8 ms·

The death toll for Covid-19 in Nembro, Italy

110 points by myth_drannon 7y ago

lisper 7y ago
[Retracted]
- graeme 7y ago
  No. In four areas in Italy, including a mid sized city. > We have made exactly the same calculation for the municipalities of Cernusco sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco the number of anomalous deaths is equal to 6.1 times those officially attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo figures, where the ratio reaches 10.4.
- deleted 7y ago
  [deleted]
graeme 7y ago
Excellent work, and I hope more people in other cities start running these calculations. > In the hypothesis - not at all remote - that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship and - made proportionally by demographic structure - in South Korea. We have made exactly the same calculation for the municipalities of Cernusco sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco the number of anomalous deaths is equal to 6.1 times those officially attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo figures, where the ratio reaches 10.4. This seems an unreasonable assumption, no? I don’t think any models predict a 100% infection rate: herd immunity would kick in beforehand, at the least. If true, then the death counts and death rates would be higher. E.g. with 50% infection, deaths are 4x, 12x and 20x, and the death rate is 2%. Of course, you also have to account for local demographics. Edit: I checked the numbers for Bergamo, and they’re troubling. It’s a city of 122,000, and it has a 0.5% death rate for the whole city. Further, people are still sick and dying, so these death rates will only go up.
- csomar 7y ago
  Shouldn't the Covid-19 be immune to herd-immunity though because of the very long incubation time, during which you can still transmit the virus?
  - maxander 7y ago
    Herd immunity kicks in when a large fraction of the people you encounter were already infected, giving you fewer chances to infect new people. So incubation time doesn’t matter there (though certainly it doesn’t help, for other reasons.)
    - ORioN63 7y ago
      > Herd immunity kicks in when a large fraction of the people you encounter were already infected Alternatively, immunized people.
  - Gibbon1 7y ago
    I think there is a momentum effect if the percentage of infectious people gets high enough. Where you overshoot the static herd-immunity threshold. If you can keep the number of infected below 10% then you don't see it. At least that's what I saw when I tried to model it. (Take that as you will).
- stonogo 7y ago
  Naturally-occurring herd immunity is a temporary effect. Only artifically-imposed herd immunity (i.e. vaccination) is lasting.
  - graeme 7y ago
    Yes, but unless herd immunity lasts only a couple weeks that shouldn’t be a factor in these Italian analyses. The infection spread over a short period.
  - ShorsHammer 7y ago
    What a ridiculously incorrect statement. SARS back in 2002 only lasted 3 flu seasons before being entirely wiped out naturally. SARS-CoV-2 which we are dealing with here is a related virus. > No cases of the first SARS-CoV have been reported worldwide since 2004. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr... https://www.nhs.uk/conditions/sars/ https://www.nhs.uk/conditions/sars/
zamfi 7y ago
That the official numbers underreport Covid-19 deaths by a factor of 4 is one hypothesis -- but it's also possible that this is how many people would be saved by quick interventions at the hospital, but who otherwise died. For example, maybe the ICU beds were full for a month, and in that time they would've saved 96 people, but couldn't.
- gdubs 7y ago
  Are you saying a spike in non-covid deaths — e.g., heart-attack, etc? That’s certainly a possibility and one of the main dangers at the moment with an overwhelmed healthcare system. It also raises an interesting question of how you account for the toll of the disease: on one hand you have deaths due to the disease itself, and on the other deaths that could have been preventable had the disease not overwhelmed hospitals.
  - scarmig 7y ago
    Depending on how you count, you could hypothetically end up with mortality rates >100%. I.e. a disease that kills everyone it infects, and also closes down a hospital causing deaths among people it doesn't infect.
- hanklazard 7y ago
  Good point. Some part of the increase is almost certainly this ... just hard/impossible to know how much. Edit: actually, i guess if you also looked at the top 10 typical causes of death, seems like you could account for it (ie, heart attack, MVA, or whatever would show abnormally low numbers).
scarmig 7y ago
