Why is mortality from Covid-19 higher in Italy?

[Dagne]

I was wondering why North Italian fatality rates are so high. Apart from typical risk factors, air pollution, there could be an issue of annual flu vaccination. There are very strong programmes for free flu vaccination for people >65 in Lombardy. Annual flu vaccination helps to reduce flu risks, but can reduce immune's system response to different viruses. This is how it works:

"After being vaccinated with a new strain of flu, our immune systems appear to be expanding and boosting antibodies generated by previous exposures to earlier flu viruses, whether by infection or vaccination," said George Georgiou, a professor of biomedical and chemical engineering and molecular biosciences, a leader in the field of therapeutics and immune responses and co-author of the study.
The researchers examined the composition and dynamics of an individual donor's antibody repertoire over a five-year period during which the donor had been infected or vaccinated with influenza multiple times. The study suggests our immune systems are "imprinted" by antibodies that had been elicited in response to influenza strains encountered previously in life.
"Each vaccination still elicits new antibodies that are highly specific to the new strains, but these new antibodies decay over time, returning to the antibody repertoire that already existed before the vaccination," said Jiwon Lee, a postdoctoral fellow in Georgiou's Laboratory of Protein Therapeutics and Applied Immunology who led the study.
The researchers found that the antibody repertoires remained highly static throughout. More than 70 percent of the antibody molecules found in the donor's bloodstream remained the same over five years. More than two-thirds of these persistent antibodies targeted invariant parts of the virus -- the elements that do not change from one year to the next.
These persistent antibodies continue to be produced by the immune system for years and can affect our ability to generate novel antibodies that recognize unique molecular features of a new seasonal strain."

https://www.sciencedaily.com/releases/2019/03/190320110619.

The key finding is that annual flu vaccination can affect immune systems ability to recognise unique molecular features of a new virus. In this case - novel coronavirus. It is not clear if this is really the case, but if so, people who get their flu shot annually could be also in a risk zone, if their immune system's response is impaired by annual flu vaccination.

[New Englander]

^
One of the oldest populations in Europe is in The Po Valley. Lots of smokers, poor diet, and kissing culture. Also lots of commutability by Chinese workers. Blood type A might also be a predisposition.

[Angela]

^
One of the oldest populations in Europe is in The Po Valley. Lots of smokers, poor diet, and kissing culture. Also lots of commutability by Chinese workers. Blood type A might also be a predisposition.

We've gone over and disproved much of this in other posts both here and in the other thread.

They smoke less than many other Europeans; we've posted the documentation to prove it.

If by "poor diet" you mean heavy in fats, the traditional diet of Lombardia is not a particularly rich one. Perhaps you're thinking of Emilia Romagna. In both cases, other than the very old, modern Italians are too appearance conscious to overindulge; Italians are always among the thinnest people in Europe. You'll have to look elsewhere to find a preponderance of fat Europeans eating a lot of animal fat.

You do realize that in Lombardia you have one of the richest areas of Europe, do you not? It is not the Italy of the half forgotten memories of Italian American grandparents and great-grandparents.

The Chinese workers, centered, for example, around Prato, are remarkably free from infection, partly because of mask wearing and partly because they rather quarantined themselves. Plus, Prato is in Toscana, not Lombardia.

Honestly, it's not helpful when foreigners who know nothing of modern Italy and Italian regions do this kind of unresearched musing.

The pollution is a possibility, the close relationships of young people with the old, and the warmth of personal relationships may also be factors.

Until they have the "real" patient zero, and the time of that infection, it's all speculation. By this I mean that it may have been in Italy "before" the first "official" case, going by findings in hospital records from late December/early January.

There is a great deal of business between Chinese and North Italian firms. Also, tourism is an important part of the economy; it may also have been part of our downfall in this case.

[Dagne]

^
One of the oldest populations in Europe is in The Po Valley. Lots of smokers, poor diet, and kissing culture. Also lots of commutability by Chinese workers. Blood type A might also be a predisposition.

I think age is a factor, the diet cannot be, because the reason for Italian longevity - as many think - is their diet and lifestyle. Sociability and high level of connections is a factor for spread, too.

