Covid Why is mortality from Covid-19 higher in Italy?

For now it seems that Italy's extraordinary mortality was just a random, not in time with rest countries, peak,
Britain has reach that mortality with the mistake of 3rd class number,
which probably means that Italy's high mortality was just a temporary phaenomenon, giving false impressions
or I said Coronavirus caught Italians on sleep, not expecting it so soon to them

Anyway most numbers West of Alps show a better normal distribution now,
but seems we can break the stats to 2-3 different distributions
the West Europe,
the SE Europe -Balkans
the NE Europe
 
i just read that in Italy around 30% of the tested people are positive. in Germany it's only 4%.

so what i take from this is, that in Italy tests more people based on visible symptoms, because of this they see way less infected than there really are in Italy. their mortality rate is probably not really higher than in other countries but they have way more infected people than they think. based on the number of deaths it could already be 6 millions.
 
Age is indeed a factor, I think, but it's in combination with other factors.

As with everything else, there is a north/south skew in Italy with respect to life expectancy...

gv6sIE5.png


These numbers for northern Italy seem really high to me. Air pollution in Lombardia may have pushed it down a bit, but not by all that much, it seems.

So, let's say that the age of the population is one factor.

Then, there's the fact, which I mentioned weeks ago, that Italians have a great deal of close contact across generational lines. Here's an article which finally highlights that fact:
https://www.spectator.co.uk/article...d-be-its-biggest-weakness-against-coronavirus

What is often forgotten in these discussions is that the number of Coronavirus "infections" in Germany and Italy are not that dissimilar, despite all the vaunted testing, tracing, isolation, which Germany has supposedly done. The disparity which does exist could be a function of other factors as well, as I'll mention below.

". Italy has 143,626 confirmed coronavirus cases; Germany has 114,257." Yet, the "death rate" in Germany is 2% versus 12.7% in Italy. Why?

One clue is in the average age of the infected. Given the known fact that it is so much more fatal in those over 70 and particularly those over 90, that accounts for a great deal of the difference.

"
The median age for confirmed cases of coronavirus in Italy is 63-years-old. In Germany, it is 48."

It seems that the first infected in Germany were young, and younger people in Germany have much less contact across generational lines than do Italians.

"
Among Germans aged 60 or over, only 6.9 per cent live with children, while that number is 27.4 per cent for elderly Italians, according to a UN report. "

"Italy’s elderly are encouraged to live in familial homes as opposed to seeking residential care, since 72.4 per cent of Italians own their homes. In contrast, only 51.5 per cent of Germans own theirs, so more German elderly people are separated into residential facilities. Germany also provides more pre-school services than Italy. Italy’s children under three years of age are therefore often taken care of by their grandparents when their parents are busy working."

So, then, what about deaths in nursing homes. They're virtual death camps in other countries. Perhaps families in Germany don't visit as often?

Age and amount of intergenerational contact are not the only factors, however.

There is also the question of ICU/ventilator availability. I think this is more important than I initially thought. Britain has a younger population than Italy, perhaps more like Germany? Also like Germany, there is less intergenerational contact than in Italy. I'll have to wait and see the CFR for Britain, but Britain's number of ventilators is extremely low, so that may indeed be a factor.

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Then there's the issue of reporting. Germany DOES NOT count deaths OF Coronavirus if the patient had a prior co-morbidity but died WITH Coronavirus. The article calls that "scrupulous"; I call that misleading. What are the odds the patient "wasn't" impacted by the existing Coronavirus infection?

So, as we can see, there are numerous factors which might be involved. Differing genetic susceptibility might also be a factor. That will have to be studied.

Note that I'm trying to look at CFR, not the number of infections, so when countries, or areas, closed down is not a factor.

Note also that some of these factors play out in Spain as well. We can't analyze Greece in the same way, because there initial exposure was very small, and from only one area, and they immediately shut down, so there are too few cases to analyze properly.
 
