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Italy’s COVID19 death rate is almost 3 times higher than expected. Why?

Workers stand next to coffins and remains of the coronavirus victims, in Bergamo, Italy CREDIT: FOTOGRAMMA/EPA-EFE

PortandTermial.com, March 24, 2020

ROME – Almost three times the number of people in Italy are dying from COVID19 than was initially forecast.

In his opening remarks at the March 3 media briefing on Covid-19, WHO Director-General Dr Tedros Adhanom Ghebreyesus said that “Globally, about 3.4% of reported COVID-19 cases have died.”

As of today, Italy’s latest tally reported a total of 6,078 deaths from 63,927 infections, with a world-leading fatality rate of more than 9%.

Think about it in these terms. Every day in Italy, the equivalent of two large passenger airplanes full of people die from COVID19. Four hundred and thirty-three dead one day. Six hundred twenty-seven dead the next. Seven hundred ninety-three dead on a different day…Plane crash after plane crash. It never stops.

Compare Italy’s death rate of 9% to China, where the outbreak originated and the mortality rate stands at 3.8%. In Germany, which has reported more than 24,000 cases and 94 deaths, it is at 0.3 %.

Why are more people dying in Italy?

There are a few possible explanations. The truth is probably a combination of all of them.

1. More elderly people

Row of elderly Italian men sitting on chair outside
After Japan, Italy has the second oldest population worldwide.

According to Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, the country’s mortality rate is far higher due to demographics – the nation has the second oldest population worldwide.

Older adults, whose immune systems have declined with age, appear to be more vulnerable to becoming severely ill after contracting the virus.

In Italy, 85.6 % of those who have died were over 70, according to the National Institute of Health’s (ISS) latest report. 

2. The percentage of infected people is understated

Another possibility is that the true number of infected people in Italy is understated because it simply hasn’t been measured well enough.

The death rate is simply the number of people who have died divided by the number of people who have been infected. The number of people who have died is easy to measure. The number of people who have been infected is not.

“The numbers we have are not representative of the entire infected population,” said Massimo Galli, head of the infectious disease unit at Sacco Hospital in Milan, the main city in the worst-hit region of Lombardy where 68% of the total national fatalities have been reported.

As of March 15, Italy had carried out about 125,000 tests. In contrast, South Korea – which implemented a strategy of widespread testing – has conducted some 340,000 tests, including for those showing mild or no symptoms at all. It has recorded almost 9,000 infections to date, with a mortality rate of 0.6%.

3. Italy has lots of people with preexisting conditions

Like in many other European countries, Italy’s healthcare system provides universal coverage and is largely free of charge. If you get sick in Italy, its easier to get treated. Thanks in part to this, Italy has the 5th longest life expectancy in the world after Switzerland (3) and Singapore (4).

“We have many elderly people with numerous illnesses who were able to live longer thanks to extensive care, but these people were more fragile than others,” Galli said an interview with Al Jazeera, adding that many patients at Sacco Hospital – one of Italy’s largest medical centres – who died due to coronavirus were already suffering from other serious diseases.

According to ISS’s latest report tracing the profile of COVID-19 victims, 48% of the deceased had an average of three pre-existing illnesses.

4. Italy’s health care system is being overwhelmed

Medical worker wearing a protective mask and suit treats patients suffering from coronavirus 1disease CREDIT: REUTERS/Flavio Lo Scalzo
Medical worker wearing a protective mask and suit treats patients suffering from coronavirus 1disease CREDIT: REUTERS/Flavio Lo Scalzo

There’s also no question that parts of Italy’s health system have been overwhelmed with a surge of coronavirus patients and are struggling to cope. 

“Doctors in Italy haven’t been dealing with one or two patients in care but up to 1,200,” says Dr Mike Ryan, health emergencies programme executive director at the World Health Organization. “The fact they’re saving so many is a small miracle in itself.”

This pressure is likely to get worse as more healthcare workers are infected and have to isolate – already, 2,000 have contracted the virus in Italy. 

This final point is perhaps the most sobering for those of us in the United States where the vulnerability of our own healthcare system has now become evident.

At the time that this article is being written, New York Gov. Andrew Cuomo has just announced that the anticipated need for hospital beds and ICU places is 140,000 and 40,000 respectively.

There are currently 53,000 hospital beds and just 3,000 ICU beds available, he said.  

What will happen to the tens of thousands of sick people in two weeks time when there is no place for them in our hospitals?

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