
The death toll for Covid-19 in Nembro, Italy - myth_drannon
https://www.corriere.it/politica/20_marzo_26/the-real-death-toll-for-covid-19-is-at-least-4-times-the-official-numbers-b5af0edc-6eeb-11ea-925b-a0c3cdbe1130.shtml
======
coopsmgoops
There a few possible (and reasonable) explanations in the HN comments, one
more is that often covid-19 leads to pneumonia and that may be what is
attributed as the cause of death, (nefarious or not).

I did hear rumors of Japan doing this intentionally to make it look more under
control than it was.

Another possibility is that medical resources are being monopolized by covid
patients, or people don't want to go to hospital for fear of catching it
themselves. This situation is still caused by covid but wouldn't be shown in
the reported deaths from covid.

The article brings up a valid concern, but doesn't explore any other possibile
explainations which is irresponsible when people are already panicking.

~~~
goatlover
The numbers really don't seem consistent across all the countries. Just one
example is the death rate in Germany is 0.9% while the death rate in Spain is
8.5%, nearly a magnitude of difference with both countries have several 10s of
thousands of cases, and that number varies between the two extremes all over
the continent (and world).

~~~
voisin
I read that Germany is not testing the dead, so if someone wasn’t tested while
alive then their death is attributed elsewhere. Italy is testing the dead to
get a more accurate picture. I find it baffling that there isn’t an
international standard for testing in a situation like this so that we can get
a handle on what is actually going on. If we don’t have data, how can we
possibly draw inferences and learn anything?

~~~
krona
There are international standards and the standard is that flu is not normally
considered a cause of death. It's not realistic to expect autopsies to be
performed and coroners reports to be written on every person who dies of
pneumonia during an epidemic.

~~~
voisin
And yet I understand this is what is happening in Italy where the suspected
cause of death is Covid19. If we don’t make it realistic to expect this
(during a pandemic), then how can we trust the numbers?

------
ardit33
I think when all the dust will settle, we will know the real death count by
doing a delta of total deaths of 2020 vs. 2019 and 2018. There will be two
main reasons of the extra deaths:

1\. Deaths related directly by Covid-19. (either the disease itself, or the
underlying conditions got worse by the disease)

2\. People that didn't have the coronavirus, but died because they couldn't
get the usual care due to hospitals being totally overwhelmed (things like
heart attacks, strokes, car accidents, insuline/asma shock, etc... turn into
death sentences)

Same as in war, while many deaths are caused directly by the fighting, a lot
of the other extra deaths are indirect (famine, disease... etc)/

~~~
mNovak
Potentially a 2020 vs previous years approach would even slightly
underestimate the death toll.

I have to assume being in lockdown suppresses other 'normal' causes of death
(fewer car accidents, or conventional disease spread). Depending on how long
these lockdowns really last, it could actually dent the real impact of those
causes of death, making the covid peak look slightly smaller vs the average.

~~~
aquadrop
We can subtract traffic accidents, homicides, suicides, falls etc and compare
only remaining numbers.

------
zamfi
That the official numbers underreport Covid-19 deaths by a factor of 4 is one
hypothesis -- but it's also possible that this is how many people would be
saved by quick interventions at the hospital, but who otherwise died.

For example, maybe the ICU beds were full for a month, and in that time they
would've saved 96 people, but couldn't.

~~~
gdubs
Are you saying a spike in _non_ -covid deaths — e.g., heart-attack, etc?
That’s certainly a possibility and one of the main dangers at the moment with
an overwhelmed healthcare system. It also raises an interesting question of
how you account for the toll of the disease: on one hand you have deaths due
to the disease itself, and on the other deaths that could have been
preventable had the disease not overwhelmed hospitals.

~~~
scarmig
Depending on how you count, you could hypothetically end up with mortality
rates >100%. I.e. a disease that kills everyone it infects, and also closes
down a hospital causing deaths among people it doesn't infect.

------
zmmmmm
All the statistics seem like a mess for this - we know every single region is
doing different amounts of testing with many only testing highly symptomatic
people, yet all these are being combined together. Then different protocols
for what counts as different levels of severity etc. It will be interesting
when people have had more time to sort through the data and clean it up
properly what the real estimates of mortality and transmission actually are.
Right now everything seems plausible right through from 50% of the population
already had it and is immune through to the death rate being drastically
under-estimated and we are about to experience an apocolyptic event for
humanity ....

------
graeme
Excellent work, and I hope more people in other cities start running these
calculations.