Salento was right: fatalities aren't highest in Italy; they're highest in Spain. The same factors apply, however, as is pointed out in post #43.
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The thing with the average age of the infected is, that with more testing it automatically decreases. if you only test people with strong symptoms the average age of the infected will be high because the old people show the strongest symptoms.

https://www.weforum.org/agenda/2020...-meticulously-traced-its-coronavirus-outbreak

"The difference between Germany and Italy is partly statistical: Germany?s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since Feb. 21, according to its Civil Protection Agency. With a few local exceptions, Italy only tests people taken to hospital with clear and severe symptoms."


also:

?We learned that we must meticulously trace chains of infection in order to interrupt them,? Clemens Wendtner, the doctor who treated the Munich patients, told Reuters.

Wendtner teamed up with some of Germany?s top scientists to tackle what became known as the ?Munich cluster,? and they advised the Bavarian government on how to respond. Bavaria led the way with the lockdowns, which went nationwide on March 22.

Scientists including England?s Chief Medical Officer Chris Whitty have credited Germany?s early, widespread testing with slowing the spread of the virus. ??We all know Germany got ahead in terms of its ability to do testing for the virus and there?s a lot to learn from that,?? he said on TV earlier this week.

Christian Drosten, the top virologist at Berlin?s Charite hospital, said Germany was helped by having a clear early cluster. ?Because we had this Munich cohort right at the start ... it became clear that with a big push we could inhibit this spreading further,? he said in a daily podcast for NDR radio on the coronavirus.
 
I don't know how many more ways I can explain that the number of cases in Germany and Italy are not that dissimilar, so all that contact tracing in Germany didn't stop it from spreading. The difference is indeed the number of tests with Italy still testing a lot of people.

Much more importantly, we've gotten studies with data from random tests of the population in hot spots in both Germany and Italy (the city with the Carnival cluster and Lombardia's hardest hit areas), and the infection rate is about the same: 15%, much lower than people expected. They're posted somewhere upthread. If you don't read everything you can be very misinformed.

Also, if the contact tracing hasn't turned up a lot of people who are elderly it proves my point that younger Germans don't have much contact with grandparents, and perhaps not even parents. If they did, the average age of the infected would be higher.

What is dissimilar is the death rate. That's influenced not only by age but by availability of PPE and ventilators.

The countries which stopped the SPREAD don't include Germany. Hong Kong is the best example.
 
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According to this article https://www.dailymail.co.uk/sciencetech/article-8204255/There-THREE-separate-types-coronavirus.html
Italy suffers from a different strain of coronavirus than elsewhere. "Methods used to trace the prehistoric migration of ancient humans were adapted to track the spread of the SARS-CoV-2 virus, which causes COVID-19. The team have now updated their analysis to include more than 1,000 COVID-19 cases up to the end of March to provide a clearer snapshot. It has not yet been peer-reviewed."

I wish someone could comment on how much this study could be trusted - if the predominant strain in Italy is different from other places in Europe and Americas, perhaps it is really more lethal ? On the other hand, if we take deaths per 1000 population, then Belgium is in the first place. At the same time, it is not reasonable to compare countries with different real infection rate, different progress in term of peak time, etc.

 

The real difference per country is about availability of ICU beds, rather than their numbers per capita. All Western and Northern European countries, apart from Germany, are doing badly, because the forecast is that there will be a shortage of ICU beds/ventilators when these are needed on peak times.
The Eastern side of the EU, including Greece, is doing fine, because hospitals are not and will not be overburdened with COVID patients. These countries closed faster/they were less connected from the beginning and imported less virus.


Sweden has really messed up with their open politics http://covid19.healthdata.org/sweden compared to Finland http://covid19.healthdata.org/finland (with only 3 ICU bed shortage, or Lithuania, which had at most 6 deaths per day during the peak time, and no shortage of ICU beds at all).
The situation looks pretty bad in case of the UK, the Netherlands or Belgium. Of course, this is just mathematical forecasting, however, it is pretty much accurate in case of Italy where during the peak, which was at the end of March, they have ended up with about 4,500 ICU beds shortage or Spain with 5,500 ICU beds shortage.

At the same time, it might be that death rate is higher in those countries where a lot of patients cannot received medical help when it is needed. Of course, the rate of survival of critical cases in ICU is not very high in case of patients with underlying conditions, too. Nevertheless, even Boris Johnson said that he owns his life to St Thomas Hospital and their ICU.
 
