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Why are deaths from coronavirus so high in Italy?

People stroll across the Piazza del Duomo, in front of the Duomo, in central Milan, Italy, wearing protective masks amidst the coronavirus outbreak, on Feb. 23, 2020.
People stroll across the Piazza del Duomo, in front of the Duomo, in central Milan, Italy, wearing protective masks amidst the coronavirus outbreak, on Feb. 23, 2020.
(Image: © Andrea Diodato/NurPhoto via Getty Images)

Updated on March 26 with new information about COVID-19 in Italy. It was originally published on March 10.

Deaths from the new coronavirus in Italy continue to soar, with the country reporting 919 deaths in a single day on Friday (March 27) — the biggest single-day death toll reported in any country since the start of the outbreak. But why are deaths in Italy  so high?

Italy now has the highest number of deaths in the world from COVID-19, the disease caused by the new coronavirus. As of Friday (March 27), the country had reported more than 9,100 deaths, according to worldometer, a website tracking COVID-19 cases. And the country's fatality rate from COVID-19 — at 10% — is much higher than the global average of 3.4%, according to the World Health Organization. 

One factor affecting the country's death rate may be the age of its population — Italy has the oldest population in Europe, with about 23% of residents 65 or older, according to The New York Times. The median age in the country is 47.3, compared with 38.3 in the United States, the Times reported. Many of Italy's deaths have been among people in their 80s, and 90s, a population known to be more susceptible to severe complications from COVID-19, according to The Local.

What's more, older adults appear to make up a greater proportion of cases in Italy, with about 37% of cases ages 70 and older, compared with 12% of cases in China, according to a paper on the issue of deaths in Italy, published March 23 in the journal JAMA.

Related: Live updates on COVID-19

The overall mortality rate is always going to depend on the demographics of a population, said Aubree Gordon, an associate professor of epidemiology at the University of Michigan. In this case, the reported mortality rate is not "age standardized," which is a way to adjust for the underlying demographics of a population, she said.

Given Italy's older population, "you would expect their mortality rate to be higher on average, all else being held equal," compared with a country with a younger population, Gordon told Live Science.

In addition, as people age, the chances of developing at least one condition that weakens their immune system — such as cancer or diabetes — increases, said Krys Johnson, an epidemiologist at the Temple University College of Public Health. Such conditions also make people more susceptible to severe illness from coronavirus, she said.

Another issue may be the number of people in a given area who require medical care — having a lot of severely ill people in a single region could potentially overwhelm the medical system, Gordon said. She noted that this was likely the case in Wuhan, China, where the coronavirus outbreak began and which saw the majority of COVID-19 cases in China. A recent report from WHO found that the fatality rate was 5.8% in Wuhan, compared with 0.7% in the rest of the country, Live Science previously reported.

Finally, the country may not be catching many of the mild cases of COVID-19. Often, as testing expands within a community, more mild cases are found, which lowers the overall death rate, Gordon said. This was the case in South Korea, which had tested more than 295,000 people as of March 18 and had a death rate of about 1%, according to Business Insider.

"We probably don't know how many people have actually become infected," Johnson said. People with more mild symptoms, or those who are younger, may not be going to get tested, she said. 

Indeed, although Italy initially conducted extensive testing of both symptomatic and asymptomatic contacts of people with COVID-19, the Italian Ministry of Health issued more stringent testing policies on Feb. 25, according to the JAMA paper. The policy prioritized testing for people with severe symptoms and limited testing for asymptomatic people or those with mild symptoms. This could result in an increase in the fatality rate because patients with more mild symptoms are not getting tested, the paper said. 

Italy has conducted a substantial number of tests — more than 134,000 as of March 17,  according to The New York Times. However there is likely "quite a sizeable outbreak" in the area, which would need even more testing to identify, Gordon said.

Editor's note: This article was updated with additional information from epidemiologist Krys Johnson.

Originally published on Live Science.

