The pope is described as becoming increasingly worried by his health that he has moved to ensure sympathetic figures remain in key posts should a papal election be on the horizon (Picture: Alberto PIZZOLI/AFP)
Pope Francis has been diagnosed with bilateral pneumonia, the Vatican said.
The pope, 88, was admitted to Rome’s Agostino Gemelli Polyclinic hospital on Friday after experiencing symptoms of bronchitis for several days.
He has since been forced to cancel a number of public appearances, including his Sunday Angelus address to pilgrims from his balcony overlooking St Peter’s Square and tomorrow’s weekly audience.
The Vatican has now said new scans show the pope has ‘the onset of bilateral pneumonia’, but added that he ‘remains in good spirits’.
It comes as the pope is reportedly rushing to tie up loose ends and secure his legacy ahead of the race to succeed him.
It has once again raised concerns over the health of the Argentine pontiff, who famously had part of one lung removed following a severe infection in his 20s and has experienced multiple medical problems over the past two years.
Flowers and candles are laid at the foot of a statue of Pope St John Paul II outside the Gemelli University Hospital, where Pope Francis is being treated (Picture: EPA)
Francis is said to have been experiencing severe pain during his current hospital stay and has confided to those closest to him that he will not make it this time, according to a Politico report.
The report says the pope was warned before his admission that he was so unwell he was at risk of dying if he refused to go to hospital.
He is described as becoming increasingly worried by his health that he has moved to wrap up key initiatives and ensure sympathetic figures remain in key posts should a papal election be on the horizon.
One of those is said to be Cardinal Giovanni Battista Re, 91, whose term as dean of the College of Cardinals was extended days before Francis went into hospital.
The term of the vice-dean, Argentine Cardinal Leonardo Sandri, 81, also was extended.
As depicted in the film Conclave, the dean of the College of Cardinals plays a key role in the life of the Catholic hierarchy.
What is a conclave and how does it work?
On the death of the pope, the chair of St Peter is declared vacant – sede vacante in Latin.
The papal funeral will be celebrated within four to six days, followed by nine days of mourning and special Masses.
During that time, cardinals from all over the world who have travelled into Rome gather for a series of meetings known as ‘general congregations’.
While all cardinals can participate in these discussions, only those under the age of 80 are eligible to vote for the new pope in the Sistine Chapel.
Once the oath of secrecy is taken, the master of liturgical ceremonies gives the order ‘Extra omnes’ (everyone out) and all those not taking part in the conclave leave the frescoed walls of the chapel.
An elderly cardinal remains and reads a meditation about the qualities a pope should have and the challenges facing the church, after which he and the master of ceremonies leave the cardinals to begin voting.
Ralph Fiennes in a scene from the new film ‘Conclave’ (Picture: AP)
On the first day, the cardinals participate in an opening Mass and an initial vote takes place in the evening, often taken as a symbolic poll in which voters name someone they have particular admiration for.
From then on, there are two sessions every day – one in the morning and another in the afternoon – each comprising two votes.
The cardinals are instructed to mask their own handwriting while completing a card inscribed ‘Eligo in Summum Pontificem’ – ‘I elect as Supreme Pontiff’.
They approach the altar one by one and say: ‘I call as my witness, Christ the Lord who will be my judge, that my vote is given to the one who, before God, I think should be elected.’
The folded ballot is placed on a round plate and slid into an oval urn.
After the votes are counted and the outcomes announced, the papers are bound together with a needle and thread, each ballot pierced through the word ‘Eligo’.
Then they are burned with a chemical to send black smoke (meaning no new pope) or white (meaning yes, a pope has been chosen) out of the Sistine Chapel’s chimney.
He is a point of reference for his fellow cardinals and a crucial figure during the transition between one papacy and the next.
After a pope dies or resigns, the dean runs the secret meetings where cardinals discuss the needs of the church and the qualities a future pope must have, and then organises the conclave balloting in the Sistine Chapel.
Once a new pope is elected, it’s the dean who asks the winner if he accepts the job, and the name he wants to be called.
Due to the job’s importance, speculation had swirled about who might take Re’s place after his five-year term ended last month.
In a 2019 reform, Francis had imposed a once-renewable, five-year term limit on the job which until then had been an appointment for life. Given Re’s age and the rigors of the eventual job of running a conclave, it was expected that he would be replaced.
Possible contenders included Sandri and Francis’s number two, Vatican secretary of state Cardinal Pietro Parolin.
There was no word if Francis’ extension of Re’s mandate, decided January 7 but only announced last week, was for another full five-year term or was just a temporary extension.
According to the 2019 reform, the dean’s five-year term may be ‘renewable if necessary’, but doesn’t explicitly provide for a mere extension.
Previous deans have been some of the most influential cardinals in the church, including Cardinal Joseph Ratzinger, who was elected Pope Benedict XVI after presiding over the funeral of Pope John Paul II in 2005.
