By Alex Fraser

MILAN (Reuters) – Residents in Lombardy, the Italian region worst hit by the coronavirus, have been forced to scrounge scarce protective face masks or to improvise solutions of their own after authorities ordered anyone moving outside to cover their nose and mouth.

With protective gear in short supply across the world, the northern region pledged to distribute at least 3 million masks to the public through supermarkets, pharmacists and tobacconists. Until they arrive, many people have been forced to make do with scarves or homemade substitutes.

“We can’t find protective masks,” Milan resident Giulio Colombo said. “I haven’t found any so I made this by myself. Authorities say masks will be available in three days but they’ve been saying it for a month.”

Lombardy, the region around the financial capital Milan, is where the epidemic first emerged on Feb. 21 and it remains by far the worst affected area of Italy, with more than 50,000 cases and almost 9,000 deaths.

Regional governor Attilio Fontana said on Sunday the masks, which will be less elaborate than the top grade medical masks used in hospitals, would begin to be distributed this week, a month after Italy imposed a strict lockdown on March 9.

As the weeks have passed, increasing numbers of people have worn protective masks of various kinds, despite the difficulty of getting hold of medical masks and wildly varying prices charged by distributors.

It is unclear whether improvising with a scarf is effective, but research has found face masks could help to limit the spread of the COVID-19 pandemic.

A report by consumer association Altroconsumo said 43% of 122 pharmacists it sampled in eight different Italian cities did not have any masks available, with almost one in two pharmacies in Milan out of stock.

The decision by Lombardy authorities to issue the masks order came after weeks in which the official advice has been that they are not necessary for most people in normal circumstances and that precious stocks should be reserved for health workers.

However the U.S. Centers for Disease Control and Prevention last week recommended the use of cloth face coverings to slow the spread of the virus, especially in confined spaces, along with frequent hand-washing.

Over the weekend, the head of the Civil Protection department, charged with coordinating Italy’s disaster reponse, said maintaining social distancing between people was the best protection and he would not be wearing a mask.

Otherwise there has been little sign of public opposition to the new measures.

“I think face masks protect us and other people,” Milan resident Alessandra Merletti said. “I think not wearing them is wrong, seeing people not wearing them bothers me, I think they are selfish.”

(Reporting by Alex Fraser; writing by James Mackenzie; editing by Barbara Lewis)