I'd be curious how much variation there is in previous years; are there any previous significant month spikes that have been washed out by the average? It doesn't seem plausible that random chance could account for 2020's, though.
- roywiggins 7y ago
  I don't know what the distribution of deaths looks like normally, but a 4x difference is going to be several sigma unlikely in any reasonable one. Also, consider that it happened exactly at the same time coronavirus deaths spiked, which seems vanishingly unlikely to be a coincidence.
cameronfraser 7y ago
I remember the death toll for H1N1 to have been reported in the thousands when it happened but recently read that after a few years they said it was more like 150,000. It's possible they were just reporting US deaths where the 150k number is worldwide. How come the response for H1N1 is nowhere near as intense as the response for COVID?
- TwoBit 7y ago
  It's possible that 150K was a number reported by somebody else, with a motivation for reporting a very high number. I'm not saying I'm convinced the number is lower, but just as much as there are entities that under-report deaths for selfish reasons, there are those that over-report them.
- Waterluvian 7y ago
  Based on current trends, Covid-19 is trending to be around 10x or more worse than the 150k figure. Current projections have the US alone at 100k-200k deaths. That would be why this response is more intense.
  - nostromo 7y ago
    Except the high estimate for H1N1 in 2009 from the CDC is 575,000 deaths worldwide. https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic
    - buboard 7y ago
      > The Infectious Diseases Society of America estimated that the total number of deaths in the U.S. was 12,469
- Robotbeat 7y ago
  The seasonal flu is a pandemic every year and kills a similar amount of people. It’s a shame people don’t take it seriously enough to get vaccinated. H1N1 is a newer variant of seasonal flu. But it’s not nearly as lethal and it doesn’t usually leave survivors with the kind of lung damage COVID-19 does. It’s about carrying capacity of the healthcare system. Flu already strains hospitals, but COVID-19 is multiple times worse so people go without treatment because here aren’t enough beds or doctors and nurses. That’s the difference.
sdffdsfdsfsddsf 7y ago
Wasn't there a thing were deaths were recorded for the place where the person died, not where they normally live? So maybe those people just died in a hospital in another city? (I don't remember if this was for Italy, but I remember reading that about some place in connection with Corona). In any case, why not make an effort to reach out to the cities in question and ask for an explanation?
maxander 7y ago
Has anyone looked at the equivalent numbers in the US? Or South Korea, or other places with outbreaks?
TaylorGood 7y ago
I know of deaths at the local hospital ER with overlapping symptoms but not being officially counted as the deceased were never tested. On a county level there’s maybe one or two recorded. This testing debacle is hurting everybody in more ways than one.
emersonrsantos 7y ago
I wonder why no one is using Wuhan, China numbers. Not reliable?
- 9nGQluzmnq3M 7y ago
  The same phenomenon has been anecdotally reported there as well, with a lot of untested "pneumonia" deaths: https://www.scmp.com/news/china/society/article/3050311/its-pneumonia-everybody-china-knows-about-many-deaths-will-never https://www.scmp.com/news/china/society/article/3050311/its-...
  - lonelappde 7y ago
    Evey time I see an article critical of Chines government in SCMP I feel a shock until I remember it's a Hong Kong paper. But then I feel a little confused over Hong Kong's semi autonomous status.
- deleted 7y ago
  [deleted]
not2b 7y ago
It is possible that more people than usual are dying from other causes (heart disease, cancer, injuries) because the overwhelmed medical system is unable to treat them.
- moioci 7y ago
  If so, it's still indirectly caused by the pandemic.
  - buboard 7y ago
    but not an actionable statistic for other countries
coopsmgoops 7y ago
There a few possible (and reasonable) explanations in the HN comments, one more is that often covid-19 leads to pneumonia and that may be what is attributed as the cause of death, (nefarious or not). I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Another possibility is that medical resources are being monopolized by covid patients, or people don't want to go to hospital for fear of catching it themselves. This situation is still caused by covid but wouldn't be shown in the reported deaths from covid. The article brings up a valid concern, but doesn't explore any other possibile explainations which is irresponsible when people are already panicking.
