Fear, distress, relief. The many emotions of the pandemic can be found in Italy’s pharmacy testing lines.

“Another positive?” Spagnoli, the head pharmacist and owner, was saying just an hour later.

In this omicron-driven phase of the pandemic, with hospitalization rates relatively low but infection rates skyrocketing, Europe’s pharmacies have become increasingly central — offering rapid antigen tests in makeshift outdoor tents at a breathtaking pace.

The demand for testing has quickly transformed the pharmacies, which in Italy tend to be small, family-run businesses rather than large chains. Before, those pharmacies served the straightforward purpose of selling medicine, diapers and shampoo. But now, carrying out hundreds of swabs per day, they have gained renewed prominence in public life, becoming settings of tension, relief and sometimes great distress.

Not all countries have leaned as heavily on pharmacies. Germany has set up big, privately-run testing centers. Britain has made widespread use of at-home testing kits, delivered for free, with results that can be uploaded to a National Health Service app. The United States has a mix of appointment-based testing at chain pharmacies and clinics, as well as at-home testing. But Italy’s system resembles several other nations in Europe, including France.

Those involved in Italy’s testing say the system has the advantage of being able to trace and log every positive. The pharmacies report results immediately to the government. And fines await anybody caught breaking isolation rules.

“With an at-home kit, if I test positive, it’s up to my goodwill,” said Marco Cossolo, the national president of Fedefarma, federation of pharmacy owners. “I might act as if I didn’t test positive and throw it away.” He said the pharmacy system allows for tight “monitoring.”

While swabs have become hard to find in some countries — including the United States — the Italian model so far seems to be holding, with tests available, if people are willing to wait in line. Several days this week, Italy administered more than 1 million coronavirus tests, a per capita rate more than twice that of the United States. The vast majority happened at pharmacies like Spagnoli’s.

“I can tell you my caffeine intake has reached epochal levels,” said Spagnoli, 39, a third-generation pharmacist.

Amid the omicron spike, his pharmacy is conducting some 100 antigen tests per day, and lately 20 or so have been turning up positive. The tests are conducted in a rented prefabricated cabin — “it’s for construction sites,” Spagnoli said — set up out front, and one after the next one recent morning, new people were stepping inside, handing over an information form before getting swabbed.

Then, they waited outside for the results.

The man performing the swabs on this day was a local nurse, and the first tests were complication-free. “Negativo,” the nurse said, telling the initial arrivals to go into the pharmacy and pay 15 euros.

But then came the first positive, and the nurse walked over to a 17-year-old, Vanessa Brandello, and pulled her aside to a quieter space on the sidewalk. He handed her a pamphlet with guidelines for isolating. He explained that she could get a PCR test, if she wanted, to confirm the results. Her shoulders slumped.

“If someone has a cold, could that be the reason they test positive?” she asked.

“No,” the nurse said.

Brandello stood outside the pharmacy for several more minutes. She called her dad. She started to cry. She couldn’t quite make sense of it. She kept repeating that she’d been scheduled to get a booster in less than a week.

She explained that she had gotten tested because she woke up with a sore throat and a dry cough. But now she feared going home, because she didn’t want to infect a grandparent who lived with her family. The alternative, she said, was to stay with her boyfriend, and “lock herself in a space she said was “smaller than a bathroom.” Even though she was unlikely to get seriously ill, she said she already felt sick “psychologically.”

“I’ll hole myself up and shed some more tears,” she said.

Italy created its testing system late last year, when the first pharmacies erected outdoor tents, planning for an emergency that most anticipated would last one winter, not two. At that time, the country was conducting swabs at one-fifth the level that it is now.

Since then, pharmacies have become the go-to place for testing. There are 20,000 pharmacies across the country, 14,000 of which offer swabs. Some pharmacies have swapped out tents two or three times, replacing them from wear and tear. Some pharmacies have upgraded to more durable cabins. Some have set up online appointment systems. A few have installed touch screens at the entrance, so people can take a number for their place in line. Pharmacists say that, along the way, their own lives have been pushed in ways they never imagined.

“We were even open on the morning of Christmas,” said Fabrizio Donadio, whose family owns the pharmacy in Morano Calabro, a Calabrian hilltop town that has seen an explosion of cases and special restrictions. “Let’s just say we haven’t gotten any rest.”

The pharmacies of Italy bear little resemblance to the palatial chains common in the United States. Here, they are compact. Many, in an homage to ancient apothecaries, are decorated with ceramic urns once used for herbal remedies. In Rome, a few pharmacies have frescoed ceilings. They don’t sell candy bars or breakfast cereal or greeting cards.

The pharmacists who run these places say they are earning more money because of the testing. But one pharmacist said the income was “damn hard earned.” Spagnoli quipped that he might as well be the richest man at a cemetery, not because he was so worried about covid, but because there was no downtime for leisure.

Pharmacists say there is a constantly need to juggle duties. Either they perform the swabs or contract nurses — in high demand — to do the work. Each result needs to be logged on two government websites.

“Now and then, one site is working, the other not,” Spagnoli said.

Gimbe, a research foundation in Bologna, Italy, that tracks the pandemic, says the testing system has many drawbacks. The group noted that so many asymptomatic people are lining up for tests, and then being referred to PCR tests for confirmation, that people who really need PCR tests aren’t being tested “in an adequate amount of time.” It also claimed this week that the antigen tests have a 30 to 50 percent chance of producing false negatives — a higher rate than generally cited by other scientists. (The Food and Drug Administration has said that rapid tests may be less effective at identifying the omicron variant.)

There were points earlier in the pandemic when testing positive could be more dire. Lower hospitalization rates strongly suggest omicron isn’t as severe as delta and earlier strains. But people who conduct swabs say they still sense anxiety among people lining up.

One nurse stationed inside a tent at a pharmacy in San Vito Romano, a town an hour outside of Rome, said the fear was “constant.” Part of it may be that the ambiance of the testing sites hasn’t changed: the protective covers, the face shields, the sanitizing spray used after positive tests.

“I’ll try to reassure them a bit,” the nurse, Marco Riccardi, said. “I tell them, you’re vaccinated. You might have a fever. But a few days at home and it’ll be over.”

The mandatory isolation period in Italy is at least 10 days.

But part of the fear stems from experiences from earlier in the pandemic.

Outside Spagnoli’s pharmacy, Piero Perilli, 75, a retiree, was so jittery waiting for the results of his swab that he struck up a conversation with a woman besides him. She tried to put him at ease. She said omicron was more like a cold.

Then the nurse came out of the cabin and said Perilli’s name.

“Negativo,” the nurse said, handing him a sheet of paper.

Perilli, before entering the pharmacy to pay, raised his arms to the sky.

“Thank god,” he said.

After coming back outside, he explained that he had been thinking of his wife, who died five months ago of covid.

There on the sidewalk, Perilli described calling the ambulance after she kept fainting. He described her initial text messages from the hospital, before she took a turn for the worse and was ventilated. She was only 63, not in great health, but Perilli, 75, had long joked that he had picked a younger partner because he would get to die first and avoid being alone.

“I was kidding,” he said. “But it was real.”

And now he was alone. He still had his daughters and a dozen good friends, but he said his new life was “damn hard.” He was searching for ways to rebuild it — like volunteering at a museum, for instance — and one of those ways had been a recent Christmas lunch, hosted by one of his daughters.

It turned out one of the people at the table had been positive.

Perilli said he had heard that omicron was milder. But he was nonetheless relieved, he said. The sheet of paper from Spagnoli’s pharmacy meant there’d be no quarantine, no isolation.

“Given my state of mind, that would be hard to handle these days,” he said.

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