5 ms·

godspeed to you guys. Regarding the outbreak in Northern Italy...the fatality rate seems much much higher than South Korea or Germany. Do you have any theories

by _red 7y ago

godspeed to you guys. Regarding the outbreak in Northern Italy...the fatality rate seems much much higher than South Korea or Germany. Do you have any theories on why the fatalities are so much worse?

raverbashing 7y ago
No need for theories, the disease is more fatal to those over 80 y.o. That's why the mortality is higher: demographics
- _red 7y ago
  >No need for theories Germany has 700 cases and 0 deaths. Austria has 80 cases and 0 deaths...both of these countries are adjacent to Northern Italy region, in which 233+ have died. Saying "no theory needed" frankly raises more questions than provides answers.
  - raverbashing 7y ago
    Death rate being 0.5% in Italy, for 80 Austrian cases we might have one fatality soon. When was the 1st case in Germany and when was the 1st case in Italy?
    - xendo 7y ago
      233 out of 5883 is not 0.5%
      - raverbashing 7y ago
        Yes, you're right, bad mental math it's ~ 4% https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries
hamstercat 7y ago
Wild guess here but fatality rate is based on the number of dead and the number of reported cases. High fatality rate means either high number of dead, or low number of reported cases. Knowing the real number of infected is really hard, especially in population less at risk (the young and healthy). For example, there was this anecdote this week about a woman in the US. She believes she's infected, but none of the responsible authorities will let her pass a test unless she's physically been to one of the high-risk countries. So she either self-quarantine or ignore all of it and go to work. The twist is that she's a health practitioner...
- inetsee 7y ago
  I would guess that the anecdote about the woman who can't get tested is because of a severe under supply of test kits. The CDC developed a test kit last month, but it is only being sent to approved laboratories, and the tests will only be given to people "who meet CDC criteria for COVID-19 testing." [1] Test suppliers who develop test for hospitals and doctors offices are ramping up production as fast as they can, but it will take time. [1] https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html
berberous 7y ago
I’ve read that the average age in those Italian areas is very old.
csomar 7y ago
My wild guess is that the virus is quite spread there but healthcare caught up very late. South Korea has 7.041 cases with 36 persons in ICU; while Italy has 5.883 cases with 567 in ICU. If we correct by ICU numbers, then Italy should have diagnosed 109k persons with Coronavirus. That assumes that South Korea did diagnose anyone who got the virus which is unlikely. So the real number might be in hundreds of thousands. The virus is yet to hit the rest of Europe very hard, though. Italy should be a warning to the other countries of how bad the coronavirus is.
- marvin 7y ago
  You've arrived at the same order as my estimate of the real number of cases in Italy (I arrived at ~80k, see sibling comment), using a different technique. Yours seems more reasonable. But note that South Korea must inevitably have missed some cases, so assuming the same ratio of diagnosed to serious cases between Italy and SK. So the real number of diseased people in Italy must actually be a little higher.
davidw 7y ago
A population that skews old is part of it. This site is good for up to date, and fairly detailed numbers about Italy: https://lab24.ilsole24ore.com/coronavirus/ https://lab24.ilsole24ore.com/coronavirus/ They are doing a pretty good job of testing: 4000 yesterday. Oregon, by comparison, has the capacity to test about 40 a day. Edit: also, they are not being "drastic" enough in Italy. Scenes from a ski area: https://ladige.it/news/cronaca/2020/03/07/come-previsto-oggi-folla-impianti-sci-trentino-fugatti-ci-appelliamo?fbclid=IwAR1AUjkRcjG8ESgnzbcFHw3WFTMJlYk304dkXUcQfpFUnveq1iAsZ2sCqGY https://ladige.it/news/cronaca/2020/03/07/come-previsto-oggi... Stay home, or if you want to go out, go for a walk in the woods or something, but don't go where it's crowded.
- votepaunchy 7y ago
  Note that the population of Italy is 15x that of Oregon, so the proportional rate of testing is much closer.
  - davidw 7y ago
    It isn't, though, it's an still an order of magnitude less in Oregon. 4.2 million, 40 tests per day 60 million, 5700 tests yesterday
craftinator 7y ago
I have a friend living in southern Italy, and she surmised that there are a few hotspots that had a combination of lifelong smokers and a much older average aged population, and those areas seem to be skewing the mortality rates.
marvin 7y ago
Here's my wild-ass guess: The percentage of lethal cases is actually close to 0.1% when the serious cases get the best care possible (my claim). If this is true, then Italy had 200*1000 = 20.000 early-stage cases 8 days ago. This yields on the order of 80.000 cases today, hopefully less as the quarantines should have an effect by now. This assumes a median of 8 days from onset to death in the lethal cases, and a doubling time of # infections of 4 days, which seems to be around the current level for the world outside of China. The number is very sensitive to average lethality rate, and hence also to the age & health distribution of the population. It's completely implausible that Italy has only 5000 cases, as people who have visited Italy for their winter holidays have very frequently tested positive after returning home. They haven't all randomly met the same 5000 Italians.
- imtringued 7y ago
  Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people? If its really common then you'd find 100-1000 infected people and then you can calculate the real mortality rate simply by monitoring them and recording how many of them have died. Of course it is possible that proper medical care results in a much lower than usual mortality rate compared to untreated people but that sounds more like good news than bad news.
  - umeshunni 7y ago
    > Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people? I think at this point, it's still very early in the spread of infection and the distribution of infection might not be random and might be clustered around certain locations, social circles etc.
    - datingscientist 7y ago
      I would LOVE to see a full population test sample... Would be expensive (probably need 5 K - 10 K tests for a significant read, most of which will likely be wasted on "likely healthy" members of the community... but would decisively settle this outstanding question of asymptomatic infection frequency. The closest data point we have is likely that South Korean church, where I think they hunted down more or less every member and tested them... Doesn't give you a true view of asymptomatic presence in the general population but does provide a cue about relative size vs. known infected...
tangental 7y ago
In Italy the average age of patients who have died is 81
bonzini 7y ago
Probably because everyone who dies of something resembling pneumonia is tested. In the first few days when they were hoping to track every infected case, they were testing everyone who was in contact with sick people, but at this point asymptomatic cases aren't tested anymore, there just isn't enough capacity. As tests are reserved to sicker and sicker people, fatality rate increases. Anyway other countries such as Switzerland, Sweden or France aren't that behind in terms of cases per million people (Iceland was even ahead of Italy as of yesterday), perhaps 10 days or so. I don't feel like my region is particularly unlucky.