- goatlover 7y ago
  The numbers really don't seem consistent across all the countries. Just one example is the death rate in Germany is 0.9% while the death rate in Spain is 8.5%, nearly a magnitude of difference with both countries have several 10s of thousands of cases, and that number varies between the two extremes all over the continent (and world).
  - ekianjo 7y ago
    There are multiple variables at play. For example in Italy there is a high percentage of people living with their parents in the age 20-40s bracket, which should lead to more elderly contamination. Also the health services between Germany and Italy should not be even comparable in terms of equipment and capacity.
    - goatlover 7y ago
      Do you think that's enough to account for a 146 to 6 difference in deaths per million between Spain and Germany?
      - ekianjo 7y ago
        In Italy the hospitals were overwhelmed so you should expect the mortality to increase very fast when you can't even give basic treatment to patients in need. The same thing happened in Wuhan and that led to massive death toll. But as I said, many variables at play and we will surely have a better understand of what mattered the most to prevent mortality.
mrfusion 7y ago
Just wait until the deaths of despair hit from the crashed economy and isolation. Alcoholism, opiates.
- gdubs 7y ago
  Counterpoint: While suicide increased, life expectancy overall increased during the Great Depression: https://www.pnas.org/content/106/41/17290 https://www.pnas.org/content/106/41/17290
trhway 7y ago
Was in the news that in China the funeral homes urn deliveries are suspiciously larger than expected. In Russia there is a spike of pneumonia looking like dicease and deaths...
- robocat 7y ago
  The unexpected number of urns answered by the quote from the article that initiated that “news”: There were 56,007 cremations in Wuhan in the fourth quarter of last year. After a month or two of lockdown in Wuhan, the number of backlogged urns is tens of thousands, that is to be expected.
  - robocat 7y ago
    Now incorrect: Bloomberg lowered number from 56,007 to 13,856 in their article — see note at bottom of https://www.bloomberg.com/news/articles/2020-03-27/stacks-of-urns-in-wuhan-prompt-new-questions-of-virus-s-toll https://www.bloomberg.com/news/articles/2020-03-27/stacks-of... which says “(Corrects characterization of 2018 and 2019 cremations data in story published March 27.)” Original pre-correction here: https://archive.md/g1BDx#selection-2503.0-2507.171 https://archive.md/g1BDx#selection-2503.0-2507.171
ardit33 7y ago
I think when all the dust will settle, we will know the real death count by doing a delta of total deaths of 2020 vs. 2019 and 2018. There will be two main reasons of the extra deaths: 1. Deaths related directly by Covid-19. (either the disease itself, or the underlying conditions got worse by the disease) 2. People that didn't have the coronavirus, but died because they couldn't get the usual care due to hospitals being totally overwhelmed (things like heart attacks, strokes, car accidents, insuline/asma shock, etc... turn into death sentences) Same as in war, while many deaths are caused directly by the fighting, a lot of the other extra deaths are indirect (famine, disease... etc)/
- robocat 7y ago
  Also the article assumes 100% infected. If it is only 50%, then death rate is 0.5%. Although the graph does show there are more deaths expected. We can actually expect the mortality rate is a lot lower than 1% if the hospitals are not overloaded. Counterpoint as at March 23rd: “Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).” - https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm So mortality rate is 1.3% and expected to rise, but that is probably skewed by age cohorts, so rate in countries with more young people than a cruise ship might be expected to be lower.
- fmjrey 7y ago
  https://www.euromomo.eu/outputs/zscore_country_total.html https://www.euromomo.eu/outputs/zscore_country_total.html
  - gentleman11 7y ago
    If I am reading that correctly, some countries like Spain see almost annual death spikes to around 8 standard deviations. That doesn’t make sense, what did I miss?
jml7c5 7y ago
Moderators: is it possible to have "(in Italy)" added to the title? It's not clear this can be extrapolated to other countries. (In fact, they reference South Korea as a benchmark for the true value.)
zmmmmm 7y ago
