As cranes moved in to shift truck-sized chunks of broken concrete, hundreds of firefighters searched for survivors, while public shock and grief turned to anger over the state of the 1.2 km-long bridge, completed in 1967 and overhauled two years ago.
A fire service spokesperson told AFP that the bridge had mostly fallen on rail tracks 100 metres below and that cars and trucks had fallen with the rubble.
Teams with dogs are aiding search-and-rescue operations, but rescuers are not hearing or seeing any signs of life, he said, adding that the situation around the bridge site is still risky.
So far four people have been pulled alive from cars found in the mangled ruins.
Rescue teams worked among the rubble of the collapsed Morando highway bridge in Genoa, northern Italy, Tuesday.
Eyewitness Ivan, 37, evacuated from a nearby building, described the collapse as unbelievable.
"We didn't hear or see anything, but after passing the bridge stopped at an Autogrill [roadside restaurant], and started to receive calls from family". It is in continual maintenance. I saw the road collapse then I fell with them.
Italian premier Giuseppe Conte and deputy PMs Luigi Di Maio and Matteo Salvini sit at the Lower House ahead of a confidence vote on the government programme in Rome on June 6, 2018.
Asked if authorities had any warning that the bridge could be risky, Cozzi indicated that no serious safety concerns had reached his office before the collapse. "Autostrade had to maintain it but didn't".
Danilo Toninelli, the infrastructures and transports minister, said on Wednesday the collapse was "unacceptable" and that if negligence was a factor "whoever made a mistake must pay".
Blame for the tragedy is being pushed by the national government on to a major infrastructure group, which operated the motorway on which the bridge collapsed.
"I've had some time to calm down and am now trying to understand what happened, but my wife and our friends are very shocked", Pierami said.
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The collapse occurred about midday Tuesday, the eve of Italy's biggest summer holiday, when traffic was particularly busy on the 51-year-old span that links two highways - one leading to France, the other to Milan. "There was no reason to consider the bridge risky".
A project worth 20 million euros ($29.8 million Cdn) to upgrade the bridge's safety had already been approved, with public bids to be submitted by September.
The tender would have covered strengthening of the bridge's pier cables, including those of pier nine, the one that collapsed on Tuesday.
That year, Giovanni Calvini, then-head of the Genoa branch of the Italian employers organisation Confindustria said it would collapse in "10 years' time".
"Many of the bridges of the developed nations are at the end of their design lives", he said.
"It was affected by extremely serious corrosion problems linked to the technology that was used (in construction)".
A view of the Ponte Morandi Bridge in Genoa, Italy, after a section collapsed Tuesday.
In 2016, structural engineer Antonio Brencich spoke of "errors in this bridge".
Engineering experts called it a "tragedy waiting to happen".
Toninelli reiterated on Wednesday that Italy needed maintenance work on its existing structures, not "colossal" new infrastructure.
He said: 'The Morandi bridge, the part of the bridge on the river came down.