5 ms·

Not to downplay the importance of containment efforts I think there is something uniquely bad about Italy's mortality rates and something really good that the

Not to downplay the importance of containment efforts I think there is something uniquely bad about Italy's mortality rates and something really good that the Germans are doing. Based on the Johns Hopkins CSSE data for March 13 On March 13 Germany had 3675 confirmed cases and only 7 deaths. Adjusted for respective populations Italy was at this stage 9 days before with 3089 confirmed cases, by which time it has already seen 107 deaths. This projects 21x COVID19 mortality rate for Italy over Germany - what gives ? Italy's outbreak is concentrated in Lombardy so maybe weighing for the population of that area rather than the entire country is more appropriate which means Germany is currently 16 rather than 9 days behind Italy but with mortality in Italy still being 13 times higher than Germany. Possible explanations: Italy's 3089 confirmed cases 9 days before are selected for severity - only people who arrived with acute symptoms were tested, whereas Germany's 3675 are the results of more proactive testing and are dominated by mild or non-symptomatic cases that would have passed undetected in Italy. Italy squandered some of its hospital capacity on first-diagnosed-first-hospitalized basis regardless of severity and began triage too late wheres Germany does better job prioritizing hospital vs home treatment from the start. 9 days before Lombardy's hospitals were already over capacity with 3089 confirmed cases while Germany's still aren't today. Germany has 2.5x the hospital beds per population than Italy, let's assume this holds for ICU beds as well. If capacity is the sole/dominant factor in this and we say that 9 days before Italy was already over capacity with 3089 cases than Germany will have reached a similar over-capacity at around 10k confirmed cases in a few days and then its mortality rate will begin to climb.

