The brutal reality of dying under Italy’s coronavirus lockdown

The last time Mariarosa Margini saw her father was on March 13, as he was being driven away in an ambulance. Renato Margini was in good health for his age. He was like an 89-year-old boy, says Mariarosa – he’d been a hiker and a climber, and would go on daily two or three mile walks around his neighbourhood in Brescia, Lombardy until late February, when the coronavirus crisis erupted, and his daughters recommended that he stay at home.

That night, when the ambulance arrived to take him to hospital, he was still relatively well – he only had a temperature of 38 Celsius, and was able to get into the vehicle without help. Over the next four days, Renato was confined to a hospital room with hardly anyone to talk to, his condition worsened, and he died without ever seeing his family members again. All they got was a phone call.

Their case is far from unique. With Italy under lockdown, social restrictions to fight the spread of coronavirus are leaving both the sick and the bereaved to face death alone. With the UK and many other countries seemingly following the same upward curve of infections, these strange new rituals could soon become the norm here, too. The pandemic has changed the way people live, the way they die, and the way their loved ones are able – or unable – to say goodbye.

When someone dies of coronavirus in Italy, “relatives see them enter the hospital, and then no more,” says Elisa Banelli, a pneumology and gastroenterology nurse at Bergamo’s Papa Giovanni XXIII hospital, on the front line of Lombardy’s fight against coronavirus. Death by Covid-19 is inhumane, she says – not only because of how it happens, by asphyxiation, but mostly because “it is a death far away from every loved one, and from every human contact”.

After patients enter a coronavirus ward, all they will see is medical staff wearing personal protective equipment (PPE) – “dressed like aliens” – as Banelli puts it. All visits are banned. Relatives can only come to the ward’s entrance to bring personal belongings, without seeing their loved ones face-to-face.

Even contact with medical staff is minimal. The intensive care units of many Italian hospitals have swelled in an attempt to treat the growing number of people fighting for their lives, but this has also stretched medical staff, who have less time than before to get to know, chat with or comfort patients.

For a day after Renato got onto the ambulance, his family did not even know which hospital he had been taken to – and neither did he, until a nurse understood his confusion and shouted the name of the facility from afar: the Città di Brescia, a private clinic in the city’s north.

But in a way, the Marginis were lucky: because their father could still speak, they were able to call him. In those phone calls, he described what he saw around him as “an army barracks”. Alone in a room, he told his daughter that medical staff rushed in and out, commanding him to stay in bed but hardly speaking to him. “He would say, ‘I can’t talk to anyone, I can’t even walk to the door – they check my temperature and don’t even tell me what temperature I have’,” Mariarosa says.

But other families are completely unable to speak to their loved ones. Often, when someone’s health worsens, they are treated with a continuous positive airway pressure (CPAP) helmet, a noisy, bulky device that pushes oxygen into their lungs to keep them open – but also makes it impossible to talk on the phone. Instead, relatives receive a daily call from doctors updating them on the patient’s conditions.

Rather than the embrace of a loved one, all that coronavirus patients have in their final moments are the medical staff – but the protective masks, gloves and visors strip even that of its humanity. “They can’t see if we’re smiling, unless they can tell from our eyes,” says Banelli. To give patients some human contact, she has started to hold their hand, “to make them understand that at least there is a hand, although a stranger’s hand”.

To ease the loneliness of patients and relatives and allow them to see each other, associations in Brescia are now crowdfunding to donate tablets to hospitals for video calling. “We’ve seen videos of emotional ICU patients [using tablets to] tell relatives very simple things: ‘I’m ok; don’t be afraid’. They wanted to see each other,” says Paolo Carrera.

He is Renato Margini’s nephew, but also works for AssoArtigiani Brescia, an association of local businesses that is donating tablets. He spoke on the phone from his office, where 57 of 60 desks were empty. “The plight of relatives and patients, but also doctors and nurses is this detachment – the inhumanity of not being able to have any social relations,” he says.