All the statistics seem like a mess for this - we know every single region is doing different amounts of testing with many only testing highly symptomatic people, yet all these are being combined together. Then different protocols for what counts as different levels of severity etc. It will be interesting when people have had more time to sort through the data and clean it up properly what the real estimates of mortality and transmission actually are. Right now everything seems plausible right through from 50% of the population already had it and is immune through to the death rate being drastically under-estimated and we are about to experience an apocolyptic event for humanity ....
chvid 7y ago
So if the mortality rate of the decease is what it is in Germany or Korea - about 0.5% but the number of dead is 4x the official 10.000. Then about 8 mio - ca 15% - of Italy’s population has had it. Is that really correct?
- cycrutchfield 7y ago
  Korea's CFR is 1.6%. Germany is 0.9%. Both are climbing over time as the time lag from detection to death is on the order of weeks.
  - Symmetry 7y ago
    Korea's used to be, what, .6% when they stabilized the number of infections? At the time I was hoping the true IFR was that low but as you say this thing can take a long time to kill people and given what a good job Korea's done with staying on top of their testing I'm not holding out hope that the IFR is below 1%.
- elorant 7y ago
  It could be, but then the R0 should be greater than 3. Which is kind of scary.
  - nicoburns 7y ago
    Here in the UK, I personally know a lot of people who suspect that they have it, but aren't in official numbers because their symptoms are mild and access to tests is poor. 15% doesn't seem beyond the realm of possibility. Beyond a certain point I think it's actually less scary it's more people have it, no? Because it means that the serious cases are a smaller proportion.
    - goatlover 7y ago
      But that also means it will spread faster and peak higher, which creates a larger burden on hospitals.
eeemmmooo 7y ago
Has anyone seen any data on how this has made the average daily deaths in the US rise? I know that number probably isn’t updated real time like the Covid-19 numbers. I think that would really show how much this is affecting us if the numbers go up drastically over the expected amount of deaths per year. I have found the averages from last year, but haven’t seen any more up to date data on that. https://www.cdc.gov/nchs/fastats/deaths.htm https://www.cdc.gov/nchs/fastats/deaths.htm
ChrisCinelli 7y ago
I think there are already a few good probable explanations here. However without more clear data it is hard to find the real drivers.
raincom 7y ago
Good one. Always compare the current death rates with the death rates from the prior year or two. That will explain anomalies in reports by various countries.
hanoz 7y ago
The stats for this are all over the place. Speaking for the UK, no distinction at all is made between died of cononavirus and died with coronavirus. We've had a University of Oxford study claiming that 50% of us have already been infected (a figure so outlandish you might wonder if it was rather a University in Oxford) in which case we should expect the died with figures to be a great deal more already, and what's more that herd immunity should be taking the pressure of the system any week now. But I can't help but feel this belief in hidden large denominator is wishful thinking.
- nicoburns 7y ago
  50% does seem outlandish, but from what I can see, the numbers infected are a lot lot higher than officially reported. I would go as far as to say that the majority of cases aren't being reported, because almost nobody without severe symptoms has access to testing.
ChrisCinelli 7y ago
Good ideas here of why it could be happening. Let me add another: fear and hopeless. These kind of emotions may make people more prone to get sick with other illnesses and depress the immune system so it does not fight back as it really could.
- ChrisCinelli 7y ago
  Some references: - https://www.medicalnewstoday.com/amp/articles/324090 https://www.medicalnewstoday.com/amp/articles/324090 - https://psychcentral.com/news/2014/05/22/study-probes-how-emotions-affect-immune-system/70192.html https://psychcentral.com/news/2014/05/22/study-probes-how-em... - https://www.simmsmanncenter.ucla.edu/center_events/healing-and-the-mind-emotions-and-the-immune-system/ https://www.simmsmanncenter.ucla.edu/center_events/healing-a...
CriticalCathed 7y ago
This is beyond a spurious claim.
whb07 7y ago
Can anyone actually tell me what was the cause of death if an 85 yo already had 3 diseases prior to this virus? If a person has a terminal disease and has N months to live, but dies sooner from a car accident, the net deaths did not increase. This person was on the death queue. edit: bring the silent downvotes. Also, a number of my family have tested positive for this virus.