alkonaut 7y ago
Some more hypothetical explanations: - Italy has a large fraction of the population over 70. - The proportion of smokers is larger in Italy. - The amount of close contact between the “mobile” part of the population (in schools and offices) and elderly people may be higher. Not sure what the statistics are in Germany vs Italy on that final point but if I were to guess I’d say elderly taking care of grandchildren or even living together with the younger generation is a phenomenon that still exists in Italy.
- Etheryte 7y ago
  Both Germany and Italy have fairly standard developed world population pyramids, they're actually so similar you could't tell one apart from the other without the number scale [1][2]. Same for smoking, both countries are nearly identical [3][4]. I see no reason to suggest the third point is wildly different either. [1] https://en.wikipedia.org/wiki/File:Germanypop.svg https://en.wikipedia.org/wiki/File:Germanypop.svg [2] https://en.wikipedia.org/wiki/File:Italypop.svg https://en.wikipedia.org/wiki/File:Italypop.svg [3] https://www.macrotrends.net/countries/ITA/italy/smoking-rate-statistics https://www.macrotrends.net/countries/ITA/italy/smoking-rate... [4] https://en.wikipedia.org/wiki/Smoking_in_Germany https://en.wikipedia.org/wiki/Smoking_in_Germany
  - alkonaut 7y ago
    There is a rather significant difference in "% of adults 65+ living with their children" across Europe, with southern and eastern Europe significantly higher than northern and western Europe. https://ec.europa.eu/eurostat/documents/3433488/5579620/KS-SF-11-052-EN.PDF/9a190f6f-8949-4d3d-99ad-989479c6b23b https://ec.europa.eu/eurostat/documents/3433488/5579620/KS-S...
avip 7y ago
I've read (unconfirmed, citation needed) that Italy has been pathologically testing all fatalities for covid, and other countries don't. That may significantly skew the numbers.
- seemslegit 7y ago
  Would it though ? It implies a significant number of misdiagnosed hospital deaths during a time period where COVID19 was aggressively looked for in people with the symptoms.
  - Recursing 7y ago
    Many of the deaths (especially the first ones) were linked to covid after testing the cadaver and had many other health issues (as in very advanced cancer, and/or very old age). I don't know if other countries are testing cadavers
    - seemslegit 7y ago
      I don't think that cadavers would skew this much, only if a country is cheating by counting say a diabetic patient who died of covid19 as a diabetes death and not covid19 death.
freeflight 7y ago
Italy seems to have been a bit blindsided by the fact that it's home to a rather large semi-legal Chinese population [0], to a point where there were direct flights between Rome and Wuhan prior to the Italian government shutting down air-travel to China [1]. The German response has been rather decent, freeing up lab capacities and using private labs to scale up already solid diagnostics capabilities, which helps prevent cases from going terminal. [2] As somebody working in German healthcare, outpatient care to be specific, we've already seen hospitals free up beds, by releasing non-priority patients to ambulative home-care around 2 weeks ago. Starting this week schools will remain closed, Germany is going into lock-down with limited border travel and offering companies "unlimited loans" [3] to get through the resulting economic downturn. [0] https://www.businessoffashion.com/articles/news-analysis/fire-exposes-illegal-chinese-factories-italy https://www.businessoffashion.com/articles/news-analysis/fir... [1] https://www.schengenvisainfo.com/news/italy-suspends-visa-issuance-and-all-air-traffic-from-china/ https://www.schengenvisainfo.com/news/italy-suspends-visa-is... [2] https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 [3] https://www.businessinsider.de/international/coronavirus-germany-offers-affected-companies-unlimited-loans-covid-19-2020-3/?r=US&IR=T https://www.businessinsider.de/international/coronavirus-ger...
- toyg 7y ago
  Chinese links didn't matter. Patient-0 in Europe was tracked to Germany in January. The most affected Italian areas do not have a particularly large official or unofficial Chinese population - but have massive economic and social links with Germany. The areas where the Chinese concentrate, like the Prato mentioned in your first source, saw no cases - they all voluntarily self-quarantined as soon as the emergency exploded in Wuhan, and kept that discipline going. Italy simply pays the price of a very elderly and weak population, coupled with a decades-long shrinking of public healthcare. Even in Lombardia, one of the best regions for healthcare, intensive-care units in public hospitals were instructed "in peace time" to run close to capacity as much as possible, in order cut beds and save money. This is how we ended up with less than a third of the capacity of Germany, and when shit hit the fan, it wasn't enough. (Also, Germany is kinda fudging the numbers. They don't record deaths as Covid-related unless covid was absolutely the only health issue a patient experienced. That's not how victims are recorded in most other countries.)
mrighele 7y ago
I think the main reason for the difference is that probably different country don't measure the cause of death in the same way. For example in Italy right now any person that dies that resulted positive to covid-19 test before or after death is considered a victim of covid-19, regardless if there were other preconditions. This may be different in other countries. If one excludes people with preconditions, the number of deaths in Italy becomes much smaller (don't remember the exact amount, but I think it was in the tens). Also, while Italy started late with testing, at the moment it has performed 80000+ tests for COVID-19, which is behind only to China and South Korea (see for example [1], altough a 3 days old). I couldn't find any official number about tests performed in Germany, though, but unless germany tested at S.K. level I don't think that the number of tests explains the difference [1] https://ourworldindata.org/covid-testing https://ourworldindata.org/covid-testing
- seemslegit 7y ago
  I'd be very surprised if Germany excludes people with preconditions, also would expect the WHO to have a strict guideline that this goes against ?
  - toyg 7y ago
    You have a lot of trust in how health orgs report statistics to the WHO. The WHO cannot fundamentally enforce anything, all activity is fundamentally voluntary.

alkonaut 7y ago

Some more hypothetical explanations: - Italy has a large fraction of the population over 70. - The proportion of smokers is larger in Italy. - The amount of close contact between the “mobile” part of the population (in schools and offices) and elderly people may be higher. Not sure what the statistics are in Germany vs Italy on that final point but if I were to guess I’d say elderly taking care of grandchildren or even living together with the younger generation is a phenomenon that still exists in Italy.

Etheryte 7y ago
Both Germany and Italy have fairly standard developed world population pyramids, they're actually so similar you could't tell one apart from the other without the number scale [1][2]. Same for smoking, both countries are nearly identical [3][4]. I see no reason to suggest the third point is wildly different either. [1] https://en.wikipedia.org/wiki/File:Germanypop.svg https://en.wikipedia.org/wiki/File:Germanypop.svg [2] https://en.wikipedia.org/wiki/File:Italypop.svg https://en.wikipedia.org/wiki/File:Italypop.svg [3] https://www.macrotrends.net/countries/ITA/italy/smoking-rate-statistics https://www.macrotrends.net/countries/ITA/italy/smoking-rate... [4] https://en.wikipedia.org/wiki/Smoking_in_Germany https://en.wikipedia.org/wiki/Smoking_in_Germany
- alkonaut 7y ago
  There is a rather significant difference in "% of adults 65+ living with their children" across Europe, with southern and eastern Europe significantly higher than northern and western Europe. https://ec.europa.eu/eurostat/documents/3433488/5579620/KS-SF-11-052-EN.PDF/9a190f6f-8949-4d3d-99ad-989479c6b23b https://ec.europa.eu/eurostat/documents/3433488/5579620/KS-S...