Even in staunchly Catholic Italy, patients are being denied a visit from a priest – like relatives, they are also barred from entering hospital wards for fear they could become infected – so they must die without receiving last rites. Don Pierluigi Leva, a priest in Casalpusterlengo, a town in the former “red zone”, the original outbreak area south of Milan, says that he hasn’t said any last rites at all since the start of the lockdown – although as many as 50 people died in the town in the first two weeks of Italy’s coronavirus crisis alone. “We have had to tell people that they can receive last rites ‘by desire’, too,” he says. Just like in Christianity’s early days, when martyrs killed while preparing for their baptism were considered baptised because they died wanting the sacrament, Don Leva is telling families that their loved ones can receive last rites in the same way, if their heart was in the right place at the time of their last breath.

A medical worker tends to a patient inside the coronavirus intensive care unit of the Brescia Poliambulanza hospital in Lombardy

PIERO CRUCIATTI/AFP via Getty Images

Renato passed away on March 17, four days after being taken away in the ambulance. The hospital procedures following his death will have remained largely unchanged, says nurse Banelli, but with doctors and nurses wearing masks, gloves and other protection. First, medical staff run a 20-minute electrocardiogram to declare the death. The staff remove all the devices attached to the patient’s body.

CPAP helmets should be disposable, Banelli says, but sometimes staff have to sanitise and reuse them because of how many critical patients are arriving. “I work in a hospital of excellence, I am used to having everything I need,” she says. “This was traumatic.”

The body is then sealed in a bag and put into a temporary casket to be taken to the hospital morgue – all standard procedures. What has changed is that morgue staff must also work with PPE, and that they must work quickly: the bodies must be sealed into their caskets as fast as possible. This means that open caskets and funeral wakes are no longer possible. In Casalpusterlengo, Don Leva says that the restriction hits rural towns particularly hard – just as he couldn’t visit his community in hospital, he can’t visit them at home either.

“When someone dies around here, we normally have a funeral wake at home,” he says. “People come and go to visit and to offer prayer and condolences. There is a procession to bring the casket from home to the church on foot, then one to bring it from the church to the funeral. All of that has been erased in the space of a few minutes.”

The ban on open caskets means that “families can’t see their relatives after they die, just like they couldn’t see them alive,” says Nicolas Facheris, the owner of the Facheris funeral home near Bergamo, the Lombardy province with the highest number of infected people – 7,072 as of March 25. He, like other undertakers, visits hospital morgues, which Facheris describes as “super full” of caskets, bags with personal effects and stretchers with dead bodies waiting to be laid into a casket, to prepare bodies and bring them to the cemetery or crematorium.

Speaking over the phone as he drives from one burial to another, Facheris says his company is processing up to six deaths per day, a five-fold increase on their standard workload. The pressure is such that he says he couldn’t sleep for three days last week, then he had a nervous breakdown. He has started to turn down work and switch off his phone in the night to avoid receiving more calls.

A medical worker wearing a face mask talks on her mobile phone inside the coronavirus intensive care unit of the Brescia Poliambulanza hospital in Lombardy

Government restrictions add to the pressure on funeral homes. In guidelines issued to the National Federation of Funeral Authorities, Lombardy regional authorities said that the dead are thought to be unable to spread the virus posthumously – but companies should use protective equipment and minimise contact with them anyway to avoid being infected. Funeral homes now work with face masks, gloves, a protective coat and sometimes shoe protection too.

The main consequence of this pressure, Facheris says, is that it is pushing standards down. “We have a high sense of ethics, a very different one from the one we’re forced to adopt now,” he says. “Our job is to honour the dead, not just bury them. But I don’t think we succeed in our mission these days.”

The restrictions mean that bodies can no longer be dressed or arranged. They are laid into caskets with whatever they have on – often, Facheris says, only hospital robes. To make the process more efficient, his company has started to offer a “standard” service for most customers – providing simple, smooth-surface larch or fir caskets for everyone. The casket is sealed quickly in the hospital morgue and taken away, with no-one else able to see the body.

Then the search for a burial site or crematorium begins. With cremation a popular choice, crematoriums are booked out for weeks and families end up waiting up to 20 days to receive the urn.

The Bergamo crematorium is particularly busy. A spokesperson explains how, with workers staffing facilities 24/7, the plant could process 25, maybe 26 bodies per day – but that every day they receive 40 bodies. The backlog is so huge that on March 23, the crematorium was not accepting any more bodies until April 8, and the ones they were receiving that day would not be cremated until April 11 (a 19-day wait).

