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People wearing protective face masks walk across the Piazza del Duomo, in central Milan, on Feb. 24, 2020, as security measures were taken in Northern Italy against COVID-19.

ANDREAS SOLARO/AFP/Getty Images

The alarmingly fast spread of COVID-19 in Italy, the biggest outbreak beyond Asia, continued Monday after shutting down the wealthy northern parts of the country, where more than 50,000 people in a dozen towns remained in lockdown.

By the afternoon, the number of confirmed cases in Italy had reached 229, up from 155 Sunday night. The majority were in the region of Lombardy, whose main city, Milan, is the commercial capital of the country. On Friday, there were only three confirmed cases.

The coronavirus has now killed seven Italians, all of them elderly. They were the first nontourist deaths in Europe. Twenty-three Italians with coronavirus were in intensive care Monday.​

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The rising infection count makes Italy’s the third-largest COVID-19 outbreak in the world, after China’s and South Korea’s.

The shutdown of Northern Italy could push the country, the third-largest European Union economy, into recession. Even before the outbreak, Italy was flirting with zero growth. Lombardy and Veneto are the commercial and industrial engines of Italy; the two regions account for about 30 per cent of gross domestic product.

The Italian stock market plunged Monday, as investors took the view that the economic toll could be heavy. By the afternoon, the main index in Milan was down 5 per cent, the biggest decline since 2016. All other European indexes fell sharply too, and oil plunged more than 4 per cent.

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The number of confirmed cases in China, where the outbreak began, rose to more than 77,000 by Monday, with almost 2,600 fatalities.

In Iran, governments have ordered the closing of schools and universities in 14 provinces as a “preventive measure.” Iran has officially recorded 12 deaths, the highest number outside China, though the semi-official Ilna news agency reported 50 deaths in the city of Qom alone.

Italian health authorities still do not know how the outbreak started in their country. The carrier who introduced the potentially lethal virus to Italy – referred to as paziente zero, or patient zero – has yet to be found, triggering fears that he or she is still at large, infecting Italians, and that the people he or she may have infected are unaware they are contagious.

The man originally identified as patient zero, who had visited China in January and dined with a 38-year-old Unilever employee in the small city of Lodi, near Milan, has since tested negative for the virus.

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Health authorities elsewhere in Europe were worried that the sudden explosion of Italian cases would spread across borders. On Sunday, French Health Minister Olivier Véran said new coronavirus cases in France are “very likely” and that he was “particularly watchful” of the epidemic in Italy. France has reported 12 cases and the death of one man, who was Chinese.

So far, all the countries that share borders with Italy – France, Switzerland, Austria and Slovenia – have kept them open, though there were reports of Italians blocked on arrival in France and in Mauritius.

On Monday, police in Lyon locked down a bus from Milan. Authorities said the driver was hospitalized with symptoms similar to those caused by the coronavirus. Italians on an Alitalia flight from Rome to Mauritius were told they had two choices after reaching Port Louis’s airport: return to Italy without disembarking or be placed in quarantine in local hospitals. Italian newspaper Corriere Della Sera said that, eventually, the Italians who were not from the coronavirus hot spots in Northern Italy were allowed to leave the plane.

The shutdown of Northern Italy has been rapid since Saturday, when Prime Minister Giuseppe Conte banned people who live in the infected areas from leaving their towns. Police have been ordered to fine anyone caught entering or leaving, and the armed forces may be called in to ensure the travel bans are enforced.

The first town to be shuttered was Codogno, about 60 kilometres southeast of Milan. Since then, at least 10 others have gone into lockdown, and the number is bound to rise as health authorities ramp up testing. The number of detected infections rose rapidly Sunday, with new cases reported virtually every hour. “The contagiousness of this virus is very strong and pretty virulent,” said Giulio Gallera, Lombardy’s health chief.

Schools, including universities, were closed in Lombardy and Veneto, as well as Emilia-Romagna, the region to their immediate south; Piedmont, in the northwest, which shares a border with France; and Friuli Venezia Giulia, in the extreme northeast.

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Venice cancelled the final two days of its hugely popular carnival, and several professional soccer games were suspended. In Milan, the city’s top tourist attraction, the Duomo cathedral was closed. Giorgio Armani held a fashion show with no guests on Sunday, the final day of Milan’s fashion week; the event was livestreamed instead. Museums were also closing Sunday.

Lombardy, in particular, was turning into a series of ghost towns. On Sunday night, the bars were closed. Earlier in the day, photos showed shoppers loading up on food and supplies in case the shutdown confines them to their homes. Church services were cancelled in Venice.

As the Italian outbreak expanded, the number of cases in South Korea reached 763 by Monday, with seven confirmed deaths. On Sunday alone, the country reported 256 new cases, and President Moon Jae-in put the country on red alert, allowing the government to close schools and prevent public gatherings. The country was last on red alert in 2009, when the H1N1 virus killed 250 people.​

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