- nkozyra 7y ago
  Pretty important to capture the terminal catalyst to help understand the lethality of a pathogen. "They would have died anyway" is true of anyone and tends to mask critically important information.
  - whb07 7y ago
    It’s true of everyone given 150 years. Sure, but an 85 yo with 3 diseases was on the front of the queue. We need to test for those who had it and didn’t die. All evidence is pointing at orders of magnitude that had it but didn’t show
justlexi93 7y ago
Numbers are spiking up in every country, it is really scary to go out nowadays. I think that the virus won't be gone soon as some people tend to ignore the lockdown. America is now the epicenter of pandemic.
buboard 7y ago
it's bad science to pick out one small sample of the most affected town (especially when arguably they could have considered the entirety of deaths) and extrapolating that "death rate is 4 times" . There is no statistical testing here, no confidence intervals, nothing. The 4x number is unsubstantiated. The hypothesis that the numbers are misreported seems to be true, but statistical tests are missing.
kbutler 7y ago
Nembro should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. That is 123 more than the average. In the hypothesis - not at all remote - that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship The author appears to be using the total dead (158) rather than the excess dead (123) for this calculation. That suggests that rather than the 1% "exact match", the lethality rate should be 0.78%.
- graeme 7y ago
  Good catch. Though I looked up the population of Nembro. Wikipedia has it at 11,518. So would the rate actually be a bit over 1%? Bergamo’s was about 0.5% by the same metric incidentally.
gentleman11 7y ago
Is anybody familiar with the authors or the website? These findings are shocking if true, but how do we verify their numbers or decide if the source is reliable?
mohankumar246 7y ago
I believe in asian countries where sickness(which can spread) is stigmatized(i definitely believe it is in India..), people will be hesitant to get tested/treatment. There has been several news reports of medic professionals being asked to vacate rental homes, miscreants calling out names in front of patient's home. Not sure why they do them. This will just cause people with symptoms to not get tested.
mbrubeck 7y ago
Problems attributing deaths to COVID-19 will probably be common worldwide. Radio Free America had this similar report about excess deaths in Wuhan being far out of line from the confirmed COVID-19 deaths: https://www.rfa.org/english/news/china/wuhan-deaths-03272020182846.html https://www.rfa.org/english/news/china/wuhan-deaths-03272020... (Note: This article is much more speculative and weakly-sourced than the Italian one. Also, be aware that RFA is funded and overseen by the US government.)
joantorres 7y ago
Epidemic Modeling 101: Or why your CoVID19 exponential fits are wrong “Over the past few weeks, a terrible affliction has been spreading across the world. Otherwise healthy and productive members of society have been infected with this devastating illness that causes them to fire up Excel, Python or R and start extrapolating the latest numbers of confirmed CoVID19 cases in their town, state, country or even the world!” https://medium.com/data-for-science/epidemic-modeling-101-or-why-your-covid19-exponential-fits-are-wrong-97aa50c55f8 https://medium.com/data-for-science/epidemic-modeling-101-or...
sershe 7y ago
Let me get this straight (all of these are straight from the article): 1) Nembro, in the province of Bergamo, is the municipality most affected by Covid-19 in relation to the population. 2) hypothesis - not at all remote - [is] that all citizens of Nembro have caught the virus ... Given the decline seen in the last few days after the peak, flock immunity has likely been attained in Nembro. 3) 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate ... So, the worst hit city in the worst hit region, with collapsed medical system and elderly population; the absolute upper bound on possible deaths; and we get 1% until herd immunity? This, again, is the upper bound of ultimate worst case, based on the article. Isn't this a huge revision DOWN from the previous 2.5-3-6-8-15% numbers people are throwing around? EDIT: what's up with the silent downvotes? I'm quoting the central number and assumptions directly from the article and asking a question. Should I take it as "you are right but I dislike it"?

