ROME (Reuters) – Italy’s nursing homes, where the COVID-19 epidemic is believed to have killed thousands of people, did not have the equipment needed to protect staff or residents, a survey by the country’s top health body showed on Wednesday.

Since the outbreak emerged in the northern region of Lombardy in late February, the homes reported a steep increase in fatalities, although many patients died without being tested.

Many of the 1,356 homes in the survey, which had more than 97,000 residents as of Feb. 1, are in the regions of Lombardy, Veneto, Piedmont and Emilia Romagna, which were most heavily affected by the epidemic.

The survey by the Superior Health Institute, which covered more than a third of Italy’s nursing homes, reported 9,154 fatalities but just 680 had tested positive.

Over 3,000 had “influenza-like” or pneumonia symptoms, which may have been related to coronavirus.

The nursing homes surveyed said they were unequipped to deal with the surge in new cases and fatalities Italy faced between March and April.

Some 77% reported a lack of masks and gloves, while 34% said they did not have enough doctors and nurses. Around 21% had not received sufficient information on how to deal with the virus and 26% said they had difficulty isolating those who tested positive.

Early in March, some homes appealed for more protective equipment, but despite this many were told to take in COVID-19 patients to ease the pressure on hospitals, especially in Lombardy where prosecutors have recently opened investigations.

Italy has reported more than 34,400 deaths from the COVID-19 epidemic, the fourth highest toll in the world, while confirmed cases amount to more than 237,800, most of them in the northern regions.