MILAN — On the sixth floor of a skyscraper, two dozen epidemiologists and public health experts form the nerve center of the effort to contain a coronavirus outbreak in Italy that has alarmed Europe and put the wealthy Lombardy region at the center of global concern.
They work the phones, pore over digital maps and study computer screens. They update databases with confirmed cases. They track those whom infected people might have had contact with. They coordinate with hospitals and laboratories to verify test results, sometimes for people with no symptoms.
But their efforts have also fueled a political and scientific quarrel that may prove important to how Italy and other countries confront the virus: How much is too much when it comes to containment efforts?
It’s not every day that Italy is accused of being overly efficient, but Lombardy’s response has, unusually, been criticized for its vigor at a time when most governments are worried about being accused of doing too little.
Much of that criticism has come from rival Italian officials at the national level, no doubt concerned about Italy’s blighted image — and their own — as the number of cases in the country has spiked to 650, with 17 deaths.
Cases possibly linked to Lombardy have appeared in Austria, Switzerland, and the Canary Islands of Spain, adding to the impression that the region is the European source in a new stage of global contagion.
“Italy is a safe place,’’ Prime Minister Giuseppe Conte, a rival of Lombardy politicians who has himself faced intense criticism for the government’s handling of the virus, asserted defensively this week, “maybe safer than others.”
There is no doubt that Italy is confronting a significant outbreak. But beneath the political squabbling is a deeper dispute over whether Lombardy’s response has made the problem appear worse than it is.
With coronavirus spreading more widely, political leaders across the world are coming under greater pressure, with many trying to tamp down anxiety that is damaging stock markets, tourism and businesses.
Some leaders are lashing out. On Wednesday, President Trump accused journalists of making the situation “look as bad as possible.”
As a result, the dispute in Lombardy has taken on dimensions in politics, epidemiology and crisis communications that are likely to have consequences in any broader outbreak.
At its heart, the debate centers on testing.
The central government argues that other regions within Italy and other countries have respected global guidelines by focusing tests on people showing symptoms of the virus.
But according to the Health Ministry, Lombardy has also carried out swab tests on people who are more likely to have come into contact with infected people, even if they have no symptoms themselves.
Experts at the World Health Organization and Italy’s Health Ministry said in interviews that it was possible that Lombardy had created an inflated perception of the threat by including in case totals people who tested positive for the virus but who had not gotten sick. But many scientists say that attempting to track even mild cases of the virus is essential to containing its spread.
On Thursday, after insisting that their comprehensive approach to testing was the right one, Lombardy said it would now conform with national and international guidelines and test only people showing symptoms.
But the numbers tallied in Lombardy’s approach have already made Italy a focus of international concern.
Not everyone who contracts the virus gets sick, a fact that is proving a quandary for scientists and officials trying to formulate a measured response.
Walter Ricciardi, an Italian member of the executive council of the World Health Organization who was recently named councilor of the Italian Health Ministry, said that only a small percentage of people who contracted the virus were infected by people showing no symptoms who did not know they were carriers, he said.
Richard Pebody, another expert at the World Health Organization, said the organization did not consider asymptomatic transmission a significant factor in the outbreak.
But as the epidemic spreads uncertainty is growing. Other experts have raised concerns that carriers without symptoms could be spreading the virus, and the W.H.O. was under pressure to revise its guidelines, which it was expected to do on Thursday.
The Italian Health Ministry said that counting asymptomatic cases only served to cause alarm.
Of the 650 cases diagnosed in Italy, 403 were in Lombardy, according to regional officials. Of those cases, Lombardy officials said on Thursday, 216 had been treated in a hospital, with 41 requiring intensive care.
That means that 187 of those who tested positive for the virus exhibited only mild symptoms or none at all. In addition, at least 37 of those who did are now healthy and have been discharged.
But other top Italian medical officials warned that while it was possible that asymptomatic people might be less contagious, because, for instance, they cough less, very little is known about the new virus and how it behaves.
“Evidence is lacking,” said Giovanni Rezza, the head of epidemiology at the leading scientific organization of Italy’s National Health Service.
Lombardy officials said they preferred to know who had the virus.
“Either you hide problems under a carpet, or you lift the carpet and you clean the floor,” Attilio Fontana, the region’s president, said in an interview in his office, with views over a foggy and eerily quiet Milan, 29 floors above the virus hunters.
Mr. Fontana is a leading member of the League party, led by the nationalist Matteo Salvini, who has not been shy about leveraging the crisis to pursue his aim of bringing down Mr. Conte’s government. Mr. Salvini has argued in recent days that Mr. Conte had fumbled the response to the crisis and needed to be replaced.
Mr. Fontana said he disagreed with Mr. Conte’s “way of dealing with the crisis.” The region’s tests were necessary, he argued, suggesting that if other places tested as rigorously, they would find more cases, too.
“I don’t exclude that even in your country if they did a serious and attentive epidemiologic analysis they would find more than what the actual infected are,” he said, referring to the United States. Numbers were high in Italy, he added, “because we do a lot of checks.”
In the United States, the Centers for Disease Control is currently limiting testing to those who have symptoms and who have recently traveled to China or had contact with someone who tested positive for the virus.
The uncertainty surrounding the virus has opened fertile ground for political sniping, as politicians engaged in power struggles to shift blame.
Mr. Conte, the prime minister, had questioned Lombardy’s approach in an effort to project a sense of control.
He infuriated regional officials by blaming a Lombardy hospital for the virus’s spread and saying on Tuesday that “exaggerated’’ swab tests ‘‘would end up dramatizing the emergency.”
Lombardy officials had defended their methods.
“We don’t understand what he is talking about,” Mr. Fontana said.
In turn, he criticized Mr. Conte, saying that the prime minister should have listened to a proposal, made in early February, that schoolchildren returning from China stay at home for 14 days.
“They told us it was a racist behavior and they did not want to put in place this little precaution,” Mr. Fontana said.
Experts have speculated that the coronavirus outbreak in Lombardy could be attributed to the region’s close business ties with China or its densely packed population.
In search of Italy’s “patient zero,” Mr. Fontana said officials were pursuing “an Italian citizen with Chinese origins” who visited China around January.
He said that person then came into contact with someone who then “went to Codogno” — one of the Lombardy towns on lockdown. That second person is thought to have had contact with a 38-year-old Italian man, who remains in intensive care.
That man is believed to have spread the virus widely, prompting the lockdown of several towns near Milan.
In Milan’s central train station this week, people were eager to leave the city.
Donatella Monti and her children waited for a train back to Rome, all of them wearing masks bought in a hardware store.
Ms. Monti said that many in Lombardy seemed unfazed by the outbreak, but that her pediatrician back south advised her to keep her young daughter away from school for 10 days. “I’ll go to school with my mask on!” her daughter protested.
In Mr. Fontana’s office, his aides quipped that the masks “didn’t do a thing” to stop the virus and that the Milanese only wore masks during carnival.
But late Wednesday, Mr. Fontana posted a video on Facebook in which he explained that one of his aides had tested positive for the virus.
The governor said that he himself had tested negative, but that he would nonetheless “live in a sort of auto isolation” for the next two weeks, avoiding public events and news conferences and wearing a mask in the office.
“So when you see me in the coming days, I will be like this,” he said, pulling a green mask over his face. “Don’t be scared. It’s always me.”
Emma Bubola contributed reporting from Milan, and Elisabetta Povoledo from Rome.
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