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  • LisaSummit2
    My Uneducated guess is that it mutates and becomes stronger or IF IT IS MANMADE bioterrorism, maybe they unleashed a larger amount of the virus in Italy
    Reply
  • Jimbo
    That's not very scientific. Who are 'they' and how did they unleash larger amounts of the virus in Italy? Were they basting hand rails with the virus? Is it not more feasible that the virus mutated on it's own like every other virus that humans pick up. Misinformation is manmade ya big uneducated guesser.
    LisaSummit2 said:
    My Uneducated guess is that it mutates and becomes stronger or IF IT IS MANMADE bioterrorism, maybe they unleashed a larger amount of the virus in Italy
    Reply
  • Raptor213
    Jimbo said:
    That's not very scientific. Who are 'they' and how did they unleash larger amounts of the virus in Italy? Were they basting hand rails with the virus? Is it not more feasible that the virus mutated on it's own like every other virus that humans pick up. Misinformation is manmade ya big uneducated guesser.

    Why not blame the neighbor to the Northeast of China. Conspiracy theorist's can claim it was in some of the test fired missiles to get the conspiracy theories going full force. Sure they are supposed to be allies but in reality who would come to the military aid of China? Since the missile firing nation denies any cases at all period and knowing the neighbor to the South is a Nato country with thousands of U.S. military present why not.Sounds like a good conspiracy theory to me.
    In reality it most likely will never be made clear where it really came from or how it started because of where it started since China loves to keep their inner problems as quiet as possible.Who know where we would be if not for the Chinese doctor who first blew the whistle and has now paid the price with his own death from the virus.
    Still in the USA our leaders continue to point fingers when they should stand together to attempt to stop the spread but politics overrides the health of the nation.
    Reply
  • col
    This is not a very good article.
    It missed one of the obvious reasons why Italians have infected each other so quickly. Body contact! They are one of the cuddliest nations on the planet. Anyone who has hung out with them knows how touchy and feely they are, even old men walk down the street holding hands no matter their orientation. It's just friendship. They sit on the bus and lean all over each other with their arms around each other. Then you have the hugging and kissing and large families hanging out with much physical love. The large aging population also has lots of aging friends so they are very social playing Bocci Ball (sorry if that is not spelled correctly) and chess and whatnot.
    The weather helps this happen although there would be similarities in Spain, but not to the same extent.

    It's hard to take any article seriously that hasn't noticed this massive societal difference in Italy which differentiates it to many European places.
    Reply
  • Quickpig
    Please stop saying that these face masks are protective against covid 19! They're not and consumers are buying up all the masks that we desperately need in hospitals and dental practices. They only work for basic medical hygiene such as the dentist not accidentally spitting in someone's mouth and avoiding little snot pieces falling out of their nose onto people.
    Reply
  • The Goldilocks Procedure
    admin said:
    Deaths from the new coronavirus in Italy have soared in recent days, with a death rate of 5%. Here's why that rate is so high.

    Why are deaths from coronavirus so high in Italy? : Read more

    The Italians have a very poor SOCIAL-SECURITY Net; and people have to search far & wide for work. This is from my best information.
    Unless things have much changed, and very recently.

    So there is this mass movement of rural folk in the country lanes and ruddy-necked men braving the world of the towns and cities for jobs, because there is very little Social-Security support. These people are ideal Covid19 vectors.
    Reply
  • Bdoon
    LisaSummit2 said:
    My Uneducated guess is that it mutates and becomes stronger or IF IT IS MANMADE bioterrorism, maybe they unleashed a larger amount of the virus in Italy
    Lisa...you do raise a good point in spite of being "uneducated" ... hopefully FEMA, NIH, and the CDC are noting how vulnerable we (all populations) are to bio-terrorism. Very likely some others are "noting".
    Reply
  • DataDrivenFP
    More deaths among older people, older population in Italy, possibly missing milder cases especially among younger people, all possible reasons for higher death rate. From the data we have-10% death rate in older people, doubling time 3-6 days, 3-4 weeks from infection to death, there were ~3500 cases 3-4 weeks ago (when the people now dying were infected) which has doubled 3-9 times, so 8-500x since then, so Italy now has 30,000-150,000 cases, vs 9000 known cases.
    Reply
  • Holmescheddar02
    Worse Case said:
    what do you think the guys in the hazmat suits are spraying? They re spraying the virus.
    And how do you know that?
    Reply
  • Alien 👽
    I'm not a scientist but isn't it obvious the way the Italians greet each other it's no wonder it's spread so fast
    Reply