
Why have so many coronavirus patients died in Italy? - AngeloAnolin
https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/
======
fxj
"But there are other factors that may have contributed to Italy’s fatality
rates, experts say. This includes a high rate of smoking and pollution - the
majority of deaths have been in the northern region Lombardy region, which is
notorious for poor air quality."

This was also the case in china, but the age structure is different:

"A study in JAMA this week found that almost 40 per cent of infections and 87
per cent of deaths in the country have been in patients over 70 years old."

"An older population skew within the infected population explains most of the
disparity in fatality rates between high and low countries. According to a
study of the fatalities of COVID-19 cases in Italy, 99% of all deaths had an
underlying pathology. Only 0.8% had no underlying condition."

Seems like a perfect storm for the elderly in italy who smoke a lot and most
of them having an underlying condition like cardiovascular disease or diabetes
II.

~~~
ivanhoe
Lots of people over 40 have at last some mild health issues, over 60 almost
everyone. Even younger people often enough have conditions they're not even
aware of. So just wanted to say, don't get overly relaxed by these stats.

~~~
austincheney
> Even younger people often enough have conditions they're not even aware of.

True and more complicated than that sounds. I was diagnosed with asthma at 28.
A year and a half ago, at age 39, a pulmonary specialist rated my lung
capacity at 115% compared to other males of my age and height likely due to
exercising through unmedicated asthma. Undiagnosed underlying conditions
shouldn’t prevent intentional efforts to be continuously healthy.

------
pritovido
No, no, no, the main factor that they do not speak about is testing, simple as
that.

If you do proper testing, like in South Korea, you detect everybody or almost
everybody that has coronavirus, even when they don't have symptoms of the
illness. That is 7 to 10 times more people detected(and controlled), that can
actually transmit the virus.

In a country like UK, Portugal or Germany they had copied lots of things that
worked in Taiwan, South Korea, Singapur or Japan.

Germany could have as many detected cases as Spain, but that will make only
1/10 of the real illnesses cases of Spain.

In a country like Spain or Italy people in charge are so incompetent that they
have only reacted when it was too late.

That at the same time forces the entire's population to follow quarantine,
because without tests you are blind to the people that has the virus without
symptoms.

Spain's Government is today promising a million test kits(broken promises is
the seal of Mr Sanchez), in the future, but as of now there are not enough
test just for testing all people with symptoms, unless you are a politician or
family member of a politician of course.

That is the result of not getting preventive stocks early on. They simply
could not imagine(and hence prepare) what has happened and just took zero
anticipative actions like buying face masks.

Those politicians have zero scientific or technical preparation, so they could
not understand something as simple as an exponential function.

In the case of Spain, they have very well prepared people down the command
chain. But the people that takes the decisions are just scientific illiterate.

~~~
tyingq
This. It is highly irritating to me that all the popular maps and comparison
sites don't use metrics like "coronavirus deaths per 1M population" (or
similar) that are more comparable across areas.

~~~
fxj
For that information see this:

[https://ourworldindata.org/coronavirus](https://ourworldindata.org/coronavirus)

and they have very good information about testing in each country.

~~~
tyingq
Reasonably chosen metrics, and explanatory context too. Thank you.

------
jpxw
> “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.

How else could deaths be recorded? It would seem negligent to not record
someone who died with coronavirus as dying of coronavirus.

~~~
bob33212
If 5000 people die a day in average before the virus and 6000 people die a day
on average after the virus would you say that the death toll is 1000/day or
would you test all 5000 and say that any who had the virus were included in
the virus death toll?

~~~
Spare_account
Do we have these numbers to compare? How much has the _overall_ death rate
increased by?

~~~
wozer
There is an official European organisation trying to track mortality:

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

So far nothing suspicious, but they are always a few weeks behind.

~~~
wozer
Also note that you can look at subpopulations, e.g. people in Italy of age >=
65

[https://www.euromomo.eu/outputs/zscore_country65.html](https://www.euromomo.eu/outputs/zscore_country65.html)

------
iKevinShah
> Of the 47,000 people confirmed coronavirus patients in Italy, 4,032 so far
> have died - with a record increase of 627 in the last 24 hours. By contrast
> China has almost twice as many cases, 81,250, but 3,253 fatalities.

One major problem with this is China's reporting and actual figures.

~~~
Synaesthesia
How about the differences with Germany?

~~~
wuschel
Could you formulate your question in a more precise fashion?

Here are some stats for Germany [1] as of yesterday:

    
    
      cases         deaths
      16,662(+19%)  47(+52%)
    

I have a contact high up in a Gesundheitsamt. While I can not give out any
information I was asked not to divulge, I am happy to answer any questions.
Please note that top level decisions are decided in small rooms and acted upon
very quickly (Federal->Land, 2 hours lead time), so no way I can know anything
time critical before everyone knows it.

[1]
[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_G...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Germany)

~~~
qznc
The RKI statistics are not complete because the electronic submission is not
done by everybody (allegedly NRW is particularly bad and has high numbers). I
guess the system is new and the federal organizations are too busy to use it
properly?