> In the hypothesis - not at all remote - that all citizens of Nembro have
> caught the virus (with many asymptomatic, therefore), 158 deaths would
> equate to a lethality rate of 1%. That is precisely the expected and
> measured lethality rate on the Diamond Princess cruise ship and - made
> proportionally by demographic structure - in South Korea. We have made
> exactly the same calculation for the municipalities of Cernusco sul Naviglio
> (Mi) and Pesaro using exactly the same methodology. In Cernusco the number
> of anomalous deaths is equal to 6.1 times those officially attributed to
> Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo
> figures, where the ratio reaches 10.4.

This seems an unreasonable assumption, no? I don’t think any models predict a
100% infection rate: herd immunity would kick in beforehand, at the least.

If true, then the death counts and death rates would be higher. E.g. with 50%
infection, deaths are 4x, 12x and 20x, and the death rate is 2%.

Of course, you also have to account for local demographics.

Edit: I checked the numbers for Bergamo, and they’re troubling. It’s a city of
122,000, and it has a 0.5% death rate for the whole city.

Further, people are still sick and dying, so these death rates will only go
up.

~~~
stonogo
Naturally-occurring herd immunity is a temporary effect. Only artifically-
imposed herd immunity (i.e. vaccination) is lasting.

~~~
cma
Some diseases become endemic and pervasive in childhood and end up not causing
issues in the elderly who already built up their immune system in childhood.
Other times an exposure in childhood ends up cross reacting or something and
makes things more deadly later on (I think that's one theory for the 1918 flu;
elderly and middle age were protected from an earlier flu exposure, 20-30 year
olds had exposure in childhood to something different with a shared antigen
that ended up making the immune system overreactive and made things more
deadly).

------
sdffdsfdsfsddsf
Wasn't there a thing were deaths were recorded for the place where the person
died, not where they normally live? So maybe those people just died in a
hospital in another city? (I don't remember if this was for Italy, but I
remember reading that about some place in connection with Corona).

In any case, why not make an effort to reach out to the cities in question and
ask for an explanation?

------
eeemmmooo
Has anyone seen any data on how this has made the average daily deaths in the
US rise? I know that number probably isn’t updated real time like the Covid-19
numbers. I think that would really show how much this is affecting us if the
numbers go up drastically over the expected amount of deaths per year.

I have found the averages from last year, but haven’t seen any more up to date
data on that.

[https://www.cdc.gov/nchs/fastats/deaths.htm](https://www.cdc.gov/nchs/fastats/deaths.htm)

------
TaylorGood
I know of deaths at the local hospital ER with overlapping symptoms but not
being officially counted as the deceased were never tested. On a county level
there’s maybe one or two recorded. This testing debacle is hurting everybody
in more ways than one.

------
joantorres
Epidemic Modeling 101: Or why your CoVID19 exponential fits are wrong

“Over the past few weeks, a terrible affliction has been spreading across the
world. Otherwise healthy and productive members of society have been infected
with this devastating illness that causes them to fire up Excel, Python or R
and start extrapolating the latest numbers of confirmed CoVID19 cases in their
town, state, country or even the world!”

[https://medium.com/data-for-science/epidemic-
modeling-101-or...](https://medium.com/data-for-science/epidemic-
modeling-101-or-why-your-covid19-exponential-fits-are-wrong-97aa50c55f8)

------
cameronfraser
I remember the death toll for H1N1 to have been reported in the thousands when
it happened but recently read that after a few years they said it was more
like 150,000. It's possible they were just reporting US deaths where the 150k
number is worldwide. How come the response for H1N1 is nowhere near as intense
as the response for COVID?

~~~
Waterluvian
Based on current trends, Covid-19 is trending to be around 10x or more worse
than the 150k figure. Current projections have the US alone at 100k-200k
deaths.

That would be why this response is more intense.

~~~
nostromo
Except the high estimate for H1N1 in 2009 from the CDC is 575,000 deaths
worldwide.

[https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic](https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic)

~~~
buboard
> The Infectious Diseases Society of America estimated that the total number
> of deaths in the U.S. was 12,469

------
jml7c5
Moderators: is it possible to have "(in Italy)" added to the title?

It's not clear this can be extrapolated to other countries. (In fact, they
reference South Korea as a benchmark for the true value.)

------
kbutler

       Nembro should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. That is 123 more than the average.
    
      In the hypothesis - not at all remote - that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship
    

The author appears to be using the total dead (158) rather than the excess
dead (123) for this calculation. That suggests that rather than the 1% "exact
match", the lethality rate should be 0.78%.

