puglia, in the far south, have also been badly affected.

The hospital crisis in the north and in parts of the south is due in part to a shift of funds from the public to private health care system, a process that began some 25 years ago and accelerated under Silvio Berlusconi, who was first elected prime minister. minister in 1994 and last took office in 2011.

In that era, Italy developed a public-private system, in which public hospitals and private clinics competed for government funding. Over time, the private system began to suck up as much government funding as the public. With the profit motive at play, private clinics devote their resources to the most lucrative services and specialties, such as oncology.

Funding for general public health care is deteriorating. Crucially, the number of beds in public hospitals has plummeted, and equipment such as ventilators has become scarce. Private hospitals are increasing their capacity, but only slightly.

The destruction of public hospitals is clearly visible in Lombardy. When the pandemic came, Lombardy and several other areas lacked the beds, equipment and medical talent to deal with the raging disease. “They stopped investing in public hospitals,” said Dr. Schiraldi. “Politicians are cutting the number of public beds, equipment and staff because so much financial resources are being diverted to the private system.”

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