I also heard that Milan's fashion industry is a "culprit" as it attracts a lot of wealthy Chinese visitors after the new year, because it is the time for fashion brands sales. And even if Italy closed its flights from China early on, but it is so very easy to reach Milan by connecting flights via other European cities. I heard this theory told by an Italian nurse who lives and works just outside of Bergamo. It is true that it is not longer Europeans, but Chinese that the luxury fashion brands depend on now.

Overall, it is true that Norther Italian cities are very well connected, and that Italian culture is very "touchy" and that families of several generations are in touch and it all combined helped with the spread. Besides, Po valley has a very polluted air, which may also have added to spread/heaviness of the illness.

However, it still cannot account for all that mortality figures, compared to other similar regions. Japanese have the oldest population Worldwide, but they have been doing fine so far. I somehow believe the annual flu shots, which are really a must for everyone above 65 in Lombardy - could be a factor.
If the annual vaccination impairs immune system's ability to react to new viruses, then countries with highest flu vaccination coverage, like the USA (New York), the UK will be affected worse than other places in terms of severity of the illness, as many people's immune's response may be off the target.

https://www.slideshare.net/DRIVE_EU/...penttinen-ecdc

[New Englander]

I actually just looked it up.
Smoking and obesity, turns out I was wrong.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718391/
https://valterlongo.com/obesity-in-i...re-overweight/

[Angela]

I actually just looked it up.
Smoking and obesity, turns out I was wrong.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718391/
https://valterlongo.com/obesity-in-i...re-overweight/

If the purpose is to compare Coronavirus severity across Europe, why would you look up the data only for Italy? It's a "comparative" analysis, yes?



Yes, within Italy itself, southerners skew heavier.



The picture of total tobacco use would be bigger yet. There's a high percentage of "oral" tobacco use in Sweden in particular, I think, if not all the Scandinavian countries.

Latitude and thus climate does indeed sound like a good possibility, as well as all our tourists, and the fact that we're a sociable bunch, even with all our very elderly people, a quite astounding number of whom are in their 80s and 90s.
https://www.scmp.com/news/china/scie...lines-map-hold

They should add New York...

[New Englander]

No reason to include the rest of Europe in those points because the south was higher in both categories. And other parts of Europe have higher asthma, lung cancer, and diabetes rates than Italy as a whole.

[Angela]

Yeah, right...

What you were supposedly trying to show was that Italy had a higher incidence of cases and deaths because they smoked more and had a "bad" diet, by which you meant "fatter", apparently, because you posted a paper on obesity of northern versus southern Italy.

To analyze that you have to look at Italy's stats versus those of other EU countries, southern as well as northern. Period.

If you wanted to compare Northern Italy versus Southern Italy, that's a different matter. Of course, anyone who knows Italy at all knows that obesity skews more "southern". I'd be willing to bet so does tobacco use, although I didn't look it up.

You should have stopped with: I was wrong.

No shame in that, of course. Just move on.

[Northener]

I actually just looked it up.
Smoking and obesity, turns out I was wrong.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718391/
https://valterlongo.com/obesity-in-i...re-overweight/

May be I Italy it's a factor that people are the oldest one in Europe and the families are more extended so more contacts between the young and the old?

https://www.reddit.com/r/MapPorn/com...pe_427x400_os/

[Yetos]

May be I Italy it's a factor that people are the oldest one in Europe and the families are more extended so more contacts between the young and the old?

https://www.reddit.com/r/MapPorn/com...pe_427x400_os/

I don't think so,

Simmilar at age,
and maybe more strong relations are in Greece,

and Greeks smoke more than Italians

[bigsnake49]

I don't think so,

Simmilar at age,
and maybe more strong relations are in Greece,

and Greeks smoke more than Italians

...and are fatter than Italians .

[Yetos]

Was thinking about some factors,
a comparison with others will help.

Italy and Greece comparison

1, Age, Both countries average age is very big, do not know who has bigger, but both are very aged.
Greece average is 41.9 and the distribution of aged ones is at country side,
which has much much low spread of coronavirus comparing the big cities



2 Smoking Greece could be the champion of Europe for that,
ατ 2010, 61.7 were smokers, today has droped lower than 1/3




3 relations and family Traditions
the Tradition in Greece is the young to leave family house at 18-21 for miltary, studies work etc and return back after, mainly the return after 25 but some from 19 years old, some at the age of 30.
especially the first born male, or the smallest daughter. the duty to nurse the parents.