~~~
graeme
Good catch. Though I looked up the population of Nembro. Wikipedia has it at
11,518.

So would the rate actually be a bit over 1%? Bergamo’s was about 0.5% by the
same metric incidentally.

------
ChrisCinelli
Good ideas here of why it could be happening.

Let me add another: fear and hopeless. These kind of emotions may make people
more prone to get sick with other illnesses and depress the immune system so
it does not fight back as it really could.

~~~
ChrisCinelli
Some references:

\-
[https://www.medicalnewstoday.com/amp/articles/324090](https://www.medicalnewstoday.com/amp/articles/324090)

\- [https://psychcentral.com/news/2014/05/22/study-probes-how-
em...](https://psychcentral.com/news/2014/05/22/study-probes-how-emotions-
affect-immune-system/70192.html)

\-
[https://www.simmsmanncenter.ucla.edu/center_events/healing-a...](https://www.simmsmanncenter.ucla.edu/center_events/healing-
and-the-mind-emotions-and-the-immune-system/)

------
chvid
So if the mortality rate of the decease is what it is in Germany or Korea -
about 0.5% but the number of dead is 4x the official 10.000. Then about 8 mio
- ca 15% - of Italy’s population has had it. Is that really correct?

~~~
cycrutchfield
Korea's CFR is 1.6%. Germany is 0.9%. Both are climbing over time as the time
lag from detection to death is on the order of weeks.

~~~
Symmetry
Korea's used to be, what, .6% when they stabilized the number of infections?
At the time I was hoping the true IFR was that low but as you say this thing
can take a long time to kill people and given what a good job Korea's done
with staying on top of their testing I'm not holding out hope that the IFR is
below 1%.

------
hanoz
The stats for this are all over the place. Speaking for the UK, no distinction
at all is made between died _of_ cononavirus and died _with_ coronavirus.
We've had a University of Oxford study claiming that 50% of us have already
been infected (a figure so outlandish you might wonder if it was rather a
University _in_ Oxford) in which case we should expect the died _with_ figures
to be a great deal more already, and what's more that herd immunity should be
taking the pressure of the system any week now. But I can't help but feel this
belief in hidden large denominator is wishful thinking.

~~~
nicoburns
50% does seem outlandish, but from what I can see, the numbers infected are a
lot lot higher than officially reported. I would go as far as to say that the
majority of cases aren't being reported, because almost nobody without severe
symptoms has access to testing.

------
scarmig
I'd be curious how much variation there is in previous years; are there any
previous significant month spikes that have been washed out by the average?

It doesn't seem plausible that random chance could account for 2020's, though.

~~~
roywiggins
I don't know what the distribution of deaths looks like normally, but a 4x
difference is going to be several sigma unlikely in any reasonable one.

Also, consider that it happened _exactly at the same time coronavirus deaths
spiked_ , which seems vanishingly unlikely to be a coincidence.

------
mbrubeck
Problems attributing deaths to COVID-19 will probably be common worldwide.
Radio Free America had this similar report about excess deaths in Wuhan being
far out of line from the confirmed COVID-19 deaths:

[https://www.rfa.org/english/news/china/wuhan-
deaths-03272020...](https://www.rfa.org/english/news/china/wuhan-
deaths-03272020182846.html)

(Note: This article is much more speculative and weakly-sourced than the
Italian one. Also, be aware that RFA is funded and overseen by the US
government.)

------
not2b
It is possible that more people than usual are dying from other causes (heart
disease, cancer, injuries) because the overwhelmed medical system is unable to
treat them.

~~~
moioci
If so, it's still indirectly caused by the pandemic.

~~~
buboard
but not an actionable statistic for other countries

------
gentleman11
Is anybody familiar with the authors or the website? These findings are
shocking if true, but how do we verify their numbers or decide if the source
is reliable?

------
raincom
Good one. Always compare the current death rates with the death rates from the
prior year or two. That will explain anomalies in reports by various
countries.

------
mohankumar246
I believe in asian countries where sickness(which can spread) is stigmatized(i
definitely believe it is in India..), people will be hesitant to get
tested/treatment. There has been several news reports of medic professionals
being asked to vacate rental homes, miscreants calling out names in front of
patient's home. Not sure why they do them. This will just cause people with
symptoms to not get tested.

------
whb07
Can anyone actually tell me what was the cause of death if an 85 yo already
had 3 diseases prior to this virus?

If a person has a terminal disease and has N months to live, but dies sooner
from a car accident, the net deaths did not increase. This person was on the
death queue.

edit: bring the silent downvotes. Also, a number of my family have tested
positive for this virus.