110 points by myth_drannon 7y ago

lisper 7y ago

[Retracted]

graeme 7y ago
No. In four areas in Italy, including a mid sized city. > We have made exactly the same calculation for the municipalities of Cernusco sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco the number of anomalous deaths is equal to 6.1 times those officially attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo figures, where the ratio reaches 10.4.
deleted 7y ago
[deleted]

graeme 7y ago

Excellent work, and I hope more people in other cities start running these calculations. > In the hypothesis - not at all remote - that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship and - made proportionally by demographic structure - in South Korea. We have made exactly the same calculation for the municipalities of Cernusco sul Naviglio (Mi) and Pesaro using exactly the same methodology. In Cernusco the number of anomalous deaths is equal to 6.1 times those officially attributed to Covid-19, also in Pesaro 6.1 times. But even more staggering are the Bergamo figures, where the ratio reaches 10.4. This seems an unreasonable assumption, no? I don’t think any models predict a 100% infection rate: herd immunity would kick in beforehand, at the least. If true, then the death counts and death rates would be higher. E.g. with 50% infection, deaths are 4x, 12x and 20x, and the death rate is 2%. Of course, you also have to account for local demographics. Edit: I checked the numbers for Bergamo, and they’re troubling. It’s a city of 122,000, and it has a 0.5% death rate for the whole city. Further, people are still sick and dying, so these death rates will only go up.

csomar 7y ago
Shouldn't the Covid-19 be immune to herd-immunity though because of the very long incubation time, during which you can still transmit the virus?
- maxander 7y ago
  Herd immunity kicks in when a large fraction of the people you encounter were already infected, giving you fewer chances to infect new people. So incubation time doesn’t matter there (though certainly it doesn’t help, for other reasons.)
  - ORioN63 7y ago
    > Herd immunity kicks in when a large fraction of the people you encounter were already infected Alternatively, immunized people.
- Gibbon1 7y ago
  I think there is a momentum effect if the percentage of infectious people gets high enough. Where you overshoot the static herd-immunity threshold. If you can keep the number of infected below 10% then you don't see it. At least that's what I saw when I tried to model it. (Take that as you will).
stonogo 7y ago
Naturally-occurring herd immunity is a temporary effect. Only artifically-imposed herd immunity (i.e. vaccination) is lasting.
- graeme 7y ago
  Yes, but unless herd immunity lasts only a couple weeks that shouldn’t be a factor in these Italian analyses. The infection spread over a short period.
- ShorsHammer 7y ago
  What a ridiculously incorrect statement. SARS back in 2002 only lasted 3 flu seasons before being entirely wiped out naturally. SARS-CoV-2 which we are dealing with here is a related virus. > No cases of the first SARS-CoV have been reported worldwide since 2004. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr... https://www.nhs.uk/conditions/sars/ https://www.nhs.uk/conditions/sars/

zamfi 7y ago

That the official numbers underreport Covid-19 deaths by a factor of 4 is one hypothesis -- but it's also possible that this is how many people would be saved by quick interventions at the hospital, but who otherwise died. For example, maybe the ICU beds were full for a month, and in that time they would've saved 96 people, but couldn't.

gdubs 7y ago
Are you saying a spike in non-covid deaths — e.g., heart-attack, etc? That’s certainly a possibility and one of the main dangers at the moment with an overwhelmed healthcare system. It also raises an interesting question of how you account for the toll of the disease: on one hand you have deaths due to the disease itself, and on the other deaths that could have been preventable had the disease not overwhelmed hospitals.
- scarmig 7y ago
  Depending on how you count, you could hypothetically end up with mortality rates >100%. I.e. a disease that kills everyone it infects, and also closes down a hospital causing deaths among people it doesn't infect.
hanklazard 7y ago
Good point. Some part of the increase is almost certainly this ... just hard/impossible to know how much. Edit: actually, i guess if you also looked at the top 10 typical causes of death, seems like you could account for it (ie, heart attack, MVA, or whatever would show abnormally low numbers).