by _red 7y ago

raverbashing 7y ago

No need for theories, the disease is more fatal to those over 80 y.o. That's why the mortality is higher: demographics

_red 7y ago
>No need for theories Germany has 700 cases and 0 deaths. Austria has 80 cases and 0 deaths...both of these countries are adjacent to Northern Italy region, in which 233+ have died. Saying "no theory needed" frankly raises more questions than provides answers.
- raverbashing 7y ago
  Death rate being 0.5% in Italy, for 80 Austrian cases we might have one fatality soon. When was the 1st case in Germany and when was the 1st case in Italy?
  - xendo 7y ago
    233 out of 5883 is not 0.5%
    - raverbashing 7y ago
      Yes, you're right, bad mental math it's ~ 4% https://www.worldometers.info/coronavirus/#countries https://www.worldometers.info/coronavirus/#countries

hamstercat 7y ago

Wild guess here but fatality rate is based on the number of dead and the number of reported cases. High fatality rate means either high number of dead, or low number of reported cases. Knowing the real number of infected is really hard, especially in population less at risk (the young and healthy). For example, there was this anecdote this week about a woman in the US. She believes she's infected, but none of the responsible authorities will let her pass a test unless she's physically been to one of the high-risk countries. So she either self-quarantine or ignore all of it and go to work. The twist is that she's a health practitioner...

inetsee 7y ago
I would guess that the anecdote about the woman who can't get tested is because of a severe under supply of test kits. The CDC developed a test kit last month, but it is only being sent to approved laboratories, and the tests will only be given to people "who meet CDC criteria for COVID-19 testing." [1] Test suppliers who develop test for hospitals and doctors offices are ramping up production as fast as they can, but it will take time. [1] https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

berberous 7y ago

I’ve read that the average age in those Italian areas is very old.

