Perhaps no initiative better illustrates Italy's confused coronavirus response than the 200-bed field hospital built in less than two weeks on the grounds of Milan's convention center.
The hospital was unveiled to great fanfare on March 31, the fruit of a 21 million euro ($23 million) fundraising campaign headed by Lombardy's governor, a member of the right-wing League party, to try to ease pressure on regional ICUs, which on that date were near capacity at 1,324 patients.
The national civil protection agency opposed the plan, arguing it could never equip it with ventilators or personnel in time. Instead, the agency, which reports to the rival 5-Star-Democratic government in Rome, preferred smaller field units set up outside hospitals and a program to move critical patients elsewhere.
In the end, the Milan field hospital was barely used, treating only a few dozen patients. Since it opened, Lombardy has seen pressure on its ICUs fall considerably, with just 700 people needing intensive care today.
Fontana, the governor, defended the decision and said he would do it again, telling Radio 24: "We had to ... prepare a dam in case the epidemic overcame the embankment."
Nursing home "massacre"
While the regional government was focused on building the field hospital and scrambling to find ICU beds, its testing capacity lagged and Lombardy's nursing homes were in many ways left to fend for themselves.
Hundreds of elderly have died in Lombardy and across Italy in what one WHO official has termed a "massacre" of those most vulnerable to the virus. Prosecutors are investigating dozens of nursing homes, as well as measures taken by local health authorities and the regional governments that may have worsened the problem.
Lombardy has more nursing homes than any other region, housing at least 24,000 elderly, and it registered more dead at those facilities than others too. Of the 3,045 dead from Feb. 1 to April 15 in the region, 1,625 were either positive for the virus or showed its symptoms, according to preliminary results from a survey by the Superior Institute of Health.
Of particular attention to prosecutors was the March 8 decision by the regional government to allow recovering COVID-19 patients to be put in nursing homes to free up hospital beds. The region says it required the homes guarantee the patients would be isolated, but it's not clear who was responsible to ensure that or whether anyone checked.
Even before that, staff at some homes said management prevented them from wearing masks for fear of scaring residents.
A March 30 regional decree, again aimed at easing pressure on Lombardy's ICUs, told nursing home directors to not hospitalize sick residents over 75 if they had other health problems. The decree said it was "opportune to treat them in the same facility to avoid further risks of decline in transport or during the wait in the emergency room."
For the elderly at a nursing home in Nembro, one of the hardest-hit towns in Bergamo province, the decree amounted to a death warrant. But it wasn't the first or only one that gave the home's managers the sense that they were being abandoned.
When management proactively barred visitors on Feb. 24 to try to protect residents and staff from infection, local health authorities responded by threatening sanctions and a loss of accreditation for cutting off family visits, said the facility's new director, Valerio Poloni.
In the end, 37 of the 87 residents died in February and March. Its doctor, as well as Poloni's predecessor as director, also tested positive, were hospitalized and died. A nursing home resident couldn't get admitted to the hospital in late February because the ER was too crowded.
The facility's health director, Barbara Codalli, said she was told to use her existing resources to treat the sick. "The patient returned a few hours later, and a few days later the patient died," she told La7 television.
To date, none of the surviving residents has been tested. Poloni said tests were expected to begin in a few days. Two more residents died so far in April, but the situation seems under control.
"We are tranquil," he said.