In late November, doctor Maurizio Cappiello visited more than 130 patients in the emergency room of Cardarelli hospital, in the southern Italian city of Naples. More than two-thirds had Covid-19.
The virus, which was limited mainly to Italy's industrial north during the first wave in the spring, was now also ravaging the poor south - overwhelming its fragile public health system.
"Despite our efforts it was impossible to help them as we would have wanted and to transmit a sense of humanity, we tried to be fast and concentrate on the most critical," Mr Cappiello, a top official at Italy's national ANAAO-ASSOMED doctors' union, said.
Campania, the populous region around Naples, numbered just 430 coronavirus deaths by June 15th. The total has now risen to more than 2,300 as Italy's overall death toll has overtaken Britain's to become the highest in Europe.
The first Western country to be hit by the virus in March, Italy won plaudits for seemingly getting its outbreak under control by the summer. Now questions are once more being asked about why more people apparently die of Covid-19 in Italy than in other wealthy nations.
Explanations
Among explanations often put forward are its older population; a social structure in which the young often live with the old, exposing them to the virus; an underfunded health system; and a lack of preparedness and organisation.
"During the summer, when daily cases were low, we failed to recruit more staff and made no plan to reorganise," the Naples doctor Mr Cappiello said.
According to Worldometers data, Italy has registered 65,011 Covid-19 fatalities since February, against 64,170 in Britain, 57,911 in France and 47,624 in Spain - three other European nations badly battered by the disease.
On a per capita basis, Italy lies 37th in the world for number of cases, but 4th when it comes to deaths, with 1,076 Covid fatalities per million people. This compares with 943 in Britain, 886 in France and 924 in the United States.
The only European Union state with a higher per capita death ratio is Belgium on 1,546 - the worst in the world.
Counting
Countries count Covid deaths in slightly different ways and medical experts cautioned against drawing hasty conclusions, saying a clearer picture would only emerge when excessive death figures for the whole year became available.
But officials acknowledge Italy has suffered more than most, and pin the blame largely on the fact that it has many older citizens who have proved especially vulnerable.
According to Eurostat data for 2019, Italy had the oldest population in Europe, with 22.8 per cent of its people aged over 65. It also ranks as one of the countries with the highest life expectancies worldwide - 83 years.
But doctors say that while Italians live a long time, they are not especially healthy. A 2017 report by the Osservatorio Nazionale health association said 71 per cent of over-65s had at least two underlying health conditions. Almost half of this age-group took at least five different medicines a day.
"There is a very dangerous nexus between the high number of elderly people here and (the high number of) health conditions. We are paying a very, very high price for this," Health Minister Roberto Speranza told La7 television channel.
Sadly we don't seem to have made much progress. Perhaps we have even done worse
The first wave of the pandemic, which accounted for roughly 35,000 lives, was concentrated in the north, where some emergency wards were swiftly overwhelmed - a problem that pushed up the death toll as doctors were forced to decide who they could treat, and who they had to push away.
Doctors hoped that knowledge gained from the initial contagion would help them sharply reduce fatalities in any new outbreaks. However, as the second wave sweeps over the whole country, Stefano Centani, professor of respiratory illnesses at Milan University, said the death rate remained elevated.
"Sadly we don't seem to have made much progress. Perhaps we have even done worse. This will have to be analysed," he said.
Prolonged underfunding of the public health service was probably partly to blame, he said.
"We are paying for 20 years, maybe more, of constant cuts to health resources...When this pandemic exploded all our problems were exposed."
Mr Speranza also bemoaned spending cuts introduced more than a decade ago to try to help contain a ballooning national debt.
"The biggest problem is a lack of doctors. You can buy masks, respirators and protective clothing on the international market but you cannot buy doctors, and you cannot buy nurses, you cannot buy personnel," he said.
