Dr Luca Cabrini was certain his hospital in the heart of Lombardy's lake district would reach its breaking point caring for 300 COVID-19 patients. So far, virus patients fill 500 beds and counting.
Italy, which shocked the world and itself when hospitals in the wealthy north were overwhelmed with coronavirus cases last spring, is again facing a systemic crisis, as confirmed positives pass the symbolic threshold of 1 million.
"We are very close to not keeping up. I cannot say when we will reach the limit, but that day is not far off,'' said Cabrini, who runs the intensive care ward at Varese's Circolo hospital, the largest in the province of 1 million people northwest of Milan.
The hospital expanded its 20-bed ICU ward to 45 beds during Italy's deadly spring peak.
It had 38 patients last weekend, and Cabrini was preparing to set up beds in an operating theatre this week, "something we would have preferred to avoid." As dire as Italy's ICU situation is once again, it's not critical care that is most worrying doctors during the pandemic's autumn resurgence.
It's sub-intensive and infectious disease wards caring for less gravely ill patients, who are often younger and sometimes require care for longer periods.
The Italian doctors federation called this week for a nationwide lockdown to forestall a collapse of the medical system, marked by the closure of non-emergency procedures. The government is facing tougher criticism than in the spring when the health crisis was met with an outpouring of solidarity.
As of Wednesday, 52 per cent of Italy's hospital beds were occupied by COVID-19 patients, above the 40 per cent warning threshold set by the Health Ministry.
Nine of Italy's 21 regions and autonomous provinces are already securely in the red-alert zone, above 50 per cent virus occupancy, with Lombardy at 75 per cent, Piedmont at 92 per cent and South Tyrol at an astonishing 99 per cent.
Lombardy, Italy's most populous and productive region, is again the epicentre of Italy's pandemic.
The region's hospitals are responding by reorganising wards in a bid to avoid shutting down ordinary care, as happened spontaneously during Italy's first deadly coronavirus spike. Still, hospitals in Lombardy and neighbouring Piedmont - designated red zones by the government last week - have closed surgical, pediatric and geriatric wards to make room for COVID patients.
Veneto, still a lowest-tier yellow zone, is preparing to cancel all non-urgent procedures this week.
"We must continue to offer at least a minimum of services to all the other pathologies," Cabrini said.
"If we close our emergency room, it means a population of 1 million people will be without urgent care. We cannot let that happen." Doctors regret that a tougher line wasn't held this summer when infections dropped. Instead of consolidating the gains, Italians headed to the beaches, setting the stage for the fall surge.