avip 7y ago

I've read (unconfirmed, citation needed) that Italy has been pathologically testing all fatalities for covid, and other countries don't. That may significantly skew the numbers.

seemslegit 7y ago
Would it though ? It implies a significant number of misdiagnosed hospital deaths during a time period where COVID19 was aggressively looked for in people with the symptoms.
- Recursing 7y ago
  Many of the deaths (especially the first ones) were linked to covid after testing the cadaver and had many other health issues (as in very advanced cancer, and/or very old age). I don't know if other countries are testing cadavers
  - seemslegit 7y ago
    I don't think that cadavers would skew this much, only if a country is cheating by counting say a diabetic patient who died of covid19 as a diabetes death and not covid19 death.

freeflight 7y ago

Italy seems to have been a bit blindsided by the fact that it's home to a rather large semi-legal Chinese population [0], to a point where there were direct flights between Rome and Wuhan prior to the Italian government shutting down air-travel to China [1]. The German response has been rather decent, freeing up lab capacities and using private labs to scale up already solid diagnostics capabilities, which helps prevent cases from going terminal. [2] As somebody working in German healthcare, outpatient care to be specific, we've already seen hospitals free up beds, by releasing non-priority patients to ambulative home-care around 2 weeks ago. Starting this week schools will remain closed, Germany is going into lock-down with limited border travel and offering companies "unlimited loans" [3] to get through the resulting economic downturn. [0] https://www.businessoffashion.com/articles/news-analysis/fire-exposes-illegal-chinese-factories-italy https://www.businessoffashion.com/articles/news-analysis/fir... [1] https://www.schengenvisainfo.com/news/italy-suspends-visa-issuance-and-all-air-traffic-from-china/ https://www.schengenvisainfo.com/news/italy-suspends-visa-is... [2] https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 https://apnews.com/ad9a6af47c3b55fd83080c9168afaaf4 [3] https://www.businessinsider.de/international/coronavirus-germany-offers-affected-companies-unlimited-loans-covid-19-2020-3/?r=US&IR=T https://www.businessinsider.de/international/coronavirus-ger...

toyg 7y ago
Chinese links didn't matter. Patient-0 in Europe was tracked to Germany in January. The most affected Italian areas do not have a particularly large official or unofficial Chinese population - but have massive economic and social links with Germany. The areas where the Chinese concentrate, like the Prato mentioned in your first source, saw no cases - they all voluntarily self-quarantined as soon as the emergency exploded in Wuhan, and kept that discipline going. Italy simply pays the price of a very elderly and weak population, coupled with a decades-long shrinking of public healthcare. Even in Lombardia, one of the best regions for healthcare, intensive-care units in public hospitals were instructed "in peace time" to run close to capacity as much as possible, in order cut beds and save money. This is how we ended up with less than a third of the capacity of Germany, and when shit hit the fan, it wasn't enough. (Also, Germany is kinda fudging the numbers. They don't record deaths as Covid-related unless covid was absolutely the only health issue a patient experienced. That's not how victims are recorded in most other countries.)

mrighele 7y ago

I think the main reason for the difference is that probably different country don't measure the cause of death in the same way. For example in Italy right now any person that dies that resulted positive to covid-19 test before or after death is considered a victim of covid-19, regardless if there were other preconditions. This may be different in other countries. If one excludes people with preconditions, the number of deaths in Italy becomes much smaller (don't remember the exact amount, but I think it was in the tens). Also, while Italy started late with testing, at the moment it has performed 80000+ tests for COVID-19, which is behind only to China and South Korea (see for example [1], altough a 3 days old). I couldn't find any official number about tests performed in Germany, though, but unless germany tested at S.K. level I don't think that the number of tests explains the difference [1] https://ourworldindata.org/covid-testing https://ourworldindata.org/covid-testing

seemslegit 7y ago
I'd be very surprised if Germany excludes people with preconditions, also would expect the WHO to have a strict guideline that this goes against ?
- toyg 7y ago
  You have a lot of trust in how health orgs report statistics to the WHO. The WHO cannot fundamentally enforce anything, all activity is fundamentally voluntary.