Italian authorities said today that they were investigating the country's biggest nursing home where 70 residents died last month, in a stark reminder of the difficulties Europe faces in accurately counting its pandemic victims, particularly among the elderly
Lombardy regional Governor Attilio Fontana said he had opened a commission of inquiry into the deaths at Milan's Pio Albergo Trivulzio home, given published claims by a doctor and a union leader that management downplayed the risk of infection and wrongly attributed the causes of death. La Repubblica newspaper said Milan prosecutors had opened a criminal investigation.
The Trivulzio home, which has 1000 residents, disputed the Repubblica report, saying it had abided by all healthcare precautions, that Covid-19 tests simply weren't available for its sick residents, and that the number of dead was in line with its 2019 toll.
Nursing home deaths have come to represent a significant hidden toll from the pandemic in Europe, since many elderly were never tested for the coronavirus, were never hospitalised and their deaths were never counted in official virus tolls.
"There is an underestimate of deaths in nursing homes, it's futile to deny it," said Dr Giovanni Rezza, head of infectious disease at Italy's National Institutes of Health.
He dodged questions about why residents weren't being tested en masse, but acknowledged that entire clusters of infection had been traced to nursing homes, including at three facilities in central Lazio, far from Europe's main epicentre in the north.
It's not just Italy.
Authorities in the Madrid region, where more than 3300 elderly have died at nursing homes, enacted an emergency response plan last month which included sending troops to disinfect buildings.
In late March, they made a shocking discovery, finding residents living in squalor among the infectious bodies of people suspected of having died of Covid-19.
In a normal month about 1000 deaths are reported at Madrid regional nursing homes but now the rate is around 3000, said regional president Isabel Díaz Ayuso, though she noted it is "very difficult" to know whether they died of the virus or something else.
Catalonia has also been hit hard, with 909 deaths reported at nursing homes by yesterday.
The Italian Health Ministry's deputy minister, Pierpaolo Sileri, told Radio Capitale that inspectors backed by the Carabinieri's healthcare squad would gather documentation from the Milan facility as well as other nursing homes that have seen huge numbers of dead during the pandemic.
"One thing is certain, where there are fragile people and critical situations in nursing homes, there are more risks and it's correct to go and check," Sileri said.
"Milan isn't the only case in Italy; there have been similar situations near Catanzaro, in Sicily and in Lazio. I'm not identifying only one place, we're checking across the board."
The toll has been so high that Italy's National Institutes of Health launched a specific study for nursing homes nationwide to try to get a handle on what went wrong.
Preliminary data released last week, based on responses from 236 of the 4629 eldercare facilities in Italy, found a 9.4 per cent death rate in February and March, with only a fraction of them classified as Covid-19.
The survey found 87 per cent of the responding facilities reported a lack of protective equipment for medical personnel and that 36 per cent were suffering from staffing problems because so many staff were infected. Another 23 per cent reported having no information about how to contain the virus in the facility.
The association of doctors in the hard-hit Lombardy region estimated that 600 of the 6000 elderly in residential facilities in Bergamo province alone had died — an astonishing 10 per cent toll.
Fontana, the Lombardy governor, said he had authorised a commission to investigate the "real situation" in all the region's nursing homes, which are run by a combination of public, private, and religious entities.
A separate commission was created for the Trivulzio home.
Despite the heavy toll at the Milan facility and nursing homes nationwide, Italy's new infection rate continued to slow today with the lowest number of new cases since mid-March, bringing the official total to 135,586.
Another 604 people died, bringing the world's highest toll to 17,127.
Italy's commissioner for the virus, Domenico Arcuri, welcomed the easing on new infections.
But he warned Italians not to think that they can now put aside stay-at-home orders, particularly with Easter weekend coming.
"Be careful with illusions and mirages," he said.
"We are not at few steps from the exit of the emergency, we are not close to that hypothetical X hour that will quickly bring us back to the previous situation. Nothing could be more wrong than fantasising about an imminent moment."
Spain saw a slight rise in the number of recorded deaths and coronavirus infections to 13,800 and 140,000 respectively.
Health officials attributed the uptick to a backlog of reporting new data over the weekend.