
Report on the characteristics of Covid-19 positive deceased patients in Italy [pdf] - Cantbekhan
https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf
======
pseudolus
Some excerpts (courtesy of Google translate):

The mean age of deceased and positive COVID-19 patients is 79.5 years (median
80.5, range 31-103, RangeInterQuartile - IQR 74.3-85.9). There are 601 women
(30.0%). The figure 1 shows that the median age of patients COVID-19 positive
deaths is more than 15 years higher than that of patients who contracted the
infection (median age: patients who died 80.5 years - patients with infection
63 years). The Figure 2 shows the number of deaths by age group. Women who
died after contracting COVID-19 infection they are older than men (median
ages: women 83.7 - men 79.5)

The Figure 4 shows the therapies administered in patients who died COVID-19
positive during hospitalization. ThereAntibiotic therapy was the most widely
used (83% of cases), least used antiviral (52%), most rarely steroid therapy
(27%). The common use of antibiotic therapy can be explained by presence of
super infections or is compatible with initiation of empirical therapy in
patients with pneumonia, pending laboratory confirmation of COVID-19. In 25
cases (14.9%) all 3 therapies were used.

The figure 5 shows, for the patients who died positive COVID-19, the median
time in days, who spend from onset of symptoms to death (8 days), from onset
of symptoms to hospitalization (4 days) and from hospitalization to death (4
days). The time elapsed from hospitalization to death was 1 day longer in
those who were transferred to resuscitation than those who did not they were
transferred (5 days against 4 days).

To date (17 March), 17 COVID-19 positive patients have died under the age of
50. In particular,5 of these had fewer than 40 and were all male people aged
between 31 and i39 years with serious pre-existing pathologies
(cardiovascular, renal, psychiatric pathologies, diabetes, obesity).

~~~
becausecombi
huh, no one else has mentioned this, am I interpreting this wrong? If 30% of
deceased positives are female, then 70% are male? That's quite a big
difference!

~~~
derision
this is highly anecdotal, but my family is from a small town in italy,
population of ~1500, and the men are way less healthy from a lifestyle
perspective - lots of drinking, smoking, hard manual labor without lung
protection, etc etc, while the women mostly stay home handling home duties and
socializing

~~~
huffmsa
I think prior lung damage is going to shake out as the number one prior factor
in the likelihood of severe infection and probability of death.

------
dakrisht
Some interesting data here.

\- Mean age of 79.5 sheds light on Italy’s extremely high fatality rates; in
essence, it’s the (very) elderly that are dying due to complications from
viral pneumonia. Which begs the next question...

Why are they overwhelmingly treating patients with antibiotics in cases of
viral pneumonia and _not_ antivirals (Remdesivir)/ chloroquine?

Sure, these are “experimental” therapies but decent data out of China/South
Korea shows these therapies work. Perhaps they found out too late?

\- The younger fatalities (17) show multiple, serious co-morbidities and
smoking is not listed; an assumption can be made a fair amount of these
younger patients smoke. But again, an assumption.

\- Almost 50% of patients showed 3 or more co-morbidities - this is high and
important to note. 25% of patients showed 2 co-morbidities. Roughly 75% of
patients had 2 or more co-morbidities (!).

\- Sample size (2003) is good given their current 3,500 fatality numbers.

Not a medical doctor but a few things I’m struggling to figure out:

\- How did so many elderly get infected? Did the disease simply spread in
close quarters where many elderly live? Elderly folks aren’t necessarily out
and about drinking espresso and touching surfaces yet alone having younger
asymptomatic carriers cough on them.

I wonder if Italy is similar to a Kirkland, Washington situation. High density
of elderly folks spreading infection.

It’s obvious that SARS-Cov-2 is highly, highly contagious but it’s interesting
how we’re seeing these somewhat “bomb” explosions of infection: Wuhan > Daegu
> Kirkland > Lombardy > NYC next.

Sure, quarantine works but the rate of new infection stays rather localized
and then just annihilates everyone around it.

Perhaps it’s a viral load issue; viral load increases exponentially the more
we have infected. Why you see doctors and nurses infected / critical and dying
even with full PPE.

Let’s hope the Italians figure out a way to get this curve to fall of ASAP.
Hoping they have a similar effect to Wuhan’s curve and just drop down rather
than flatten.

~~~
nostrebored
> Elderly folks aren’t necessarily out and about drinking espresso and
> touching surfaces yet alone having younger asymptomatic carriers cough on
> them.

