Death at home

It took Silvia Bertuletti 11 days of frantic phone calls to persuade  a doctor to visit her 78-year-old father Alessandro, who was gripped by  fever and struggling for breath.

When an on-call physician did go to her house near Bergamo, at the  epicentre of the coronavirus outbreak in northern Italy, on the evening  of March 18, it was too late.

Alessandro Bertuletti was pronounced dead at 1:10am on March 19, 10  minutes before an ambulance called hours earlier arrived. The only  medication he had been prescribed, over the phone, was a mild painkiller  and a broad-spectrum antibiotic.

"My father was left to die alone, at home, without help,"  Bertuletti, 48, said. "We were simply abandoned. No one deserves an end  like that."

Interviews with families, doctors and nurses in Italy's stricken  Lombardy region indicate that Bertuletti's experience is not uncommon,  that scores are dying at home as symptoms go unchecked and that phone  consultations are not always enough.

In Bergamo province alone, according to a recent study of death  records, the real death toll from the outbreak could be more than double  the official tally of 2,060, which only tracks hospital fatalities.

As the global fight to save lives centres on boosting the supply of  hospital ventilators, some doctors say a lack of primary healthcare is  proving just as costly because medics cannot or will not make home  visits, in line with a worldwide tactic of switching to remotely  delivered medical advice.

A spokeswoman for the state-run ATS health agency in Bergamo said  authorities in the Lombardy region, rated among the world's most  efficient for health services, told family doctors to "deal with  patients by phone as much as possible", limiting home visits "to reduce  contagion and waste of protective equipment".

Italy's official death toll reached 15,887 on Sunday, almost a third  of the global total, but there is growing evidence that this vastly  understates the real total because so many people are dying at home.

A study by local newspaper L'Eco di Bergamo and research consultant  InTwig, using data provided by local municipalities, estimates that  5,400 people died in the Bergamo province during the month of March, or  six times more than a year ago.

Of these, it reckons that as many as 4,500 people succumbed to the  coronavirus - more than double the official tally. This took into  account 600 people who died in nursing homes and evidence provided by  doctors, it said.

The ATS did not respond to a request for comment on the study's findings.

Pietro Zucchelli, director of the Zucchelli funeral home that serves  several villages in the Seriana Valley around Bergamo, said over the  past two weeks more than 50 percent of his job had been collecting  bodies from people's homes.

Before, most of the dead were in hospitals or nursing homes.

Munda, the doctor working in Selvino and Nembro, said he had been  visiting patients at home since late February, administering antibiotics  for bacterial pneumonia and oxygen therapy if required.

He said that although antibiotics were no cure for the virus, they  could treat some of the debilitating complications and help patients  recover without hospitalisation.

To protect himself, he bought 600 euros' worth of face masks which he sterilises at home with steam every evening.

More than 11,000 health workers have contracted the virus in Italy and 80 have died, many of them family doctors.

The Bertuletti family's ordeal shows how primary care, a health  system's first line of defence, has sometimes buckled in the face of the  coronavirus outbreak.

Ambulances that used to arrive within minutes of a call to emergency  services now can take hours, medics say. Oxygen bottles are so scarce  that nurses rush to claim them back from bereaved families as soon as  patients die.

"We are used to seeing people die, but normally it feels like you  are accompanying them at the end of the road," said Maura Zucchelli, a  nurse at Itineris, a private company which provides medical assistance  at home in the Bergamo area.

"Now you go to people's homes, and within 48-72 hours the patient is dead. It's draining. It's like war."