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A paramedic leaves a tent set up by the Italian Civil Protection Department outside the emergency ward of the Piacenza hospital, in Northern Italy, on Feb. 27, 2020.

Claudio Furlan/The Associated Press

Italian prosecutors have opened an investigation into a hospital’s treatment of an early COVID-19 carrier in an effort to determine whether the delay in his treatment triggered a surge in potentially deadly infections that could have been prevented.

The 38-year-old patient, known only as “Mattia” in the local media, is thought to be the first Italian COVID-19 case in Lombardy, the wealthy northern region at the epicentre of the outbreak in Europe. The investigation is focusing on the hospital procedures – or lack thereof – that prevented him for several days in mid-February from being placed in strict isolation.

The rise in Italian cases, and the virus’s transmission by Italians to other parts of Europe, has rattled health authorities and investors across the continent, triggering yet another warning from the director-general of the World Health Organization, Tedros Adhanom Ghebreyesus. He said Thursday that governments that fail to act aggressively to contain the disease through detection and quarantine could be making a “fatal mistake.”

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By Thursday, Italy had confirmed 650 cases, up from about 400 Wednesday, and 17 deaths. Last Friday, it had only three confirmed cases. New cases have been reported in Switzerland, Estonia, Denmark, Germany and Britain. South Korea reported 505 new cases on Thursday, its largest daily increase, raising the number to 1,766. Japan, with more than 200, is closing all public schools on Monday for several weeks. Meanwhile, Iran reported 26 deaths as of Thursday – the highest death toll outside China.

Rattled by the possibility that neighbouring countries will suspend Europe’s Schengen passport-free travel zone and close their borders with Italy, senior Italian government ministers tried to play down the crisis. Speaking to international reporters in Rome, Foreign Affairs Minister Luigi Di Maio said the 11 towns under quarantine in northern Italy represent just 0.05 per cent of Italian territory and that health authorities were being vigilant. “It’s an important message to countries blocking flights or discouraging travel,” he said.

The Mattia super-spreader case has obsessed Italians, who are still not sure who carried the virus into Lombardy, from which it spread. Mattia has been identified as paziente uno – Patient No. 1 – and is from Castiglione D’Adda, one of several small towns in the COVID-19 hot spot just south of Milan.

According to numerous reports in the Italian media, Mattia complained of feeling unwell on Feb. 14 and was given a flu shot by his local doctor (in most COVID-19 cases, victims have a fever and a dry cough). Two days later, he went to emergency in a hospital in nearby Codogno, where he was again released. On Feb. 18, he made a repeat visit, where once again he was discharged without being tested for the virus, apparently because he had no known links to China.

His third visit to the hospital was on Feb. 19, when he had breathing difficulties. By then, his wife remembered that Mattia may have met with a friend who had recently visited China. But for unknown reasons, Mattia was not tested for the virus until the next day, by which time he had come into contact with a dozen or more people, including a running partner, hospital workers and bar clients, all of whom have tested positive for the virus, as has his pregnant wife.

Earlier in the week, Italian Prime Minister Giuseppe Conte, who is under enormous international pressure to ensure the outbreak is contained, criticized the Codogno hospital’s mishandling of the Mattia case, although he did not go into details. He said the hospital’s dealings with him were not "completely proper according to the protocols that are recommended for these cases” and that “this surely contributed to the spread.”

Mattia remains in hospital, where he is reportedly in serious condition.

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Italian stock markets continued their plunge as the number of coronavirus cases rose and as businesses and the tourism industry trickled out news of vanishing clients and cancellations. The main Milan stock index fell 3.4 per cent Thursday. In London, the FTSE-100 index fell 3 per cent. Wall Street also plunged, putting U.S. shares on track to enter “correction” territory, defined as a 10-per-cent fall from recent highs. Oil has dropped more than 10 per cent since Monday, marking its worst weekly performance since 2016.

Some countries are putting restrictions on foreign visitors as the virus gallops around the world – it is now in 47 countries, according to the WHO.

Israel, which has just one confirmed case, has banned foreigners arriving from Italy. On Thursday, Saudi Arabia’s Foreign Ministry said it would suspend the entry of foreigners for pilgrimage and tourism purposes. The country has no confirmed cases. France, with 18 confirmed cases and two deaths, has urged its citizens to avoid the virus hot spots, including Northern Italy.

While the Italian government is resisting shutting down schools and transportation beyond northern Italy, the history of viral diseases suggests widespread shutdowns can slow their spread, as they have in China, where the outbreak began in December.

“[Shutdowns] do not eradicate the epidemic but reduce the number of cases for a while,” said Jerome Adda, dean of research at Milan’s Bocconi University. “The cost of the measures is high, and my research shows that a virus would have to be two to three times more deadly than a common flu to justify them. And the coronavirus is about 20 times more deadly, so these measures are indeed justified.”

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