~~~
nkozyra
Pretty important to capture the terminal catalyst to help understand the
lethality of a pathogen.

"They would have died anyway" is true of anyone and tends to mask critically
important information.

~~~
whb07
It’s true of everyone given 150 years. Sure, but an 85 yo with 3 diseases was
on the front of the queue.

We need to test for those who had it and didn’t die. All evidence is pointing
at orders of magnitude that had it but didn’t show

------
sershe
Let me get this straight (all of these are straight from the article):

1) Nembro, in the province of Bergamo, is the municipality most affected by
Covid-19 in relation to the population.

2) hypothesis - not at all remote - [is] that all citizens of Nembro have
caught the virus ... Given the decline seen in the last few days after the
peak, flock immunity has likely been attained in Nembro.

3) 158 deaths would equate to a lethality rate of 1%. That is precisely the
expected and measured lethality rate ...

So, the worst hit city in the worst hit region, with collapsed medical system
and elderly population; the absolute upper bound on possible deaths; and we
get 1% until herd immunity? This, again, is the upper bound of ultimate worst
case, based on the article.

Isn't this a huge revision DOWN from the previous 2.5-3-6-8-15% numbers people
are throwing around?

EDIT: what's up with the silent downvotes? I'm quoting the central number and
assumptions directly from the article and asking a question. Should I take it
as "you are right but I dislike it"?

------
buboard
it's bad science to pick out one small sample of the most affected town
(especially when arguably they could have considered the entirety of deaths)
and extrapolating that "death rate is 4 times" . There is no statistical
testing here, no confidence intervals, nothing. The 4x number is
unsubstantiated. The hypothesis that the numbers are misreported seems to be
true, but statistical tests are missing.

------
ChrisCinelli
I think there are already a few good probable explanations here. However
without more clear data it is hard to find the real drivers.

------
maxander
Has anyone looked at the equivalent numbers in the US? Or South Korea, or
other places with outbreaks?

------
trhway
Was in the news that in China the funeral homes urn deliveries are
suspiciously larger than expected. In Russia there is a spike of pneumonia
looking like dicease and deaths...

~~~
robocat
The unexpected number of urns answered by the quote from the article that
initiated that “news”: There were 56,007 cremations in Wuhan in the fourth
quarter of last year.

After a month or two of lockdown in Wuhan, the number of backlogged urns is
tens of thousands, that is to be expected.

~~~
robocat
Now incorrect: Bloomberg lowered number from 56,007 to 13,856 in their article
— see note at bottom of
[https://www.bloomberg.com/news/articles/2020-03-27/stacks-
of...](https://www.bloomberg.com/news/articles/2020-03-27/stacks-of-urns-in-
wuhan-prompt-new-questions-of-virus-s-toll) which says “(Corrects
characterization of 2018 and 2019 cremations data in story published March
27.)”

Original pre-correction here:
[https://archive.md/g1BDx#selection-2503.0-2507.171](https://archive.md/g1BDx#selection-2503.0-2507.171)

------
emersonrsantos
I wonder why no one is using Wuhan, China numbers. Not reliable?

~~~
9nGQluzmnq3M
The same phenomenon has been anecdotally reported there as well, with a lot of
untested "pneumonia" deaths:
[https://www.scmp.com/news/china/society/article/3050311/its-...](https://www.scmp.com/news/china/society/article/3050311/its-
pneumonia-everybody-china-knows-about-many-deaths-will-never)

~~~
lonelappde
Evey time I see an article critical of Chines government in SCMP I feel a
shock until I remember it's a Hong Kong paper. But then I feel a little
confused over Hong Kong's semi autonomous status.

------
CriticalCathed
This is beyond a spurious claim.

------
lisper
[Retracted]

~~~
graeme
No. In four areas in Italy, including a mid sized city.

> We have made exactly the same calculation for the municipalities of Cernusco
> sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco
> the number of anomalous deaths is equal to 6.1 times those officially
> attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering
> are the Bergamo figures, where the ratio reaches 10.4.

------
mrfusion
Just wait until the deaths of despair hit from the crashed economy and
isolation. Alcoholism, opiates.

~~~
gdubs
Counterpoint: While suicide increased, life expectancy overall increased
during the Great Depression:

[https://www.pnas.org/content/106/41/17290](https://www.pnas.org/content/106/41/17290)