4, the population Distribution,
Do not know for Italy, But in Greece more than 2/3 live at big Urban areas,
also spread is simmilar or bigger, some country municipals have 0 coronavirus

5. comparing the statistics
Italy holds the record today at Europe,
But Greece show an unexpected mortality comparing the spread,
the average age of Greek dead is 71 years old, !!!!
Only 1 case bellow 40, 39 years ols,
comparison with Italy


So comparison simmilar countries,
and with the agreement that N Italy around Milano is high density population area
I would seek for smoking or food or realtions or any other factor,

Than this one,
Do Italian aged people live at big Urban areas or at Countryside?
so to appear such mortality?

Personally this is second reason,
Primary is that Italy was surprised, and had a delay,

Spain is another case,
especially the 'hospitals' for aged people.

My personal aftermath
Urbanization in Italy is much older than Greece,
So the distribution of aged people could be closer to High Density areas and Big Cities,
That makes Italian aged closer to the risk of infection

We compare different things to have to have a result
but we compare simmilar things to have a clue,

[Angela]

Anyone know of any stats for people over 75 or 80?

This Pew Research paper was only looking at Italy, U.S. and Germany.
https://www.pewsocialtrends.org/2015...s-generations/

"Most grandparents communicate with their grandchildren on a fairly regular basis. The contact is much more frequent in Italy than in the U.S. or Germany.In Italy, 43% of grandparents (that is, adults with at least one grandchild of any age), say they communicate with their grandchild or grandchildren at least once a day. An additional 40% say they are in touch at least once a week. Some 7% say they are in touch at least monthly, and 8% say it’s less often than that or never.
In the U.S., one-in-five grandparents say they communicate with their grandchildren daily, and 41% say they are in touch weekly. Some 19% communicate with their grandchildren once a month and another 19% say they communicate less often or never. The shares are nearly identical in Germany, with a plurality (44%) of grandparents saying they communicate with their grandchildren at least once a week."




It's certainly not drug use, which popped up when I looked up aging.

[Yetos]

they do not make stats after the retirement age

the stats usually have the age of retirement about 65 years ols

[Yetos]

Italy was oldest in Europe at 2018
but the tense might Bring Greece or Finland the oldest at 2020
by comparing above tense and 2018 demographics

[New Englander]

Well if the hot spot is in the North, and the South has higher obesity and smoking than that itself would dispute the causation would it not? And like I said, I looked up lung cancer, diabetes, and asthma and Italy is very healthy in those rankings.
So I assumed the North is full of a bunch of fat, rich, old retirees from all over and they are the ones getting sick. Im guessing it's 80 and 90 year olds and the unhealthy 50 and 60 year olds getting the worst of it.
Still doesn't explain why it's such a hot spot compared to other places unless it's the latitude or the health care system is bad?

But yes, the population density and intergenerational contact.

[Yetos]

I do not know if this article can help,

https://www.biznews.com/inside-covid...g-vaccine-nyit

'The analysis actually shows that the countries that don’t have the universal TB vaccine program seem to have worse infection rates. The number of infections that are in those countries – when you compare it with countries like Japan and all the other Asian countries – where there is some form of enforcement of this universal TB vaccine clinician programs. '

According the author Italy has such mortality comparing with Japan and others
due to not systemic use of BCG vacine against tuberculosis

[Angela]

Well if the hot spot is in the North, and the South has higher obesity and smoking than that itself would dispute the causation would it not? And like I said, I looked up lung cancer, diabetes, and asthma and Italy is very healthy in those rankings.
So I assumed the North is full of a bunch of fat, rich, old retirees from all over and they are the ones getting sick. Im guessing it's 80 and 90 year olds and the unhealthy 50 and 60 year olds getting the worst of it.
Still doesn't explain why it's such a hot spot compared to other places unless it's the latitude or the health care system is bad?

But yes, the population density and intergenerational contact.

Once again, your knowledge of modern Italy is non-existent.

You have now learned that Italians are not fat, at least in relative terms compared to the rest of Europe, don't smoke more than the average European, are generally very healthy in terms of many diseases, and have a lot of old people as a result.

