Italy has a high number of seniors. That makes this battle far more complicated

A carnival mask and a protective mask are worn in Venice, Italy. Photos / AP

As the coronavirus death toll ticks up day by day in Italy, a picture has emerged of the people most at risk: a 77-year-old found dead in her home, an 84-year-old man who lost his battle with the virus, and another who was 88.

The virus can be carried by anybody. But as it spreads through China and accelerates in other parts of the world, it is delivering an unequal demographic blow to the elderly and those already sick.

That has set off a race in countries with significant older populations - such as Italy - to figure out whether there are ways to protect their most vulnerable: those in hospitals, in nursing homes, and seniors in sealed-off hotspot towns who are watching television and fearing the worst.

"The purpose is preventing the virus from entering our facility," said Danilo Achilli, the health director of one Italian nursing home in the northern town of Chignolo Po, where the workers now wear masks, and where management has decided to put strict limits on visits from relatives.

But even as Italy works to contain what is the first major coronavirus outbreak in Europe, there is growing concern that the virus is outracing the health measures.

New cases popped up farther from the original cluster, including in the southern island of Sicily and the tourist-heavy Tuscan capital, Florence. Italy has at least 322 confirmed cases and 11 deaths, all people who were elderly or already sick, and cases have soared as well in South Korea and Iran.

Italy, though, presents a particularly grim laboratory for the virus' risks.

It has Europe's highest proportion of people older than 65, a ratio that is second in the world to Japan.

And in the dense northern strip of small Italian towns where the virus first flared - now put on lockdown by authorities - life has become complicated for the many older people who live there. Some elderly inside those restricted zones are unable to see relatives or caretakers. Some smaller health clinics are closed. Most people simply have nothing to do.

"I spend the whole day with the TV set on, a shut-in, and I only get out for the most important chores," said Piera Salamina, 71, a retired maths teacher in one of the sealed-off towns, Casalpusterlengo.

Nursing homes say they have employees who haven't been able to come to work. One nursing home director said his employees still on the job were "scared."

Efforts to study the illness are only at the beginning stages, but flu-like viruses of all kinds tend to be disproportionately risky for the old.

In one of the first major Chinese studies into the coronavirus, published this month, researchers found that people younger than 50 died in roughly one of every 325 cases, or 0.3 per cent. But for people in their 70s, roughly 8 per cent of people who contract the virus don't survive. For people 80 or older, the death rate hits nearly 15 per cent.

Italy has a far higher proportion of people in their 80s than does China. Italy reported four deaths today; the victims were 76, 83, 84, and 91 years old.

"The rate of lethality will be higher in Italy," said Raffaele Antonelli Incalzi, the president of the Italian Society of Gerontology and Geriatrics. "[The elderly] have no higher risk of contagion; the opposite - they'll likely get infected less, since they have fewer social relations. But if they do fall sick, the illness is graver."

An Italian Army soldier checks transit to and from the cordoned areas near Turano Lodigiano.

Italy's Government has not imposed steps specifically aimed at the elderly, and instead has tried to limit movement of people in areas where the virus has emerged.

Across the north of the country, schools, churches and museums are closed. The Government has tried to curb unnecessary crowding in hospitals, urging people who think they might have a fever or respiratory problems to dial a hotline before getting into their cars.

The steps to limit the spread are most obvious in a dozen small towns at the centre of the outbreak, where authorities have cordoned off entrance points, and where residents like Santino Gobbi, 75, say they feel a mounting sense of isolation.

Several of Gobbi's grandchildren live in the same town, but now he mostly talks to them on the phone. He no longer has a place to stop for a coffee. When he went outside today, he said he saw people lining up for two things, medicine and cigarettes. They took care to remain a fair distance apart from anybody else.

Gobbi says he is still healthy, going for walks in the countryside, taking 10,000 steps per day, and says he can't remember the last time he even had the flu. But what worries him is his sister, who is 80 years old and rarely leaves her house.

"The news is constantly saying that people don't need to be afraid because the disease is only killing the elderly who are already sick," said Gobbi, a retired building manager who lives in Casalpusterlengo, southeast of Milan. "Well, this is not something nice to hear from television. If you say something like that, for many elderly people who are at home alone, tension only increases."

A Carabinieri (Italian paramilitary police) officer at a checkpoint in Casalpusterlengo.

Sixteen kilometres away, in Chignolo Po, which has not been closed off, the nursing home has been taking new precautions, and several visitors who showed up in recent days to see their elderly relatives were turned away.

Many of the 72 residents suffer from memory loss and pass the time playing card games or watching TV, but over the weekend, they listened to a staff member try to give the news about what was happening in their country.

Tina Lista, the staffer, felt it was necessary to tell them about the coronavirus because some might already be having questions about why people were wearing masks, and why fewer visitors were coming through the door.

She described the virus as an "aggressive flu."

Hearing the news, one of the residents brought up the Spanish flu, a 1918-19 pandemic blamed for about 50 million deaths worldwide.

Others said they were worried about their children.

"Usually when I read them the news, we try to keep it colorful - never anything about politics or the economy," Lista said. "I try to safeguard them." But now, she said, "the risk is there for everyone."