
Italy’s coronavirus death toll is far higher than reported - adventured
https://www.wsj.com/articles/italys-coronavirus-death-toll-is-far-higher-than-reported-11585767179
======
Pfhreak
There's a second order death toll too, because resources that would otherwise
be available are being used to treat the pandemic.

That means many things that might not be lethal if treated quickly and with
the best care, for example injuries from a car accident or a heart attack, are
now entering a stressed health care system and likely have worse expected
outcomes.

Then, all the folks who would normally be secondary concerns and receiving
preventative care are now most likely not receiving that care. It's less
likely that these develop into death, but could easily turn into serious
health complications.

It's important to remember that it's not _just_ covid-19 we're dealing with.
It's covid-19 plus all the stuff we'd normally be taking care of. We'll be
unwinding this ball of yarn for a long time after addressing the virus itself.

~~~
_-___________-_
Very true. There's a second order _reduction_ in deaths, too. The huge
reduction in vehicle traffic leads to far fewer car accidents [0]. The
temporary closure of polluting industries improves air quality. Working out
the overall impact of this thing will be quite a challenge indeed.

[0] A pretty extreme example is here in Vietnam where I'm "sheltering in
place" \-- normally an average of two people a day die in traffic accidents in
Saigon alone. Traffic has been reduced so much (although there isn't a strict
lockdown) that it's apparently down to one person in two weeks. Meanwhile,
Covid-19 hasn't directly killed anyone in the whole country (according to
official figures).

~~~
bb2018
This will obviously be studied for years but I imagine plotting taking "total
deaths in region X for time period Y - total deaths in region X given
comparable previous time period Y" will give a pretty good estimate of the
complete effect of Covid. It won't be able to pinpoint individual cases but it
seems like a very simple and unbiased way of getting the complete delta in
deaths due to Covid.

~~~
_-___________-_
I mentioned this in another thread but check out
[http://euromomo.eu/](http://euromomo.eu/) \- all-cause mortality vs. baseline
for every European country, overall and by age group, going back a decade.
There's a time lag because of reporting delay so it will be a few weeks before
the current situation in Italy/Spain is well reflected there.

It does only have country-level data, so some amount of excess mortality in
one sub-country region (e.g. Lombardy) can get diluted by the rest of the
country, although Lombardy is 1/6 of the population of Italy so significant
excess should show up.

~~~
yread
It's interesting how even the delay adjusted z-score in countries doesn't work
very well. Compare the graph of Netherlands to the graph that RIVM presented
to the government yesterday (page 6):

[https://www.tweedekamer.nl/downloads/document?id=fb38642a-88...](https://www.tweedekamer.nl/downloads/document?id=fb38642a-88e7-4da6-a681-db2739496546&title=PowerPoint%20presentatie%20update%20coronavirus%20.pdf)

------
fxj
The Eu is monitoring mortality in europe at this website:

[http://www.euromomo.eu/](http://www.euromomo.eu/)

It goes back several years and you can clearly see the last influenza
pandemics (2017). It also show the mortality for each member country and of
course italy. At the moment there is no increase in mortality there.

They write on their website:

Note concerning COVID-19 related mortality as part of the all-cause mortality
figures reported by EuroMOMO

Over the past few days, the EuroMOMO hub has received many questions about the
weekly all-cause mortality data and the possible contribution of any COVID-19
related mortality. Some wonder why no increased mortality is observed in the
reported mortality figures for the COVID-19 affected countries.

The answer is that increased mortality that may occur primarily at subnational
level or within smaller focal areas, and/or concentrated within smaller age
groups, may not be detectable at the national level, even more so not in the
pooled analysis at European level, given the large total population
denominator. Furthermore, there is always a few weeks of delay in death
registration and reporting. Hence, the EuroMOMO mortality figures for the most
recent weeks must be interpreted with some caution.

Therefore, although increased mortality may not be immediately observable in
the EuroMOMO figures, this does not mean that increased mortality does not
occur in some areas or in some age groups, including mortality related to
COVID-19.

------
freyir
Even if they can't test everyone who dies for Covid-19, I'm sure Italy is
recording the total number of deaths. It should be possible to determine how
much the total death rate increased each week or month relative to the average
death rate over the past few years.

EDIT: I found a non-paywall version of the article on MSN and that's
essentially what they're reporting. _" Nowhere in Italy has been harder hit
than Bergamo, a city of about 120,000 people. In March 2019, 125 people died
in the city. This March, 553 people died."_

[https://www.msn.com/en-us/news/world/italys-coronavirus-
deat...](https://www.msn.com/en-us/news/world/italys-coronavirus-death-toll-
is-far-higher-than-reported/ar-BB122vvc?li=BBnb7Kz)

~~~
jsnell
More comprehensive data, accounting for the majority of the province rather
than one city: [https://www.ecodibergamo.it/stories/bergamo-
citta/coronaviru...](https://www.ecodibergamo.it/stories/bergamo-
citta/coronavirus-the-real-death-tool-4500-victims-in-one-month-in-the-
province-of_1347414_11/)

4.5k excess deaths in March, on a total population of 607k.

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flocial
[http://archive.is/UWxPP](http://archive.is/UWxPP)

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olliej
It seems like this could apply to pretty much every effected country.

We know the US has drastically under tested which again results in under
reporting.

~~~
topkai22
Had under tested, the rate of testing has increased drastically in the last
two weeks. It’s not where we need it to be, but the US is now testing at a
rate comparable with any other country.

~~~
ChristianGeek
Can you provide a source (other than the president) that backs that up?