This is sad because RKI is the official authority.

~~~
wuschel
The efforts to compile good numbers are a difficult task indeed. This is,
after all, the first pandemic that hits the country for a long time. Not sure
what happens at the interface RKI/Bunderland, but it seems the problem does
not start with electronic submission, but from the intelligence generating and
patient tracking in the field. While doctors in the 'Gesundheitsaemter'
(federal and local public health organisation of the goverment) are on the
phone the whole day, tracking and advising people (testing, quarantine
protocols) that had contact with Corona patients, the foreign office
(Auswaertiges Amt) allows 30000+ people come in from vacation destinations
like Egypt without any testing or quarantine, mixing people in planes, and
just letting them spread in Germany - effectively sabotaging the the entire
process. Moreover, it seems that it is difficult to track infection cascades
in high contact places such as hospitals (especially with staff): It is not
clear how and when infections are taking place.

As far as I know, they were on the limit of tracking existing cascades in
southern Germany last week, and word was that they realized that it was out of
hand. Carneval, public gatherings, and failing personal hygiene and isolation,
plus our tourists from Tirol and Egypt made tracking measures obsolete. Before
that, so my source said, they had a very good overview of the number of
infected (minus those without symptoms).

~~~
qznc
Taiwan and Singapur seem to have learned their lessons from SARS-CoV-1 but it
did not hit us enough to act back then.

------
chvid
It is the level of testing isn't it?

Death pr. infected goes from 0.4% (Germany) to 1% (Diamond Princess) to 7.8%
(Iran) to 9% (Italy).

If you have plenty of resources and you do contact tracing you are going to
find many cases and the denominator will be high. If you are pressed on
ressources and only test people admitted to hospitals with obvious symptions
then the denominator will be low.

Demographics, overall population health, polution explains some of it but not
a difference of factor 20.

~~~
akvadrako
Although an important thing to consider, I'm not sure how much it contributes.
Look at:

[https://www.worldometers.info/coronavirus/#countries](https://www.worldometers.info/coronavirus/#countries)

Italy has one of the highest rate of cases per capita and the highest CFR.

------
tgragnato
> with a record increase of 627 in the last 24 hours.

Worth pointing out that the record increase in 630 deaths was the number of
two days ago... Yesterday, the increase in deaths was even bigger: 790 (from
4035 to 4825 total casualties).

Source: [https://github.com/pcm-dpc/COVID-19](https://github.com/pcm-
dpc/COVID-19)

------
happywolf
It depends how a country classifies casualties outside those confirmed cases.
Autopsy usually would not be viable given the scarcity of health care staff.

------
synnick
I find this article disingenuous and misleading to readers. Yes, there are
cultural and demographic differences between Italy, China and Germany, but the
subtitle claims a level of certainty that the experts interviewed in the piece
do not support.

> "The country's high death toll is due to an ageing population, overstretched
> health system and the way fatalities are reported"

This can be read with a level certainty that minimizes the seriousness of this
virus for English speaking readers that may be faced with making life saving
choices over the next week.

Further, the Italian expert interviewed __in the article__ underlines the
importance of not searching for explanations, because right now it is hard to
be certain.

> “It’s too early to make a comparison across Europe,” he says. “We do not
> have detailed sero-surveillance of the population and we do not know how
> many asymptomatic people are spreading it.”

Unfortunately the author chooses to make exactly such a comparison in the
fourth paragraph!

> In very crude terms, this means that around eight per cent of confirmed
> coronavirus patients have died in Italy, compared to four per cent in China.
> By this measure Germany, which has so far identified 13,000 cases and 42
> deaths, has a fatality rate of just 0.3 per cent.

This is a moment where we need very concise and accurate information. Even if
this article comes from a reputable source, I find it misses that mark.

I find significantly more enlightening the ISS's (Istituto di Sanità
Superiore) info-graphics which are prepared quasi-daily. [1] They are
translated into english. [2]

Stay safe out there.

[1]: [https://www.epicentro.iss.it/coronavirus/sars-
cov-2-sorvegli...](https://www.epicentro.iss.it/coronavirus/sars-
cov-2-sorveglianza-dati) [2]:
[https://www.epicentro.iss.it/coronavirus/bollettino/Infograf...](https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_21marzo%20ENG.pdf)

------
giovan-ni
It is very hard not to think that also the number of deaths (not only that of
cases) is under-reported. For instance, the Major of Bergamo, one of the few
not entirely rotten politicians, claims that actual deaths in the Province in
the last days have been 4 times the reported deaths. He verified the figures
with the other majors. Who died at home, and there have been many, has not
been tested.

Here the interview:

[https://www.huffingtonpost.it/entry/giorgio-gori-chiudete-
tu...](https://www.huffingtonpost.it/entry/giorgio-gori-chiudete-tutto-anche-
le-fabbriche_it_5e74ad81c5b63c3b648e6263?utm_hp_ref=it-giorgio-gori)

And it is very hard not to think that the most plausible explanation for the
anomaly is shortage in ICUs.

------
csomar
> 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.

But people who died without a diagnose for the Coronavirus are deemed to be
dead not because of it.

From [https://www.reuters.com/article/us-health-coronavirus-
italy-...](https://www.reuters.com/article/us-health-coronavirus-italy-homes-
insigh/uncounted-among-coronavirus-victims-deaths-sweep-through-italys-
nursing-homes-idUSKBN2152V0)

> in the city of Bergamo, there were 108 more deaths in the first 15 days of
> March this year compared to 2019 (164 deaths in 2020 vs. 56 deaths in 2019)
> according to the mayor of the city Giorgio Gori. During this period, 31
> deaths were attributed to the coronavirus (less than 30% of the additional
> deaths this year)

> "There are significant numbers of people who have died but whose death
> hasn't been attributed to the coronavirus because they died at home or in a
> nursing home and so they weren't swabbed," said the mayor

Granted, the sample and time interval is small to draw conclusions. But we'll
know (perhaps when it's too late) what's the real death-toll of the
coronavirus is.

tl;dr: The death count is not generous; probably the other way around. By,
perhaps, a very big margin.