From what I understand about Italian culture, they kind of are. Older Italians
seem to have much stronger social lives than in the US.

~~~
dakrisht
There’s truth to this and perhaps I jumped to an invalid American based
assumption, stupid given that I’m European.

In Europe, the elderly are out and about, walking, sitting at parks, drinking
coffee, the works. They’re actually still doing this as we speak in countries,
from what friends and family tell me. Go figure.

However, even if they are in cafes, grocery stores, parks - the numbers are
still very high.

This virus is either incredibly efficient and contagious (spread by totally
asymptotic carrier pigeon patients > elderly) and/or it’s been there for a
long time. Months.

~~~
mercer
If my experience with 'southern' cultures is anything to go by, the amount of
interaction between young and old people probably plays a huge role.

For comparison, I live in NL and for me and the vast majority of my
20-30-something friends, visiting grandparents is relatively rare. For many of
us even visiting parents is a 'once every x months' kind of thing.

On the other hand, when I lived around the mediterranean, not only was it
expected to regularly interact with parents and grandparents, but it was often
the case that they lived together, or at least close by.

Perhaps the 'quarantining'/neglect of the elderly in Northern-Europe that I've
often criticised as inhumane is actually saving them in this particular
situation.

------
ramblerman
Summarizing the deaths, by age distribution is quite telling (page 4):

\- no deaths under 30

\- Less than 1% of deaths under 50

\- less than 4% of deaths under 60

\- 87% of deaths above 70

This disease is incredibly dangerous for our elderly, and isolating them to
prevent infection should be our top priority.

~~~
Grue3
That's because Italy's hospitals are overcrowded and very old patients are
simply not treated at all. It's a vicious circle because they're thought being
less likely to survive, are denied treatment, which makes them even less
likely to survive.

~~~
ramblerman
Triage is unfortunately applied in some hospitals, especially around Bergamo.

But you would need to provide some data to make the claim that the stats are
skewed this much purely because all elderly are just cast away. Given the vast
majority of hospital cases are actually the elderly.

Finally, proper ethical triage never looks at how long a patient is expected
to live after their recovery as a condition.

~~~
bart_spoon
> Finally, proper ethical triage never looks at how long a patient is expected
> to live after their recovery as a condition.

But it does look at chances of survival, which for this particular disease
looks very closely correlated with how long a patient is expected to live
after their recovery.

------
kayoone
Doesn't the median age of 60 years for positively diagnosed patients suggest a
huge number of non-detected cases?

~~~
dakrisht
Probably tens of thousands of undiagnosed, asymptomatic.

Aka super carriers.

The virus is smart and has evolved from an evolutionary standpoint. Infect
younger and asymptomatic patients with the goal of spreading and infecting as
many as possible. Eventually, the more infected, the more that will die. The
young are just carrier pigeons and don’t even know it.

~~~
laGrenouille
> The virus is smart and has evolved from an evolutionary standpoint. Infect
> younger and asymptomatic patients with the goal of spreading and infecting
> as many as possible.

I think you are giving a bit too much agency to the virus. It has evolved in
such a way that optimises for further spreading for sure, but I do not think
it has a sneaky strategy to use young people as attack vectors.

What's more likely is that it has evolved to replicate and spread within the
human population, while not acting so fast as to kill most people. The problem
is that replicating at a rate that doesn't kill most people will kill some of
the oldest and sickest within a population.

~~~
ram1981
Another important insight is that Viruses, and germs in general, try to evolve
and adapt inside the host. They don’t gain if they end up killing the host
because that ends them too. Not to sound apocalyptic but I think their holy
grail is something like what the machines do to humans in the movie Matrix

~~~
rumanator
> Another important insight is that Viruses, and germs in general, try to
> evolve and adapt inside the host.

That assumption has no basis at all. Evolutionary pressures don't happen due
to a intentional guidance from the evolving species. Individuals mutate by
chance and replicate as they can. That's it.

~~~
ram1981
This does have basis Refer to this section in the publication from National
Academy of Sciences.
[https://www.ncbi.nlm.nih.gov/books/NBK209710/?report=reader#...](https://www.ncbi.nlm.nih.gov/books/NBK209710/?report=reader#ddd00005)

------
Arnt
I found page 3 most remarkable: 48% of those who die of covid-19 in Italy also
suffer from three or more other diseases (or did recently), and 99.2% suffer
from one or more.

~~~
circlefavshape
What counts as a co-morbidity? Obesity seems fairly ... well, trivial. I have
high (total) cholesterol. Does that count? Constipation? Itchy spot on the
back of my knee?