~~~
riffraff
It is a very sad state of affairs that a Presidential statements cannot
considered reliable anymore.

~~~
sg47
Random lies don't Presidential statements make.

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rubber_duck
One thing I saw in a news report here is a doctor checking in on the status in
Italy - she said that they were not doing autopsies - patient was on a
respirator and had symptoms or was confirmed - cause of death corona. So I'm
not sure about the reasoning with testing - but I could be wrong.

~~~
_-___________-_
My understanding is that in many countries, the "Covid-19 deaths" count is the
number of people who tested positive (i.e. confirmed cases) who subsequently
died.

This is different to the way deaths are normally attributed to a cause, in
that every single death of a person who tested positive is recorded as a
Covid-19 death regardless of the severity of their Covid-19 symptoms or any
other factors. This has an upward pressure on the reported Covid-19 mortality
vs. other diseases.

Separately from that, in any country there are of course people dying who were
not tested before death and thus were not a confirmed case. They are not
recorded as Covid-19 deaths. This has a downward pressure on the reported
Covid-19 mortality.

The relative magnitude of the upward pressure and the downward pressure are
pretty much unknown at this point.

~~~
npunt
Good summary. One additional thing to point out is the upper bound of the
first case is the total covid deaths counted, whereas the upper bound of the
second could be much larger.

------
riffraff
I cannot read this article ATM, but there was another one a couple days ago on
an Italian newspaper, in English, which gets the same conclusion by looking
directly at the number of deaths in the period compared with last year. The
number seems to be a much better proxy of the gravity of the epidemic than the
reported infected.

[https://www.google.com/amp/s/www.corriere.it/politica/20_mar...](https://www.google.com/amp/s/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_amp.html)

~~~
_-___________-_
If you're interested in this perspective, EUROMOMO[0] is worth keeping an eye
on. It's the all-cause mortality monitoring data that Europe has collected on
a per-country and per-age-group basis for a decade or so, for the purpose of
early detection of increased mortality due to e.g. a bad flu season. There is
some time lag in the data (probably more than usual right now in Italy/Spain)
but increased mortality should show up within a few weeks there.

[0] [http://euromomo.eu/](http://euromomo.eu/)

~~~
notechback
Really interesting. It currently shows week 12, so the second half of march.

It looks like there is overall a lower number, especially for 0-4 year olds.
Staying home saves lives beyond covid...?

~~~
_-___________-_
Staying home means fewer traffic accidents, and closing businesses means fewer
workplace accidents (admittedly not relevant for the 0-4 age group) and maybe
lower pollution. So it definitely seems possible that all-cause mortality for
some age groups would reduce.

------
rurban
More than 54.000? That was the number of deaths with the last big flu in Italy
2014. It's also still half of the death toll in a typical flu season. The flu
IFR is 1% for years in Italy, the COVID-19 IFR in most countries at about
0.6%. But thanksfully pneumonia deaths are so much more media triggery than
normal flu deaths.

[https://www.ijidonline.com/article/S1201-9712(19)30328-5/ful...](https://www.ijidonline.com/article/S1201-9712\(19\)30328-5/fulltext)

~~~
MagnumOpus
Your source says 20,250 excess deaths from 14/15 winter?

~~~
rurban
"A mortality rate of 10.7 per 1,000 inhabitants was observed in the winter
season 2014/2015 (more than 375,000 deaths in absolute terms), corresponding
to an estimated 54,000 excess deaths (+9.1%) as compared to 2014"

------
ImpressiveWebs
I haven’t read the article due to the paywall, but it’s also worth considering
the following quote from the Telegraph on March 23, which quotes Prof Walter
Ricciardi, scientific adviser to Italy’s minister of health:

> “The way in which we code deaths in our country is very generous in the
> sense that all the people who die in hospitals with the coronavirus are
> deemed to be dying of the coronavirus.

> “On re-evaluation by the National Institute of Health, only 12 per cent of
> death certificates have shown a direct causality from coronavirus, while 88
> per cent of patients who have died have at least one pre-morbidity - many
> had two or three,” he says.

So while it may be true that many deaths have not been reported, it’s also
true that many deaths are misreported.

Source: [https://www.telegraph.co.uk/global-health/science-and-
diseas...](https://www.telegraph.co.uk/global-health/science-and-disease/have-
many-coronavirus-patients-died-italy/)

~~~
triangleman
No, I think it's fair to say that if someone dies for whatever reason and they
test positive for COVID-19 then their death should be included in the official
total.

~~~
nordsieck
> I think it's fair to say that if someone dies for whatever reason and they
> test positive for COVID-19 then their death should be included in the
> official total.

You think that someone who has COVID-19 asymptomatically, and dies from being
crushed by a falling piano should be included in the official death total?

If you applied the same logic to prostate cancer, probably 50%+ of men "die"
of prostate cancer.

~~~
e98cuenc
You are right strictly speaking, but misleading. In the vast majority of cases
of people dying with COVID-19 from another condition, COVID-19 is the reason
why this other condition became lethal. That's why it makes sense to attribute
the death to COVID-19.

~~~
guscost
That’s just the absurd example. How do you call it when someone dies five
minutes early because they got a stuffy nose? How about a day early? A year
early?

The coroner is supposed to make these judgements, and it’s not entirely clear
how you should aggregate them into a big-number statistic. If you go by
official cause of death, _nobody_ dies of a cold in most countries. If you go
by a positive test, _loads_ of people do.

------
guscost
Take on the one hand these untested victims, and on the other the folks who
tested positive but did not die of pneumonia or respiratory distress. Right
now it’s awfully hard to guess whether the true “death toll” (to the extent
that such a vague thing can even be defined) is more or less than the reported
number. But folks will try to estimate this retroactively, far into the
future.