I'll now add another piece of information for you: Lombardia, as one of the richest regions in Europe, has an excellent health system.

[Angela]

Just another data point...

[Angela]

In the major thread, Yetos brought up the fact that Italy, The Netherlands, and the U.S. don't do mass vaccination for TB.

From Wiki:

• France: The BCG was mandatory for school children between 1950 and 2007,^[39][40] and for healthcare professionals between 1947 and 2010. Vaccination is still available for French healthcare professionals and social workers but is now decided on a case-by-case basis.^[41]
• Italy: BCG mass vaccination has never been performed in Italy. ^[37]
• Ireland: The BCG was mandatory for all children until 2015 when it was discontinued as a result of global supplie issues.^[42]
• Germany: Mass vaccination was performed from 1961 until 1998. ^[43]
• Norway: In Norway the BCG vaccine was mandatory from 1947 to 1995. It is still available and recommended for high-risk groups.^[44]
• Spain: Past national BCG vaccination policy for all from 1965 to 1981. ^[37]
• United Kingdom: The UK introduced universal BCG immunization in 1953. From then until July 2005, UK policy was to immunize all school children aged between 10 and 14 years of age, and all neonates born into high-risk groups. The injection was given only once during an individual's lifetime (as there is no evidence of additional protection from more than one vaccination). BCG was also given to protect people who had been exposed to tuberculosis. The peak of tuberculosis incidence is in adolescence and early adulthood, and an MRC trial showed efficacy lasted a maximum of 15 years.^[45] Routine immunization with BCG for all school children was scrapped in July 2005 because of falling cost-effectiveness: whereas in 1953, 94 children would have to be immunized to prevent one case of TB, by 1988, the annual incidence of TB in the UK had fallen so much, 12,000 children would have to be immunized to prevent a single case of TB.^[46] The vaccine is still given to at risk healthcare professionals.^[47]
• Former Soviet Union. BCG was given regularly throughout life.^{[citation needed]}
• Bulgaria: The BCG vaccine is mandatory in children since 1951.^[48]
• Hungary: The BCG vaccination is mandatory for most newborns since 1954.^[49S

From what I can see, if this is correct, why does Spain have so many cases, or Britain? The researchers seem to believe there is no added benefit to re-vaccination.

These Italian researchers recommended that children be vaccinated, but from what I can see the recommendation was not followed.

"https://erj.ersjournals.com/content/.../1/24.full.pdf

It certainly has to be investigated, but the effect may be minor.

Fwiw, I got the pneumonia vaccine because I'm prone to it, and I thought perhaps it might have been helpful,but who knows?

[torzio]

Italy was oldest in Europe at 2018
but the tense might Bring Greece or Finland the oldest at 2020
by comparing above tense and 2018 demographics

for Italy at 25% of populace of 61M over 65yo...........makes it the second oldest populace by % in the world after japan at 28% ..................Japan seems safe because its an island and much harder to visit

[torzio]

In Australia.....it is compulsory for children to have all their shots or else they cannot go to any form of schooling , this is law............there was issues with this compulsory "shots" from 2017-2018 , when some "modern" families, refused to get their children done

[Angela]

Every country in the western world has compulsory vaccinations for children. The question is whether or not the tuberculosis vaccine is included in the list.

As you can see from above, a lot of countries did it but stopped at the end of the 20th century or beginning of the 21st, probably because there was so little TB in the developed world.

The decision could also have been impacted by the fact that it's a "live" virus; a certain percentage of people do come down with TB, especially those who are immunocompromised like HIV patients.

[ThirdTerm]

Italy's death rate is above the global average largely due to a demographic issue. Asia and Europe are home to some of the world’s oldest populations, those ages 65 and above. At the top is Japan at 28 percent, followed by Italy at 23 percent. For the age group (70+), the mortality rate is 21 percent and the vast majority of coronavirus patients in Italy belong to this age group. Of the 15,751 coronavirus deaths in Italy, approximately 85 percent were patients aged 70 years and older.

https://www.statista.com/statistics/...gion-in-italy/

[Coriolan]

The BCG vaccine was developed in France and was obligatory from 1950 to 2007. Almost every adult has been vaccinated, but the death rate in France is just as high as in Italy.