scarmig 7y ago

I'd be curious how much variation there is in previous years; are there any previous significant month spikes that have been washed out by the average? It doesn't seem plausible that random chance could account for 2020's, though.

roywiggins 7y ago
I don't know what the distribution of deaths looks like normally, but a 4x difference is going to be several sigma unlikely in any reasonable one. Also, consider that it happened exactly at the same time coronavirus deaths spiked, which seems vanishingly unlikely to be a coincidence.

cameronfraser 7y ago

I remember the death toll for H1N1 to have been reported in the thousands when it happened but recently read that after a few years they said it was more like 150,000. It's possible they were just reporting US deaths where the 150k number is worldwide. How come the response for H1N1 is nowhere near as intense as the response for COVID?

TwoBit 7y ago
It's possible that 150K was a number reported by somebody else, with a motivation for reporting a very high number. I'm not saying I'm convinced the number is lower, but just as much as there are entities that under-report deaths for selfish reasons, there are those that over-report them.
Waterluvian 7y ago
Based on current trends, Covid-19 is trending to be around 10x or more worse than the 150k figure. Current projections have the US alone at 100k-200k deaths. That would be why this response is more intense.
- nostromo 7y ago
  Except the high estimate for H1N1 in 2009 from the CDC is 575,000 deaths worldwide. https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic https://en.m.wikipedia.org/wiki/2009_swine_flu_pandemic
  - buboard 7y ago
    > The Infectious Diseases Society of America estimated that the total number of deaths in the U.S. was 12,469
Robotbeat 7y ago
The seasonal flu is a pandemic every year and kills a similar amount of people. It’s a shame people don’t take it seriously enough to get vaccinated. H1N1 is a newer variant of seasonal flu. But it’s not nearly as lethal and it doesn’t usually leave survivors with the kind of lung damage COVID-19 does. It’s about carrying capacity of the healthcare system. Flu already strains hospitals, but COVID-19 is multiple times worse so people go without treatment because here aren’t enough beds or doctors and nurses. That’s the difference.

sdffdsfdsfsddsf 7y ago

Wasn't there a thing were deaths were recorded for the place where the person died, not where they normally live? So maybe those people just died in a hospital in another city? (I don't remember if this was for Italy, but I remember reading that about some place in connection with Corona). In any case, why not make an effort to reach out to the cities in question and ask for an explanation?

maxander 7y ago

Has anyone looked at the equivalent numbers in the US? Or South Korea, or other places with outbreaks?

TaylorGood 7y ago

I know of deaths at the local hospital ER with overlapping symptoms but not being officially counted as the deceased were never tested. On a county level there’s maybe one or two recorded. This testing debacle is hurting everybody in more ways than one.

emersonrsantos 7y ago

I wonder why no one is using Wuhan, China numbers. Not reliable?

9nGQluzmnq3M 7y ago
The same phenomenon has been anecdotally reported there as well, with a lot of untested "pneumonia" deaths: https://www.scmp.com/news/china/society/article/3050311/its-pneumonia-everybody-china-knows-about-many-deaths-will-never https://www.scmp.com/news/china/society/article/3050311/its-...
- lonelappde 7y ago
  Evey time I see an article critical of Chines government in SCMP I feel a shock until I remember it's a Hong Kong paper. But then I feel a little confused over Hong Kong's semi autonomous status.
deleted 7y ago
[deleted]

not2b 7y ago

It is possible that more people than usual are dying from other causes (heart disease, cancer, injuries) because the overwhelmed medical system is unable to treat them.