The real difference per country is about availability of ICU beds, rather than their numbers per capita. All Western and Northern European countries, apart from Germany, are doing badly, because the forecast is that there will be a shortage of ICU beds/ventilators when these are needed on peak times.
The Eastern side of the EU, including Greece, is doing fine, because hospitals are not and will not be overburdened with COVID patients. These countries closed faster/they were less connected from the beginning and imported less virus.


Sweden has really messed up with their open politics http://covid19.healthdata.org/sweden compared to Finland http://covid19.healthdata.org/finland (with only 3 ICU bed shortage, or Lithuania, which had at most 6 deaths per day during the peak time, and no shortage of ICU beds at all).
The situation looks pretty bad in case of the UK, the Netherlands or Belgium. Of course, this is just mathematical forecasting, however, it is pretty much accurate in case of Italy where during the peak, which was at the end of March, they have ended up with about 4,500 ICU beds shortage or Spain with 5,500 ICU beds shortage.

At the same time, it might be that death rate is higher in those countries where a lot of patients cannot received medical help when it is needed. Of course, the rate of survival of critical cases in ICU is not very high in case of patients with underlying conditions, too. Nevertheless, even Boris Johnson said that he owns his life to St Thomas Hospital and their ICU.

Yes, that's why I said the following:
What is dissimilar is the death rate. That's influenced not only by age but by availability of PPE and ventilators.

Of course, the number of ICU units is going to be a factor in that, but only a factor.
 
The real difference per country is about availability of ICU beds, rather than their numbers per capita. All Western and Northern European countries, apart from Germany, are doing badly, because the forecast is that there will be a shortage of ICU beds/ventilators when these are needed on peak times.
The Eastern side of the EU, including Greece, is doing fine, because hospitals are not and will not be overburdened with COVID patients. These countries closed faster/they were less connected from the beginning and imported less virus.


Sweden has really messed up with their open politics http://covid19.healthdata.org/sweden compared to Finland http://covid19.healthdata.org/finland (with only 3 ICU bed shortage, or Lithuania, which had at most 6 deaths per day during the peak time, and no shortage of ICU beds at all).
The situation looks pretty bad in case of the UK, the Netherlands or Belgium. Of course, this is just mathematical forecasting, however, it is pretty much accurate in case of Italy where during the peak, which was at the end of March, they have ended up with about 4,500 ICU beds shortage or Spain with 5,500 ICU beds shortage.

At the same time, it might be that death rate is higher in those countries where a lot of patients cannot received medical help when it is needed. Of course, the rate of survival of critical cases in ICU is not very high in case of patients with underlying conditions, too. Nevertheless, even Boris Johnson said that he owns his life to St Thomas Hospital and their ICU.

What we may not underestimate is that an ICU may save a live, but you can question the quality of life afterwards......Many with corona that have used an ICU have severe after effects.....

https://en.wikipedia.org/wiki/Post-intensive_care_syndrome
 
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According to this article https://www.dailymail.co.uk/sciencetech/article-8204255/There-THREE-separate-types-coronavirus.html
Italy suffers from a different strain of coronavirus than elsewhere. "Methods used to trace the prehistoric migration of ancient humans were adapted to track the spread of the SARS-CoV-2 virus, which causes COVID-19. The team have now updated their analysis to include more than 1,000 COVID-19 cases up to the end of March to provide a clearer snapshot. It has not yet been peer-reviewed."

I wish someone could comment on how much this study could be trusted - if the predominant strain in Italy is different from other places in Europe and Americas, perhaps it is really more lethal ? On the other hand, if we take deaths per 1000 population, then Belgium is in the first place. At the same time, it is not reasonable to compare countries with different real infection rate, different progress in term of peak time, etc.


Well, that would certainly explain it, but the researchers say this:

"The virus appears to mutate very slowly, with only tiny differences between the different strains and that none of the strains of the virus are more deadly than another, experts say.They also added it does not appear the strains will grow more lethal as they evolve."


Do I believe that? I don't know. I don't think anyone really knows anything definitively yet.

