Coronavirus: Isolating the sick at home, Italy stores up family tragedies

The predicament of home infections is emerging not just in Italy but in hot spots across the globe. PHOTO: EPA-EFE

ROME (NYTIMES) - When her middle-aged son got sick, Ruffina Pompei did what she had done for decades, bringing vegetable soup and freshly squeezed orange juice to his room. She slept in an armchair outside his room and changed his clothes. She told her husband, 89, to steer clear.

But the coronavirus tore through the apartment.

Her son died in a hospital in the region of Abruzzo on March 29. Her husband died the next day in the same hospital. Pompei, 82, was also diagnosed with the virus.

"I could not leave him alone," she said of her son.

Before everyone else in the West, Italians received and largely obeyed an order to stay at home. "I'm staying home" became a hashtag, then the name of a national ordinance and then a motto hung from balconies and windows. But while staying home has worked, reducing the rate of infections, bringing down the daily toll of the dead and creating breathing room for hospitals, home has become a dangerous place for many Italians.

Italian households represent "the biggest reservoir of infections," said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases "the possible restarting point of the epidemic in case of a reopening".

The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. "This is a ticking time bomb," he said.

The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighbourhoods of Rome and Milan. It is also a problem that local officials and epidemiologists say is getting too little attention, particularly as the government has announced tentative steps toward reopening in early May.

Italy's leading virologists now consider home infections, alongside clusters in retirement homes, to be a stubborn source of the country's contagion. Living together in close quarters and the failure to move the infected into dedicated quarantine facilities have, they say, paradoxically propped up the curve of infections that "stay home" measures were designed to suppress.

The problem is one the Chinese government bludgeoned quickly. It ordered the round-up of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule.

Italy, like other Western democracies, has wrestled with the difficulty of balancing the containment of the virus with the economic, social and political costs of removing people without symptoms from their own homes. The government has not made isolating patients outside their homes a priority.

"As a doctor I would say let's put tanks in the streets and let's do a police state," said Guido Marinoni, the president of the Bergamo doctors' association. "But the Western world has different realities."

Italy has not enacted, or articulated, a clear national effort to prevent contagious people from infecting their households. The country has essentially accepted a controlled tragedy at home as it focuses on preventing a contagion from running like wildfire through the society at large.

"Domestic contagion is the lesser evil," said Giorgio Palù, a former professor of virology and microbiology of the University of Padova and the former head of the European and Italian Society for Virology. Compared to unleashing the contagion on the streets, it was better to keep the virus in the family.

"At home," he said, "I block it."

Silvio Brusaferro, the president of Italy's national health institute, and one of the leading advisers to the Italian government in the crisis, acknowledged that homes were "higher-risk places". What is essential is home infections "do not spread further", he added.

But that offers little solace to the close-knit, multigenerational families decimated by the virus in their own homes - to the infected sisters who lost their father and then saw their grandfather hospitalised in hard-hit Bergamo; to the Campanian hairdresser who lost both her parents; to the metalworker in Voghera who died days after losing his two sons.

Experts have estimated that more than one million people in Italy could be infected with the virus at home. The persistence of cases is telling. Despite a nationwide drop in the number of new infections and deaths, Lombardy, which remains the Italian epicentre, announced nearly 4,000 new cases this week alone, with more than 700 deaths.

Many public health officials say that the actual number of infections could be as many as 10 times that.

Federico Ricci-Tersenghi, a scientist at the University of Rome La Sapienza who specialises in theoretical modeling, said that stemming the contagion required facilities like those in China dedicated to isolating positive cases.

"Staying home is not the solution, not for the economy or for the epidemic," he said. "To reopen without having this in place is very risky. It's probable that the epidemic will start up again."

Italian households represent "the biggest reservoir of infections".. PHOTO: REUTERS

When a delegation of Chinese doctors came to Italy in March, they emphasised the importance of prefabricated structures with a high number of beds to isolate all the positive cases.

"They explained that it was essential to separate positive cases from the family," recalled Giampietro Rupolo, the president of the Red Cross in Padua, who was among those who greeted them. "Otherwise it was harder to contain."

But Italian officials have clearly determined that housing the infected in dedicated facilities is not feasible.

Giovanni Rezza, director of infectious diseases at the national health institute, said that the government did not think that a centralised effort was "feasible, possible, appreciated".

Italian media have reported that the government is considering making the lifting of lockdowns in Italy's regions contingent on local authorities providing quarantine facilities for the infected. Experts have also emphasised the importance of contact tracing and early diagnoses, since contagion can also happen before a patient starts showing symptoms.

For now, however, Prime Minister Giuseppe Conte has largely steered clear of the issue of home infection. A government decree in March allowed local authorities to seize hotels to host patients who cannot safely self-isolate at home. But, as is the case with many of the government decrees, it is being interpreted and implemented differently around the country.

In most cases, only people with confirmed cases can go to dedicated hotel rooms. But the hotel rooms are not available everywhere, and neither are tests for the virus, which in the hardest-hit places are given only to people who have been hospitalised.

Officials in Tuscany have urged people who left the hospital with mild symptoms to isolate in converted hotels. But urge is all they could do, and by mid-April only 200 had chosen the facilities. Others preferred to sign a document declaring they would self-isolate at home. In Milan, the Michelangelo Hotel, set aside for residents with positive coronavirus test results, was far from full.

In Bergamo, the hardest-hit part of Italy, there are only 400 spots set aside in local hotels for an infected population at home estimated to be around 65,000, according to the local doctors' association.

Working-class Italians often face the hardest choices.

In the southern region of Calabria, Paolina Mazza, 63, who has the coronavirus, self-isolated at home after her husband was hospitalised with the virus. She expressed frustration that authorities gave her no alternative but to go home, where she tried to keep some distance from her son, 39.

"We don't have a second house to isolate and they live in a tiny apartment," her daughter Daniela said. "We are constantly scared."

Even some doctors considered the infection of their own families as inevitable.

Federica Brena, a 35-year-old doctor in the coronavirus ward of Bergamo's Humanitas Gavazzeni hospital, came down with symptoms and immediately diagnosed herself and self-isolated at home, with her husband and one-year-old son.

"The ideal option would have been to never go back home," she said. "It was obvious that I would infect the two of them." Her son came down with a fever and a cough. Her husband also got sick a few days later, and his fever did not go down for 12 days.

"Living in a home with other people, for as much as one tries to isolate, it's hard," she said, adding everyone was improving.

"Especially if you don't live in a palace."

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