Italy’s medical community feels a sense of trauma.
At the time of writing this, 80 doctors and 21 nurses have lost their lives to COVID-19 since February.
In that time, two more nurses have taken their own lives.
As medics grieve for the colleagues they have lost, they are working to compensate for so many others that have been infected and are in quarantine.
More than 12,000 healthcare workers have tested positive for the coronavirus so far in Italy.
In one hospital alone in Bresica, Lombardy, more than 300 staff have been infected.
The town’s mayor called for more support after precious beds in Spedali Civili’s intensive care had to lie empty due to a lack of healthy staff.
Professor Francesco Castelli, director of the Infectious Diseases Unit at Spedali Civili, described the psychological impact on staff to Sky News.
“We were asking each other who will be the next and that of course is psychologically demanding because apart from colleagues, we are friends,” he said.
On top of the unprecedented pressure at work, staff are so scared of passing the virus onto their families that they are self-isolating at home.
“All of us we have some kind of concern about bringing the contagion back to our homes,” said the professor.
“We live for one month isolated at home because we also fear to transfer the contagion to our beloved ones.
“If you put all that together… the workload, the fatigue, the tiredness… that is fairly psychologically demanding.”
As doctors and nurses fight to keep patients alive, they carry a fear of their own exposure to the virus.
We were invited to see one of six new dedicated COVID-19 hospitals in Rome.
It’s not yet at capacity but the staff at the COVID 3 Hospital are overworked already.
Health director Antonino Marchese shows us up to the intensive care unit and says the situation is “pesante”.
Literally translated, it means “heavy” – but as he describes endless days of 14-hour shifts and a fear of contagion, it’s clear it’s a modest description.
Mr Marchese says: “It is a job we do very willingly, we try to give our best, certainly with great caution and trying not to contaminate ourselves. Despite all of the precautions, at the beginning not all of us felt we had to behave in a strict manner, practically military-like.”
It’s clear here staff are now taking no risks. Everyone wears protective clothing. The fear of contagion is palpable.
The shortage of personal protective equipment (PPE) in the early stages of the outbreak is in large part to blame for the infection of staff.
The pandemic is often described by doctors as hitting “like a tsunami”.
And at the point of outbreak, it’s too late to prepare.
As experts continue to work to understand COVID-19, evidence is emerging to suggest that frontline healthcare workers are more in danger.
But for Italy, they learned this too late.
“The situation was discovered when it was already a large issue,” says researcher Flavia Ricardo, from the Italian Institute of Public Health.
“One thing we know about this family of viruses is that they do tend to transmit very well in a healthcare setting… a disease that is normally transmitted through large droplets… it becomes transmitted through the air.
“So it spreads much wider. And of course the people who are more exposed to that are the people who are at closer contact with patients and are involved in those medical procedures.”
While PPE for hospital staff is now a top priority, there’s still a shortage of face masks for GPs in Italy.
Generations of doctors and nurses are now working and trying to survive in circumstances they may never have imagined. Circumstances that have left Italy in a state of trauma and now stretch globally.