As for the other assertions in the paper, they seem to contradict what "Next Strain" found. I linked to it above. Take a look and see what you think. More eyes and brains are always better than one. :)

They do seem to show two different entries into Europe, one from China directly, mediated mostly through Belgium, it seems, and one perhaps from Singapore. I can't tell from the map if that was directly from Singapore, or if it was mediated through Australia. However, although Italy does show up there as one of the infected countries, there don't seem to be any subsequent samples with that particular mutation from Italy. So, how could most of the cases in Italy be of that strain if their sampling was representative?

There are other strains into Italy from the "parent" one from Belgium.

I could be all wrong about this, let's be clear.

For what it's worth the original paper by this group was criticized in a lot of quarters.

https://nextstrain.org/narratives/ncov/sit-rep/zh/2020-04-10

As for Sweden, they seem remarkably comfortable, to me, with saying well, they're old, they were in poor health anyway, so that's a blow we can absorb. That's even before it was known there were lasting effects in people with severe cases.

I can only say I'm glad my elderly relatives don't live in Sweden.
 
Thanks for the update. Too bad that rs11385942 is not tested by any of the main personal genomics companies like 23andMe, FTDNA, Ancetsry or Living DNA.
You could check rs10490770 instead (apparently it doesn't work as proxy for people with African or Hispanic descent, but it'd work well for Caucasians - over 90% of cases).

From SNPedia:
"Note that rs11385942 is not present on the DNA chips used by the major direct-to-consumer genotyping companies such as 23andMe, Ancestry and MyHeritage. In Caucasians, a SNP present on most Ancestry chips, rs10490770, is a reasonable proxy for rs11385942. The minor allele of rs10490770(C) corresponds most of the time (r2 >0.9 in Caucasians) to the minor rs11385942(A) allele based on data available in ensembl. There is no equivalent linkage in those of African descent; and the correlation is low in Hispanic populations (r2 < 0.2)."

Fortunately, my rs10490770 result in 23andMe is TT.

But we should keep in mind that rs10490770(C) doesn't "always" correspond to rs11385942(A) even in Caucasians.
 
The new Swedish study by Soratto et al. (2020) found that the Italian strain of Covid-19 (B.1/G) mutated further in Sweden at position 364 in the S1 subunit, which destabilized the viral spike protein. This novel mutation in Sweden made Covid-19 less infectious by weakening the attachment of the viron to the cell. Sweden got a lucky break as a result of the fluke mutation, which is why the death rate is much lower as compared to that of Italy.


SARS-CoV-2 genome sequences from late April in Stockholm, Sweden reveal a novel mutation in the spike protein

Abstract
Large research efforts are going into characterizing, mapping the spread, and studying the biology and clinical features of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we report four complete SARS-CoV-2 genome sequences obtained from patients confirmed to have the disease in Stockholm, Sweden, in late April. A variant at position 23463 was found for the first time in one genome. It changes an arginine (R) residue to histidine (H) at position 364 in the S1 subunit of the spike protein. The genomes belonged to two different genetic groups, previously reported as two of the three main genetic groups found in Sweden. Three of them are from group B.1/G, corresponding to the Italian outbreak, reported by the Public Health Agency of Sweden to have declined in prevalence by late April, and more investigation is needed in order to ensure that the spread of different types of SARS-CoV-2 is fully characterized.

https://www.biorxiv.org/content/10.1101/2020.08.03.233866v1
 
Thanks very much for this, Third Term. That completely changes the analysis. All of that looking at government action, societal differences etc., and a lot of this is that they encountered a different virus.

I wonder if Germany also had a mutated and less contagious form?

By implication, Maybe Spain but perhaps even Britain has the more contagious version?
 
The new Swedish study by Soratto et al. (2020) found that the Italian strain of Covid-19 (B.1/G) mutated further in Sweden at position 364 in the S1 subunit, which destabilized the viral spike protein. This novel mutation in Sweden made Covid-19 less infectious by weakening the attachment of the viron to the cell. Sweden got a lucky break as a result of the fluke mutation, which is why the death rate is much lower as compared to that of Italy.

Interesting, but Sweden was one of the few countries that did not implement any kind of lockdown. As people move around Europe all the time, and with Covid being so infectious, I don't see why both strains of the virus shouldn't have reached Sweden?
 

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