~~~
andruby
The co-morbidities reported here are mentioned in the report (in Italian).
Translated by Google:

    
    
      diseases N %
      Ischemic heart disease 117 33.0
      Atrial fibrillation 87 24.5
      Stroke 34 9.6
      Hypertension 270 76.1
      Diabetes mellitus 126 35.5
      Dementia 24 6.8 COPD 47 13.2
      Active cancer in the past 5 years 72 20.3
      Chronic liver disease 11 3.1
      Chronic renal failure 64 18.0
    

Hypertension and Diabetes seems very prevalent in older people. Especially in
western countries like the US.

~~~
jeltz
Maybe it is just correlation between old age and hypertension, but I find it
interesting how ACE2 which the coronavirus uses as its entry point into cells
is also part of regulating blood pressure.

------
gregoriol
There is a summary of this by Bloomberg news:
[https://www.bloomberg.com/news/articles/2020-03-18/99-of-
tho...](https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-
died-from-virus-had-other-illness-italy-says)

------
emayljames
[https://translate.googleusercontent.com/translate_c?depth=1&...](https://translate.googleusercontent.com/translate_c?depth=1&nv=1&rurl=translate.google.com&sl=auto&sp=nmt4&tl=en&u=https://www.epicentro.iss.it/coronavirus/bollettino/Report-
COVID-2019_17_marzo-v2.pdf&usg=ALkJrhhtAr5nOIYSlTRIwXfaWvyLmI0o8Q)

------
Cantbekhan
It's unfortunately not yet translated but I think the graphs and tables are
clear enough and can easily be translated by Google Translate.

Personally my surprise is that it seems half of those deceased people did not
receive any kind of antiviral therapy.

~~~
topynate
Possible explanations for the absence of antiviral therapy: lack of
availability, reluctance to prescribe untested treatment (all antiviral
treatments are currently experimental), some of the antivirals actually work
really well and a lot of the people who got them are missing from this study
because they recovered. I hope it's the latter.

------
k__
How many were so sick that they would have died anyway?

I read that they were testing dead people and the theory was, their count was
so high because they would add people to it that would have died anyway but
just happen to be infected right before their death.

Edit: I think this is an interesting question. Why do Italy, France and Spain
have such high death ratios? Are they measuring more than needed or are the
others measuring not enough?

~~~
gambiting
Right, but you need to establish the cause of death and it's kind of
important. Like for example my father was fighting cancer for 8 years before
he died, but when he passed away the hospital wrote that he died of "cardiac
arrest", since his heart just couldn't go anymore. So in some statistic
somewhere he will exist as a person who died of heart problems, not someone
who died because of cancer. That's not right either I don't think.

~~~
bart_spoon
This is a problem with counting diabetes deaths as well. We have evidence to
believe that people with diabetes are much more likely to get heart disease or
cancer, which is what they usually die from. There's lots of debate on if
mortality due to diabetes is underestimated for the same reasons.

------
jasimmohdk
Does anyone has a translated version of of this?

~~~
ytgh76
[https://www.epicentro.iss.it/coronavirus/bollettino/Infograf...](https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_19marzo%20ENG.pdf)

------
rezeroed
Confirms that this is a disease of the elderly and unwell, and everyone else
should be getting on as normal.

~~~
mkl
This is about deaths, not cases. If everyone else tries to get on as normal
then the virus will spread like wildfire among them and the elderly and unwell
will quickly become infected.

~~~
rezeroed
Isolate the elderly and unwell, let the virus spread among the rest.

~~~
mkl
How could you possibly isolate 10s of millions of people who are thoroughly
mixed in with the rest of society? Many of them live with or are dependent on
the younger healthier people. Even if the isolation were possible, letting the
virus spread like that would overwhelm the health system and push the death
rate way up.

~~~
rezeroed
The same way they're doing it now.

------
gvjddbnvdrbv
This is encouraging for healthy youngsters BUT age and health are also the
criteria for receiving treatment in Italy at the moment. As the epidemic grows
the categories of people that get ventilation decrease and the deaths will get
younger and healthier.

~~~
xenonite
Even if a youngster as a higher change of survival, there are serious effects
reported. Fibrosis (damage of the lung tissue) lasts for much longer (over 4
weeks) than it is known in any typical flu. And what happens after 4 weeks is
still totally unclear.

As we don't know yet of the long term effects, please don't take that lightly!

~~~
dakrisht
Source for this comment?

All pneumonia’s have decreased lung function post-infection and require
therapy to retain full or close to full lung function.

Curious where you’re getting this info from

~~~
xenonite
Sure, thank you for asking.

My source is an interview in the first German state TV station (ARD). I am
sorry that I can't provide you with an English source. If you understand
German, please watch
[https://youtu.be/IHF0IDtW6LA?t=882](https://youtu.be/IHF0IDtW6LA?t=882) from
minute 14:42.

As a second source, I found a written report on the TV talk here, for which
you may use, e.g., deepl.com to translate it:
[https://www.express.de/news/promi-und-show/corona-talk-
spd-p...](https://www.express.de/news/promi-und-show/corona-talk-spd-
politiker-wagt-bei--maischberger--drastische-prognose-zum-wochenende-36440162)

