MILAN/PARIS • Italy's coronavirus death toll has overtaken that of China, where the virus first emerged, as hospitals said they were overwhelmed and the government prepared to prolong an emergency lockdown.

A total of 427 deaths were registered in Italy in a single day, bringing the tally to 3,405 since the outbreak surfaced on Feb 21 in the country, officials said on Thursday. China has recorded 3,248 deaths since early January.

However, Italy has far fewer confirmed cases - 41,035 as of Thursday against 80,967 in China.

Officials believe the number of infections in the European nation is much higher, with testing largely limited to those arriving for hospital care. Its large elderly population, particularly vulnerable to the virus, is also seen as a factor for the high number of fatalities.

Hospitals said they were overwhelmed. "We are working in a state of very high stress and tension," said Ms Daniela Confalonieri, a nurse at a hospital in Milan, the capital of the wealthy northern region of Lombardy, which has been the epicentre of the epidemic.

"There is a high level of contagion, and we are not even counting the dead any more... Look at the news that is coming out of Italy and take note of what the situation really is like. It is unimaginable."

Italy went into virtual lockdown before other countries in Europe, but with cases still rising, officials are considering even tougher measures. Mr Luca Zaia, governor of the Veneto region, demanded stronger curbs from Rome, including closing all shops tomorrow, and said if they were not passed, he would consider passing a regional decree.

"I hope there will soon be measures to restrict people jogging or going out for walks. I am sorry about that, but the alternative is intensive care, hospitalisation and contagion," he said.

In Sicily, the regional governor said the army would now help police conduct spot checks to ensure only people with legitimate reasons were out. Police across Italy have stopped more than 1.2 million people over the past week and booked some 51,000 for violating the rules, the Interior Ministry said.

The Corriere della Sera newspaper quoted Prime Minister Giu-seppe Conte as saying the government would extend the deadline on emergency rules closing schools and many businesses. The measures currently order most shops to stay shut until Wednesday at least, and schools until April 3.

The contagion is also badly damaging Italy's economy, which was already on the brink of recession before the virus struck. The Treasury has announced a €25 billion (S$39 billion) package of measures to support companies and workers, and sources said it was considering extending guarantees on bank loans to help firms hit by a collapse in orders.

Across Europe, the scale of the outbreak and the subsequent lockdowns have brought new ways of dealing with death as the continent struggles to cope. Families have been forced to stay away from their loved ones' funerals, mourners fined for following a hearse, and undertakers have taken to setting up live links to burials because no one is allowed at the graveside.

In Italy, particularly in the worst-hit Bergamo province, coffins are piling up because undertakers have been overwhelmed. Some of the dead are being left sealed in the rooms they died in because there are not enough coffins. Hearses even had to wait in line in front of a cemetery's closed gates on Wednesday.

With funeral services suspended, the city's mayor Giorgio Gori said that "we had to close the cemetery so people wouldn't take the bus there for a final farewell to their loved ones".

In Sicily, 48 people were fined for breaking the lockdown to join a funeral procession.

Spain has postponed formal funerals and wakes for coronavirus victims in the worst-affected areas of Madrid and Barcelona.

In France, people have been banned from the bedsides of their dying parents for fear of bringing the virus into nursing homes. Mourners at funerals have also been ordered not to hug and the number of people allowed to attend limited to just 20.

"It broke our hearts, but my sister and I had to give up going to the funeral," Parisian Emmanuelle Caradec said, after her grandmother died in Nantes, 400km to the west.

French funeral group AdVitam has offered to provide "free video transmission of funeral ceremonies to all families" unable to attend.

But even this cannot make up for the thwarted grieving process, experts said.

"I don't deny at all that the measures are well-founded... but it is not without human consequences," said France's Catholic Funeral Services head Christian de Cacqueray. "The trauma of certain families for whom the event will be botched will be terrible."

The best solution is to come up with replacement rituals, according to professor of psychopathology Marie-Frederique Bacque of the University of Strasbourg.

"Lighting a candle is the simplest and most evocative symbol, thinking of the person you loved, putting up photos or flowers. It is the best thing to do while waiting to go to the grave later."

REUTERS, AGENCE FRANCE-PRESSE