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The small Italian village of Celleno thought it had escaped the coronavirus - nearly a month into Italy's national lockdown. No confirmed cases of the potentially deadly virus had been recorded. The more than one thousand residents of the village on the outskirts of Rome breathed a collective sigh of relief.
But in the past week all that has changed.
First there were seven cases - stemming from a dinner friends had on the eve of the lockdown announced last month by Italian Prime Minister Giuseppe Conte. And then came a big shock last week when a nursing home in the village for the elderly, Villa Noemi, recorded more than 30 cases among the frail residents.
The virus has now spread.
One of the nursing-home residents died midweek from coronavirus, shocking the closely-knit village. Celleno and its modest little farms dotted around the rugged northern Lazio hills has now been sealed off by alarmed regional authorities with police checkpoints mounted on the four roads leading in and out of the village to prevent anyone leaving or entering, except for emergency workers.
"The situation is quite tough," says Moira Emidi, a 36-year-old restaurant worker.
Celleno's mayor, Marco Bianchi, says the whole crisis feels "surreal" and that village is fearful.
The cases at the nursing home have "shaken the entire community." And he added: "Currently, 35 of the residents are positive for the virus; another four are negative and they have been transferred to a nearby farmhouse where they are being looked after." He says he finds comfort from how Celleno is pulling together, though, saying the village "has never been so united." He adds: "The beautiful solidarity of many, many citizens comes as a great relief."
Death still lurks
The village of Celleno is unlikely to be the last in Italy to discover that the virus has been lurking in nursing homes, only belatedly to reveal itself.
Italian authorities are now engaged in what they call a "mapping exercise" of the country's residential homes for the elderly as fears mount that what is found could reverse Italy's declining numbers of confirmed cases and deaths. Officials worry that an unseen surge in fatalities in nursing homes has been happening unnoticed with the old dying untested for the virus.
As things are now, only patients who are hospitalized with severe symptoms are normally being tested for the virus. Two weeks ago, the mayor of the north Italian city of Bergamo, a coronavirus hotspot, issued a warning about nursing homes. "There are significant numbers of people who have died but whose death hasn't been attributed to the coronavirus because they died at home or in a nursing home and so they weren't swabbed," Giorgio Gori, Bergamo's mayor said.
Worst may not be over
Nurses and relatives say they believe there has been an unnoticed spike in nursing home deaths, which is not showing up in the official coronavirus statistics. Emilio Tanzi, director of a 460-bed residence in the northern Italian town of Cremona, told Reuters that nursing homes are on the front lines of a crisis that predominantly affects the elderly but that, nonetheless, nursing homes have been overlooked and not adequately supported.
He said there had been a significant and "anomalous" increase in deaths since early March in nursing homes. "We don't know if there have been coronavirus deaths because the swabs haven't been done. We've certainly seen high fevers and breathing difficulties. If we'd been in a position to know, we could have isolated these patients properly and avoided the epidemic," Tanzi said.
Researchers are now trying to get to the bottom of where nursing homes fit into the coronavirus crisis. According to incomplete data analyzed by researchers at the London School of Economics, about half of all coronavirus deaths in parts of Europe may be happening in care homes for the elderly.
Death traps
The researchers are warning that a greater effort must be put into fighting the virus in nursing homes, otherwise deaths may keep climbing. Homes are ill-equipped to deal with the crisis, they say, because of chronic staffing shortages, lack of protective gear and the paucity of testing for the virus.
"Care homes are places where physical distancing is almost impossible. It's like a perfect storm: a susceptible population, not being able to implement the measures and the staff are not well supported and trained enough. Many of the staff are care assistants with very little medical knowledge," said Adelina Comas-Herrera, one of LSE's data researchers.
A government survey in Italy suggests 45% of all deaths in the country from the virus may end up having originated in residential homes for the elderly.
Tricky numbers
Italy reported a lower number of new coronavirus cases Monday -- although daily fatalities rose -- three days after the government decided to extend a lockdown. There were 3,153 new cases, the fewest documented since April 7, compared with 4,092 on Sunday, according to the country's civil protection officials. Italy recorded 566 deaths linked to the virus Monday compared with 431 the day before. The total number of fatalities from the virus late Tuesday stood at 20,465.
Italian officials are not the only ones in Europe wondering how a full accounting of nursing homes may alter the picture. Earlier this month, French officials abruptly revealed 1,416 nursing-home residents had succumbed to the virus since the pandemic emerged. French health officials have made clear the number of cases and fatalities they report every day does not include deaths in nursing and care homes.
Cases have also been reported this month in more than a hundred care homes around Stockholm, Sweden's capital. The authorities there have not given actual case figures, but the country's public broadcaster SVT estimates more than 400 residents have been infected and around 50 have died.
In Britain, official counts do not include virus-linked deaths outside hospitals, such as those in care homes. A former regional public health director, John Ashton, has publicly warned that the number of people officially recorded as dying from the virus could be double what is officially being announced. "We need to be able to see the data and crawl over it and really see what's going on," he told British broadcaster Sky News.
Meanwhile, as national authorities try to understand the full impact of the epidemic in nursing homes, the villagers of Italy's Celleno had some good news this week. Test results of residents in another nursing facility in the village have all come back negative.
An earlier version of this story attributed one more death in Celleno to the coronavirus. It turned out to be not related to COVID-19.