Coronavirus Mortality Data from Italy: Hard-Earned Messages of Opportunity & Hope

David L. Katz, MD, MPH, FACPM, FACP, FACLM
LinkedIn
Of the slightly more than 30,000 total, global deaths from coronavirus to date, a third of them all have been in Italy. That sad distinction means Italy is the source of our best potential insights about COVID19 and the risk of severe infection and death.
Man in heavy coat and face mask walks towards the right of the camera, in front of the Basilica in Rome.

Colleagues reached me this morning with this March 26 compilation of coronavirus data from the Italian health ministry, when the mortality toll was at around 7000:

Chart depicting the characteristics of deceased positive COVID-19 patients in Italy

There are several extremely important messages in this one dense page.

1) The mean age of those dying of coronavirus was 78, and only 1.2% of all deaths occurred in those under age 50.

2) Only 2.1% of Italians dying of coronavirus were free of major, chronic diseases before- and most of those dying had more than one. In other words, being sick to start with increases the risk of dying of this new disease.

3) The percentage of those dying who were both younger (i.e., under age 50) and free of major chronic disease- was a small fraction of a percent, just as the data from South Korea have shown to date. For this group, the risk of coronavirus death appears to be very much in the same ballpark as seasonal flu.

4) The low, total number of deaths in those over 90 is a vivid illustration of the importance of “the denominator.” There are few deaths in those over 90 not because the virus is gentler to them- but only because there are few people over 90 in the population to begin with. To understand the threat of coronavirus in the United States, we can’t just track the severely ill in hospitals- we need good denominator data. We need to know who in the general population has it; who had it and got over it; and who is now immune. For every case we find, there may be 10, or 100, or 1000, or more- that we have overlooked because their disease is/was not at all serious. This is vital information- for your peace of mind, as well as public policy.

There are short-cuts to these data, relative to testing us all: representative, random samples around the country. Colleagues and I are working on this, but if we really do have a “Coronavirus Task Force,” we would all welcome the news that they are on it, and will be sharing updates soon.

These data from Italy reinforce the promise of risk-stratified approaches to coronavirus interdiction, because our risks of severe infection and death are likely highly variable here, as in Italy. One very large portion of our population is at monumentally lower risk of severe infection and death than another. We are, I think- as I have thought all along- massively over-protecting one group and thus causing all kinds of damage by means other than infection, while under-protecting the other.

I extend my heartfelt thanks to our Italian colleagues- brothers and sisters- for these valuable data, garnered through loss and tears. I extend my heartfelt condolences to all they have been through, and are going through still. And I thank them for a data set illuminating opportunity, and hope.

-fin

This article was first published on LinkedIn.

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