csomar 7y ago

My wild guess is that the virus is quite spread there but healthcare caught up very late. South Korea has 7.041 cases with 36 persons in ICU; while Italy has 5.883 cases with 567 in ICU. If we correct by ICU numbers, then Italy should have diagnosed 109k persons with Coronavirus. That assumes that South Korea did diagnose anyone who got the virus which is unlikely. So the real number might be in hundreds of thousands. The virus is yet to hit the rest of Europe very hard, though. Italy should be a warning to the other countries of how bad the coronavirus is.

marvin 7y ago
You've arrived at the same order as my estimate of the real number of cases in Italy (I arrived at ~80k, see sibling comment), using a different technique. Yours seems more reasonable. But note that South Korea must inevitably have missed some cases, so assuming the same ratio of diagnosed to serious cases between Italy and SK. So the real number of diseased people in Italy must actually be a little higher.

davidw 7y ago

A population that skews old is part of it. This site is good for up to date, and fairly detailed numbers about Italy: https://lab24.ilsole24ore.com/coronavirus/ https://lab24.ilsole24ore.com/coronavirus/ They are doing a pretty good job of testing: 4000 yesterday. Oregon, by comparison, has the capacity to test about 40 a day. Edit: also, they are not being "drastic" enough in Italy. Scenes from a ski area: https://ladige.it/news/cronaca/2020/03/07/come-previsto-oggi-folla-impianti-sci-trentino-fugatti-ci-appelliamo?fbclid=IwAR1AUjkRcjG8ESgnzbcFHw3WFTMJlYk304dkXUcQfpFUnveq1iAsZ2sCqGY https://ladige.it/news/cronaca/2020/03/07/come-previsto-oggi... Stay home, or if you want to go out, go for a walk in the woods or something, but don't go where it's crowded.

votepaunchy 7y ago
Note that the population of Italy is 15x that of Oregon, so the proportional rate of testing is much closer.
- davidw 7y ago
  It isn't, though, it's an still an order of magnitude less in Oregon. 4.2 million, 40 tests per day 60 million, 5700 tests yesterday

craftinator 7y ago

I have a friend living in southern Italy, and she surmised that there are a few hotspots that had a combination of lifelong smokers and a much older average aged population, and those areas seem to be skewing the mortality rates.

marvin 7y ago

Here's my wild-ass guess: The percentage of lethal cases is actually close to 0.1% when the serious cases get the best care possible (my claim). If this is true, then Italy had 200*1000 = 20.000 early-stage cases 8 days ago. This yields on the order of 80.000 cases today, hopefully less as the quarantines should have an effect by now. This assumes a median of 8 days from onset to death in the lethal cases, and a doubling time of # infections of 4 days, which seems to be around the current level for the world outside of China. The number is very sensitive to average lethality rate, and hence also to the age & health distribution of the population. It's completely implausible that Italy has only 5000 cases, as people who have visited Italy for their winter holidays have very frequently tested positive after returning home. They haven't all randomly met the same 5000 Italians.

imtringued 7y ago
Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people? If its really common then you'd find 100-1000 infected people and then you can calculate the real mortality rate simply by monitoring them and recording how many of them have died. Of course it is possible that proper medical care results in a much lower than usual mortality rate compared to untreated people but that sounds more like good news than bad news.
- umeshunni 7y ago
  > Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people? I think at this point, it's still very early in the spread of infection and the distribution of infection might not be random and might be clustered around certain locations, social circles etc.
  - datingscientist 7y ago
    I would LOVE to see a full population test sample... Would be expensive (probably need 5 K - 10 K tests for a significant read, most of which will likely be wasted on "likely healthy" members of the community... but would decisively settle this outstanding question of asymptomatic infection frequency. The closest data point we have is likely that South Korean church, where I think they hunted down more or less every member and tested them... Doesn't give you a true view of asymptomatic presence in the general population but does provide a cue about relative size vs. known infected...

tangental 7y ago

In Italy the average age of patients who have died is 81

bonzini 7y ago

Probably because everyone who dies of something resembling pneumonia is tested. In the first few days when they were hoping to track every infected case, they were testing everyone who was in contact with sick people, but at this point asymptomatic cases aren't tested anymore, there just isn't enough capacity. As tests are reserved to sicker and sicker people, fatality rate increases. Anyway other countries such as Switzerland, Sweden or France aren't that behind in terms of cases per million people (Iceland was even ahead of Italy as of yesterday), perhaps 10 days or so. I don't feel like my region is particularly unlucky.