Coronavirus infections are surging anew in the northern Italian region where the pandemic first took hold in Europe, putting pressure again on hospitals and healthcare workers.
At Milan's San Paolo hospital, a ward dedicated to coronavirus patients and outfitted with breathing machines reopened this weekend, a sign that the city and the surrounding area is entering a new emergency phase of the pandemic.
For the medical personnel who fought the virus in Italy's hardest-hit region of Lombardy in the northern spring, the long-predicted resurgence came too soon.
"On a psychological level, I have to say I still have not recovered," said nurse Cristina Settembrese, referring to last March and April when Lombardy accounted for nearly half of the dead and one-third of the nation's coronavirus cases.
"In the last five days, I am seeing many people who are hospitalised who need breathing support," Settembrese said. "I am reliving the nightmare, with the difference that the virus is less lethal."
Months after Italy eased one of the globe's toughest lockdowns, the country today posted its highest ever daily total of new infections at 7332 — surpassing the previous high of 6557, recorded during the virus's most deadly phase in March.
Lombardy is again leading the nation in case numbers, an echo of the trauma of March and April when ambulance sirens pierced the silence of stilled cities.
Increased testing is partially responsible for the high numbers, and many of the new cases are asymptomatic.
So far, Italy's death toll remains significantly below the spring heights, hovering around 40 in recent days. That compares with the high of 969 dead nationwide one day in late March.
In response to the new surge, Premier Giuseppe Conte's Government twice tightened nationwide restrictions inside a week.
Starting tomorrow, Italians cannot play casual pick-up sports, bars and restaurants face a midnight curfew, and private celebrations in public venues are banned. Masks are mandatory outdoors as of last week.
But there is also growing concern among doctors that Italy squandered the gains it made during its 10-week lockdown and didn't move quick enough to reimpose restrictions.
Concerns persist that the rising stress on hospitals will force scheduled surgeries and screenings to be postponed — creating a parallel health emergency, as happened in the spring.
Italy is not the only European country seeing a resurgence — and, in fact, is faring better than its neighbours this time around.
Italy's cases per 100,000 residents have doubled in the last two weeks to nearly 87 — a rate well below countries like Belgium, the Netherlands, France, Spain and Britain that are seeing between around 300 to around 500 per 100,000. Those countries have also started to impose new restrictions.
This time, Milan is bearing the brunt, accounting for half of Lombardy's daily cases, which spiked past 1800 today. Bergamo — which was hardest hit last time and has been seared into collective memory by images of army trucks transporting the dead to crematoria — had just 46.
The resurgence as the weather cools has so far been most strongly linked to holidays, both at home and abroad, as Italians flocked to beaches and crowded islands during a remarkably relaxed summer.
"The lockdown is a treasure that we scraped together with great effort and great sacrifice. We risk losing the results from a summer that in some ways was rather reckless," Massimo Galli, the director of the infection disease ward at Milan's Sacco Hospital, told AP. "The whole country acted as if they infections never existed, and was no longer among us.''
Dr Anna Carla Pozzi, a family physician in a Milan suburb, said she feared that fatigue is weakening the public's response to the virus's resurgence. That's creating a situation similar to the one in January and February, when the virus was circulating undetected in Italy, and nothing was being done, she said.
Testing is helping Italy stay on top of the curve. There is on-demand drive-through testing at the San Paolo hospital where Settembrese works.