“We asked for a lockdown at the start of November because the situation inside hospitals was already difficult,” said Dr. Filippo Anelli, head of the country’s doctors’ association. “We saw that it worked in the spring and allowed us to get out from under COVID. If this had been done, probably today the numbers would be coming down.”

But the Italian government resisted re-imposing a nationwide lockdown this fall, knowing the devastating impact on an economy that was just starting to come back to life after the springtime shutdown.

Instead, on Nov. 3 the government divided the country into three risk zones with varying restrictions. But by then infections had been doubling each week for nearly a month and hospitals were already overwhelmed in Milan and Naples.