Until then, caskets are held in temporary stores. The crematorium has one deposit for 70 caskets, but it is full. The Ognissanti church in the Bergamo cemetery became another such deposit – but it filled quickly too. Local authorities have had to scramble to find more suitable spaces – often, small secondary churches and warehouses.

On at least one occasion, army trucks carried a hundred caskets from the Bergamo cemetery to other facilities across Italy – including some in Bologna and Ferrara – to ease pressure on the city. But the Bergamo crematorium spokesperson says that this is not enough and that they expect the army to take away another hundred caskets soon.

Roberto Brambilla, who lives near Milan but lost his grandmother in Bergamo, says that one of these caskets could be his grandmother’s. “As of now, we don’t know where she is,” he says. “We don’t know if she has already been cremated or if she’s one of those who were taken away,” Brambilla says that his family doesn’t even know whom to ask for this information – they were only told that they would receive the urn in a couple of weeks.

Cemeteries are also filling up quickly, especially in towns near hospitals or assisted living facilities, Facheris says. “If we carry on at this rate, we will have to dig mass graves.”

Pallbearers pull a coffin for a funeral ceremony into a cemetery in Lombardy. Quarantined relatives were not allowed to attend

PIERO CRUCIATTI/AFP via Getty Images

The Margini’s mourned Renato on March 19, six days after he was admitted to hospital. His closest relatives gathered to remember him at the crematorium in Brescia, but to prevent the spread of the virus, the extended family could not go.

At 10:30 that morning, Carrera – Renato’s nephew – picked up his phone and opened WhatsApp. He wrote a text to his brothers, his wife and his children telling them now was the moment to remember the man whose service they were all barred from attending. “I don’t know what they did, everyone did as they felt,” he says. Then Carrera returned to his office and his job – just like that, it was over.

In most cases, when the burial happens, often several days after death, it is the first time a family is reunited with a dead relative. But the event goes by unceremoniously: funerals, like all other gatherings of people, have been suspended.

Some evangelical churches have live-streamed funerals on Facebook. But Catholics are postponing ceremonies until after the pandemic and arranging a quick meeting in place of the funeral. Instead of the whole Mass, priests are only able to say a few words of blessing before a casket is buried – a quick ten minute affair. Only up to ten close relatives can attend the blessing at the cemetery, wearing masks and gloves and keeping a distance, and this leaves families devoid of their community’s support, and family members like Carrera unable to say goodbye one last time.

In some cases, priests say only a handful of people can attend – because relatives who have come into contact with the infected before he or she died have to self-quarantine and avoid all social contact.

Other families are warned against attending the blessing. When Giovanna Savoldelli died in Clusone, in the mountains near Bergamo, and was taken to nearby Onore, the mayor warned her nephew, Milan resident Giulio Filisetti, against driving up for the blessing. The valley where Onore and Clusone lie has been ravaged by the coronavirus, and the mayor told Filisetti that the risk to become infected was too high.

In Casalpusterlengo, Don Leva says that the church doors have remained open, and in the early days under lockdown, many believers were coming in to pray for their loved ones – he could tell because he saw many lit candles. But in the last couple of weeks, he says, the number of candles has waned.

Other families have to make do with a blessing without priests at all. As Carrera texted his relatives on WhatsApp to invite them to pray, Mariarosa Margini and her relatives were unable to find a priest to conduct their father’s blessing in person. Three of Renato’s children and their partners said the prayers themselves, wearing face masks, gloves and keeping a distance. It was over in less than ten minutes, Mariarosa says.

But she only knows all this because her sister sent her a photo. She couldn’t be there herself: after her late father tested positive for the coronavirus, she was put in quarantine. She had been unable to visit him one last time while alive, see him after he died, or even attend his cremation. Self-isolating in her home to avoid infecting her husband and children, Mariarosa says she prayed and cried alone. It had been less than a week since she last saw her father.

This is the new reality for thousands of families in Italy as the coronavirus takes its toll on hospitals, morgues and funerals. “This emptiness, this impossibility to meet – it leaves a mark on you,” says Carrera. “It hurts not to be able to go and be there, see and speak to each other for a few moments.”

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