Elderly suffer heavy toll as virus spreads

MILAN » A table of old men shot the breeze next to the bocce ball courts in a Milan recreation center Wednesday, talking, like seemingly everyone else in northern Italy, about the coronavirus outbreak that had shut down towns, closed all of Italy’s schools and claimed the lives of more than 100 people, almost all of them elderly.

The men, mostly in their 70s and 80s, joked that their wives gave them a hard time for leaving the house (“not even the coronavirus can keep this guy home”), that life’s finish line was too close to get worked up about a contagion, that they had faith in northern Italy’s vaunted health care system.

But the bravado also disguised real concern.

“It’s normal that I’m a little worried.” Antonio Di Furia, the club’s owner, 67, said. “I have heart problems.”

Italy’s mortality rate in the outbreak, about 3.5%, is not much above the global average of 3.4% reported by the World Health Organization. But the virus is taking a disproportionate toll on the elderly in Italy, which has the oldest population in Europe, and the second-oldest in the world after Japan.

The number of coronavirus cases and deaths spiked again Wednesday in Italy, which has reported 2,703 people infected and 107 deaths overall. Daily jumps have become the new normal.

Even as Italy locks down towns — two more were added Wednesday, bringing the total to 13 — the virus continues to spread. Italy’s measures have slowed the outbreak, but not enough to allay concerns about the burdens it is placing on the health care system and the threat it poses, especially to older people.

“The measures introduced in these days have the aim of avoiding a large epidemic wave,” Italy’s National Health Institute said in a statement explaining its stiffening guidelines, which recommend personal separation as schools closed nationwide until at least March 15.

“In the case of the coronavirus we must take into account, moreover, that Italy has an elderly population, actually much older than the Chinese, and needs to be protected from the contagious,” it said.

About 23% of Italy’s population is 65 or older. The median age is 47.3, compared to 38.3 in the United States, according to the United Nations.

Many of those who have died in Italy already suffered from serious illnesses that put them in grave danger, then the virus “destabilized them,” said Walter Ricciardi, an official at the World Health Organization who is advising the Italian health ministry.

Angelo Borrelli, the head of Italy’s Civil Protection Agency who is coordinating the country’s response to the crisis, said Tuesday that of the people who died, “Most were over 70, and some had preexisting conditions.’’

‘‘But for the others,’’ he said, ‘‘we still aren’t sure.”

The array of preexisting conditions suffered by some victims, including cancer, diabetes and heart disease, has complicated efforts to assess the lethality of the virus.

The World Health Organization said that the casefatality ratio was highly fluid and likely to change. Infections have probably been underreported, it said, given that many are asymptomatic or very mild.

Some experts argued that the aggressive response by Italy’s northern regions had not only slowed the spread of the virus but had also brought down the death rate.

“There was a huge expansion of the intensive care units,” said Fausto Baldanti, a virologist at the San Matteo Hospital in Pavia. “That can make the difference.”

But the intense focus on coronavirus in Italy is exacting a cost.

In the north, many hospitals have suspended all but the most urgent surgeries in order to free medical beds and other resources for acute coronavirus cases. Staff have canceled vacations and put in overtime.

Speaking on Radio1, Alessandro Vergallo, the president of the national association of anesthetists, said that in Lombardy, “we can count the free spots in the hospitals on the fingers of two hands.” The health system can’t long survive under such conditions, he said.

Around Lombardy, elderly Italians expressed a mix of caution, fatalism and nonchalance.

While the men in the bocce club shrugged off the threat, they did so next to empty courts and empty tables. Most of their friends had stayed away.

“I think they’re scared,” said Annalisa Canato, 67, who sat by the bar. “For good reason.”