Italy needs to shift to mass quarantining of coronavirus patients with mild symptoms instead of letting them isolate at home, according to a group of Chinese experts who traveled to the European nation to advise officials there.

Doctors in Wuhan made the same error early on in the outbreak, said Liang Zong’An, head of the respiratory department at the West China Hospital at Sichuan University. While seriously ill patients were admitted to hospitals, doctors at the time recommended that those with mild symptoms isolate themselves at home, in part to reduce the strain on Wuhan’s overburdened health care system.

Back then, it was not well understood how infectious the virus can be even in those who don’t seem very sick. But researchers now know that those with mild symptoms who are told to stay at home usually risked passing the virus to family members, as well as to others outside their homes as some still moved around freely.

“Due to lockdown, most of the transmission that’s actually happening in many countries now is happening in the household at family level,” Mike Ryan, head of health emergencies at the World Health Organization, said in a briefing on Monday. “Now we need to go and look in families and find those people that may be sick and remove them and isolate them in a safe and dignified manner.”

Italian daily Corriere della Sera reported Monday that a Saturday crackdown on people violating lockdown rules included some 50 confirmed cases who were circulating on the streets rather than staying home.

Wuhan began quarantining all mild cases in makeshift hospitals converted from offices, stadiums and gymnasiums in early February, a move that helped dramatically slow the spread of the virus. The city where the virus first emerged last December has successfully contained the outbreak, according to official figures that show few new infections even as the pandemic accelerates in other countries.

Liang said his team advised Italy to follow China’s lead to forcibly isolate patients with mild symptoms from their families. In China, a study of one province showed that 80 per cent of cluster infections originated from people told to rest at home, according to Xiao Ning, a researcher from the Chinese Center for Disease Control and Prevention who was part of the team.

Italian families generally live in more spacious apartments than people in Wuhan, Liang said. Still, there’s growing anecdotal evidence that whole families are getting infected from one sick person in their midst, despite attempts to isolate the infected in separate rooms.

“We can’t say if Italy’s home quarantine is right or wrong because each country has its own mechanism, but we found some problems,” said Xiao. The Italian experts they met with could not say how many clusters of infections arose from home isolation, according to Liang.

Milan has started to seize hotels for patients with mild symptoms. The first one with 306 rooms will be ready this week and will be designated to isolate patients from their families during the quarantine.

Mortality Rate

Italy’s coronavirus death toll has climbed above 11,000, the highest in the world. The mortality rate is more than double that in China, where the virus first emerged in late December, though questions have emerged about whether China’s official figures capture the full scale of casualties.

The head of Italy’s emergency committee has said the number of cases in the country could be 10 times the official count, which would bring the mortality rate in the country in line with others.

The high number of deaths is mainly due to Italy’s older population, said Liang. Many also didn’t seek medical care after testing positive for the virus and died at home, he said. Multiple deaths in China went unrecorded as overwhelmed hospitals in Hubei were unable to admit or even test those who displayed symptoms of Covid-19.

Xiao praised Italy’s health care system, saying the hospitals are taking very good care of virus patients but suffer shortages of protective gear. While earlier attempts at locking down the country and getting people to stay home were too lax, Italy’s move to send the military to police the streets from March 22 likely marked a turning point, he said.

Italy “may have reached its peak already” after those strict measures to enforce the lockdown and restrict people’s movements, he said. “If these measures can continue, their new infections will drop markedly. People should be physically isolated from each other. That means no gathering at all.”

Western countries from the U.S. to Spain are now experiencing what Wuhan went through earlier, including shortages of test kits, extreme scarcity of medical supplies and overwhelmed hospitals. In Italy, doctors have fallen ill themselves while struggling to treat patients, and their Spanish colleagues have had to choose who to let die from the disease in the face of a dearth of life-saving equipment like ventilators.

The virus has sickened more than 740,000 globally and killed more than 35,000. Several nations are fully or partially locked down, and many have put in place travel restrictions to keep infections from entering.

“There are optimistic estimates as well as pessimistic ones but the epidemic won’t go indefinitely.” said Xiao. “Now the whole world has recognized this problem and is acting on it, that’s a good sign.”