For now, Italian public health experts argue that the system, while deeply challenged, is holding, and that all the thousands of people receiving tests, emergency room visits and intensive care, are getting it for free, keeping a central principle of Italian democracy intact.

But before the region of Lombardy centralized its communication on Thursday and seemed to muzzle doctors and nurses who spoke out about the conditions, there emerged troubling pictures of life inside the trenches against the infection.

A photo of one nurse, Elena Pagliarini, who collapsed face down with her mask on in a hospital in the northern town of Cremona after 10 straight hours of work, became a symbol of an overwhelmed system.

“We are on our last legs, physically and physiologically,” Francesca Mangiatordi, a colleague who took the picture said on Italian television on Wednesday, urging people to protect themselves to avoid spreading the virus. “Otherwise the situation will collapse, provided it hasn’t already.”