From The Telegraph, March 21:
Why have so many coronavirus patients died in Italy?
The country's high death toll is due to an ageing population, overstretched health system and the way fatalities are reported
The coronavirus pandemic is exacting a heavy toll on Italy, with hospitals overwhelmed and a nationwide lockdown imposed. But experts are also concerned about a seemingly high death rate, with the number of fatalities outstripping the total reported in China.
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.
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.
So why the disparity?
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 - and the manner in which hospitals record deaths.
“The age of our patients in hospitals is substantially older - the median is 67, while in China it was 46,” Prof Ricciardi says. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality.”
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.
And according to modelling the majority of this age group are likely to need critical hospital care - including 80 per cent of 80-somethings - putting immense pressure on the health system.
But Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.
“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.... MORE
