Italy is facing a second wave of problems during the coronavirus pandemic as healthcare workers fall ill with the potentially deadly infection.
Italy has suffered the deadliest outbreak of coronavirus in the world with more deaths recorded than in China that is partly due to it's ageing population and the fact the virus was able to circulate undetected there for weeks.
On Monday the country reported nearly 60,000 infections with 5,476 deaths – highter than that recorded in China's Hubei province where the outbreak began.
Now, with little left to restrict and the Prime Minister pushing for a final 10 days before experts hope the number of new cases could subside, the country is facing a secondary problem as healthcare workers succumb to the disease.
At Italy's Oglio Po hospital, 25 out of 90 doctors are infected with the coronavirus, compounding the strain faced by a health system overwhelmed by the world's second-biggest outbreak.
Adding in nurses, technicians and other employees, a fifth of the hospital's personnel has tested positive, hospital director Daniela Ferrari said. They and healthcare workers like them almost certainly unwittingly spread the virus before needing treatment or quarantine themselves, researchers and unions say.
The picture is the same at other hospitals, among family doctors and in nursing homes – exacerbated, say unions, sector leaders and medics, by a shortage of masks and gloves when the outbreak was detected a month ago.
Doctor Romano Paolucci came out of retirement to help the Oglio Po hospital near Cremona, one of the worst hit towns in the Lombardy region.
"We are at the end of our strength," he said.
"We do not have sufficient resources and especially staff, because apart from everything else, now the staff are beginning to get sick."
In Lombardy, the Italian region with the highest number of cases and deaths, at least two hospitals became vehicles of contamination.
There, patients infected medical staff who then spread the disease as they travelled around their communities before a stringent lockdown was imposed. Mario Negri Institute for Pharmacological Research director Giuseppe Remuzzi said that is one reason why the virus spread so quickly.
"Patients infected other patients and doctors, who then went out and contaminated others," Remuzzi said.
At a national level, 4268 health workers – or 0.4 per cent of the total – had contracted the virus as of March 20, according to the National Health Institute.
In Lombardy's northeast city of Bergamo, 134 family doctors out of 600 – or 22 per cent – had fallen sick or were quarantined, according to Guido Marinoni, the head of the local association of general practitioners.
Three doctors have died.
Marinoni said that for the first two weeks after the disease was first detected in northern Italy on February 21, family doctors lacked masks and gloves and so were easily contaminated by coughing and feverish patients who went to see them without knowing they had the coronavirus.
Only in early March, the family doctors of Bergamo were given 25-30 surgical masks, he said.
"If a person with the disease contaminates on average another two people, a doctor who is moving around the community can contaminate at least another 10 people and this spreads the contagion in an exponential way," Marinoni said.
"It's like fighting a war with a toy gun. I hope the rest of Europe learn from the good things Italy did, but also from our mistakes."
The head of the government's coronavirus relief effort says Italy needs 90 million masks a month and it has "activated all possible channels" to achieve that.
Lombardy governor Attilio Fontana said on Thursday he had signed a contract for four million masks from Jordan.