Pope Francis with his predecessor Pope Benedict XVI (Picture: AFP)
The Politico report claims the next conclave will be highly political.
It comes after Francis issued a major rebuke to the Trump administration’s plans for the mass deportation of migrants.
He took the extraordinary step of addressing the crackdown in a letter to US bishops which appeared to take direct aim at Vice President JD Vance.
US border czar Tom Homan immediately pushed back, noting that the Vatican is a city-state surrounded by walls and that Francis should leave border enforcement to his office.
The Politico report says the White House’s furious response raises the prospect that the election of the next successor to St Peter will be a highly politicised event.
One Vaticanista said of the Trump administration: ‘They’ve already influenced European politics, they’d have no problem influencing the conclave. They might be looking for someone less confrontational.’
The Argentine Jesuit and President Donald Trump have long sparred over migration, including before Trump’s first administration when Francis in 2016 famously said anyone who builds a wall to keep out migrants was ‘not a Christian’.
Vance, a Catholic convert, has defended the administration’s America-first crackdown by citing a concept from medieval Catholic theology known in Latin as ‘ordo amoris’.
He has said the concept delineates a hierarchy of care — to family first, followed by neighbour, community, fellow citizens and lastly those elsewhere.
Francis appeared to take direct aim at Vice President JD Vance (Picture: dts News Agency Germany/Shutterstock)
In his letter, Francis appeared to correct Vance’s understanding of the concept.
‘Christian love is not a concentric expansion of interests that little by little extend to other persons and groups,’ he wrote.
‘The true ordo amoris that must be promoted is that which we discover by meditating constantly on the parable of the “Good Samaritan”, that is, by meditating on the love that builds a fraternity open to all, without exception.’
David Gibson, director of the centre for religion and culture at Fordham University, said in a social media post that Francis’ letter ‘takes aim at every single absurd theological claim by JD Vance and his allies in conservative Catholicism (and the Catholic electorate)’.
Vance’s reference to the ordo amoris had won support from many on the Catholic right in the US, including the Catholic League, which said he was right about the hierarchy of Christian love.
Health concerns are hardly a novelty for people nearing 90, especially those with Francis’s work ethic.
While Francis uses a wheelchair and suffers regular wintertime bouts of respiratory problems he has shown little signs of slowing down.
In its latest updates on his condition yesterday, the Vatican said recent tests revealed the pope is battling ‘a polymicrobial infection of the respiratory tract, which has led to a further modification of the therapy’.
‘All tests conducted up to today are indicative of a complex clinical situation that will require an appropriate hospital stay,’ it said.
In an evening update, the Vatican said Francis was in ‘stable’ condition, with no fever.
Despite his illness, Francis has stayed in contact with Gaza’s lone Catholic parish – a routine he has maintained since the start of the war in October 2023.
‘He told us, “I am not well” and you could see he was tired,’ Father Gabriel Romanelli, the local priest based in the enclave, told Italian public broadcaster Rai about a video call he had with Francis on Saturday.
Father Romanelli, a fellow Argentine, quoted Francis as saying: ‘A few days (in hospital) and I’ll be back.’
He said he also quipped that he was ‘not an easy patient for doctors, because he is always talking, always very active’.
Pope Francis meets with members of the foundation of ‘Gaudium et Spes’ at the Vatican on February 14 (Picture: Reuters)
The Vatican said Francis did some work and read papers on Monday.
Dr Maor Sauler, who specialises in adult pulmonary medicine and critical care at Yale School of Medicine, said it’s not uncommon for people suffering from bronchitis to develop an infection with more than one organism in their lungs.
The concern, however, is that antibiotics and other drug therapies don’t work in isolation and require the body to respond, which given Francis’s other problems may make recovery more challenging.
‘Being older, wheelchair-bound, all those are risk factors for a situation in which we can’t treat it despite our best efforts,’ said Sauler, who is not involved in Francis’s care.
Dr Nick Hopkinson, medical director of the Asthma + Lung UK foundation, who is similarly not involved in treating the pope, said: It’s in the public record that he’s had chest problems in the past, he’s been admitted to hospital with pneumonia (in 2023), he’s had part of one lung removed.
‘All of that makes him a little bit more vulnerable potentially, but we just have to wait and see.’
He said that after doctors have identified clinically what is wrong, they can start treating the underlying infection with the correct therapies.
Pilgrims visiting the Vatican on Monday offered their hopes that Francis would recover soon.
‘We certainly wish for him to get better very quickly,’ said Reverend Tyler Carter, a Catholic priest from the United States. ‘He is our father and our shepherd, and so we want his continued health and blessing.’
Manuel Rossi, a tourist from Milan, Italy, said he was ‘quite worried’ when the pope cancelled his appearance on Sunday.
‘I am 18 years old, so I have seen few popes in my life, and am very close to him,’ he said. ‘I hope he recovers as soon as possible.’
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