ROME (AP) — Natalina De Santis’ three adult children come to her front door, bringing food to keep her healthy and books to relieve her boredom, but she doesn’t let them in any more.

Widowed a few months ago and living alone, the 83-year-old resident of Rome is so afraid of catching the coronavirus that she foregoes all visits as the disease that is especially deadly for the elderly grips Italy. She insists they leave their care packages outside her door and then steps onto her balcony to wave to them.

“If I get sick, what would my children do?” she said in a telephone interview. “They’d have to come, they won’t be able to leave me alone. So, to avoid all this, I stay in my home.”

Still, De Santis takes comfort in the fact that she gets to see her children, even if they are on the street two floors below.

Elderly people all over the country are being separated from their loved ones as Italy has put in place drastic restrictions on everyday life to tame its dramatic surge in contagions. In a country with one of the world’s oldest populations, the viral outbreak is taking its toll on family relationships, that bedrock of Italian life.

Two months ago, Caroline Santoro’s 76-year-old father, his dementia worsening, was moved from his home in Rome where he lived with his wife to an adult care facility. Her 70-year-old mother then drove every day to visit him.

“Putting him in the residence was already a dramatic passage for her. But seeing him once a day was the only act of consolation for such a brutal turn” of events, Santoro said, speaking by telephone from home on the day that Italy implemented a nationwide lockdown in a desperate bid to contain the spread of COVID-19.

Then, last week, her family received a devastating notice from the care facility: visits to residents were now “absolutely” forbidden.

“That was the ultimate, the supreme solitude’’ that compounded the family’s anguish for a husband, father and grandfather, Santoro said. Now her mother goes to the residence every two days to bring her husband freshly washed and ironed clothes.

“The controls are so severe now. Up to a few days ago she could at least stay at the door of his section” to peek in at him, she said. “Now someone comes downstairs and takes the clothing.”

Some of the residents, whose dementia is less advanced, can keep in touch by telephone or video calls. But her father's illness is too advanced for verbal communication, she said, anguished.

“For us, it’s hard. It is the physical contact, the physical nearness that is the essential channel of communication,” she said.

Despite the sorrow, Santoro admitted that the safety measures are necessary. Still, the lack of human contact with her elderly parents has brought “great anxiety.”

Compounding the anguish is her mother’s decision, after the nationally-ordered lockdown, to isolate herself from the family, staying away from Santoro and her children – three sons, ages 11, 9 and 5.

Most people have only mild or moderate symptoms from the new coronavirus, such as fever and cough, but symptoms can be severe, including pneumonia, especially in older adults and people with existing health problems. The virus has infected 126,000 people worldwide and killed over 4,600, most of them in China. Over 68,000 people have recovered.

In Italy, the epicenter of Europe's coronavirus outbreak, roughly 23% of the population is over 65. Along with neighboring France, Italy has the largest number of people over 100. In France, medical units are common in assisted living facilities for those over 60 who need daily nursing care.

As COVID-19 cases ratchet up in France, visits to nursing homes by those younger than 15 are being discouraged. Since last weekend, some French facilities have gone into complete lockdown, informing residents’ families by email in grim, capital letters that: “UNTIL NEW ORDERS, NO MORE VISITS ARE POSSIBLE.”

French President Emmanuel Macron has appealed to citizens not to visit their elderly relatives in nursing homes, adding “I know it can sometimes cause heartache.”

With distrust of institutions deeply rooted in many an Italian’s psyche, nursing homes and assisted-living setups are a relatively new phenomenon. With many adult children still living at home well into their 30s, older parents often rely on family members for help. Italians aren’t terribly mobile, meaning when they strike out on their own, they remain near their childhood homes. And when aging parents need help, many families hire caretakers — often foreigners eager for room-and-board and monthly salaries of about 1,000 euros ($1,100), far cheaper than a nursing home.

In Rosalia Giardino’s condominium building near Rome’s Janiculum Hill, several families are living with their elderly parents or, if they themselves are elderly, have at least one adult child living a block or two away. She’s an exception.

Her 94-year-old mother lives in Castellammare di Stabia, 240 kilometers (145 miles) south of Rome. The national lockdown, announced Monday night and forbidding people to leave the towns of their official residence except for work and proven necessity, threatens to upend how she has managed to keep her mother, who uses a walker, still living in her home.

“Just two minutes ago I was on the phone talking to my brother,” said Giardino. “I asked him, what do you think, can you go by car?”

She was referring to the restrictions on travel between cities. She and her brother, who also lives in Rome, alternate weekend trips down to Castellammare di Stabia to check up on their mother, especially since her Russian aide’s Italian is poor and they struggle to understand what she tells them by phone. Giardino doesn’t drive, so she usually makes the trip by bus.

Not long ago, purely as a precaution, Giardino put her mother on a waiting list at an assisted-living residence run by Catholic nuns, a five-minute walk from her Rome apartment. About a week ago, she looked at her cell phone and realized she had missed a call from the residence days earlier. In a panic that perhaps she had lost a potential place for her mother, Giardino dialed the nuns.

“When I called, they said, ‘Don’t worry, signora. With this virus, we are not letting anyone in,’’’ including new residents, Giardino said.

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Associated Press writer John Leicester in Paris contributed.

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