moioci 7y ago
If so, it's still indirectly caused by the pandemic.
- buboard 7y ago
  but not an actionable statistic for other countries

coopsmgoops 7y ago

There a few possible (and reasonable) explanations in the HN comments, one more is that often covid-19 leads to pneumonia and that may be what is attributed as the cause of death, (nefarious or not). I did hear rumors of Japan doing this intentionally to make it look more under control than it was. Another possibility is that medical resources are being monopolized by covid patients, or people don't want to go to hospital for fear of catching it themselves. This situation is still caused by covid but wouldn't be shown in the reported deaths from covid. The article brings up a valid concern, but doesn't explore any other possibile explainations which is irresponsible when people are already panicking.

goatlover 7y ago
The numbers really don't seem consistent across all the countries. Just one example is the death rate in Germany is 0.9% while the death rate in Spain is 8.5%, nearly a magnitude of difference with both countries have several 10s of thousands of cases, and that number varies between the two extremes all over the continent (and world).
- ekianjo 7y ago
  There are multiple variables at play. For example in Italy there is a high percentage of people living with their parents in the age 20-40s bracket, which should lead to more elderly contamination. Also the health services between Germany and Italy should not be even comparable in terms of equipment and capacity.
  - goatlover 7y ago
    Do you think that's enough to account for a 146 to 6 difference in deaths per million between Spain and Germany?
    - ekianjo 7y ago
      In Italy the hospitals were overwhelmed so you should expect the mortality to increase very fast when you can't even give basic treatment to patients in need. The same thing happened in Wuhan and that led to massive death toll. But as I said, many variables at play and we will surely have a better understand of what mattered the most to prevent mortality.

mrfusion 7y ago

Just wait until the deaths of despair hit from the crashed economy and isolation. Alcoholism, opiates.

gdubs 7y ago
Counterpoint: While suicide increased, life expectancy overall increased during the Great Depression: https://www.pnas.org/content/106/41/17290 https://www.pnas.org/content/106/41/17290

trhway 7y ago

Was in the news that in China the funeral homes urn deliveries are suspiciously larger than expected. In Russia there is a spike of pneumonia looking like dicease and deaths...

robocat 7y ago
The unexpected number of urns answered by the quote from the article that initiated that “news”: There were 56,007 cremations in Wuhan in the fourth quarter of last year. After a month or two of lockdown in Wuhan, the number of backlogged urns is tens of thousands, that is to be expected.
- robocat 7y ago
  Now incorrect: Bloomberg lowered number from 56,007 to 13,856 in their article — see note at bottom of https://www.bloomberg.com/news/articles/2020-03-27/stacks-of-urns-in-wuhan-prompt-new-questions-of-virus-s-toll https://www.bloomberg.com/news/articles/2020-03-27/stacks-of... which says “(Corrects characterization of 2018 and 2019 cremations data in story published March 27.)” Original pre-correction here: https://archive.md/g1BDx#selection-2503.0-2507.171 https://archive.md/g1BDx#selection-2503.0-2507.171

ardit33 7y ago

I think when all the dust will settle, we will know the real death count by doing a delta of total deaths of 2020 vs. 2019 and 2018. There will be two main reasons of the extra deaths: 1. Deaths related directly by Covid-19. (either the disease itself, or the underlying conditions got worse by the disease) 2. People that didn't have the coronavirus, but died because they couldn't get the usual care due to hospitals being totally overwhelmed (things like heart attacks, strokes, car accidents, insuline/asma shock, etc... turn into death sentences) Same as in war, while many deaths are caused directly by the fighting, a lot of the other extra deaths are indirect (famine, disease... etc)/

robocat 7y ago
Also the article assumes 100% infected. If it is only 50%, then death rate is 0.5%. Although the graph does show there are more deaths expected. We can actually expect the mortality rate is a lot lower than 1% if the hospitals are not overloaded. Counterpoint as at March 23rd: “Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8). As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years).” - https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm So mortality rate is 1.3% and expected to rise, but that is probably skewed by age cohorts, so rate in countries with more young people than a cruise ship might be expected to be lower.
fmjrey 7y ago
https://www.euromomo.eu/outputs/zscore_country_total.html https://www.euromomo.eu/outputs/zscore_country_total.html
- gentleman11 7y ago
  If I am reading that correctly, some countries like Spain see almost annual death spikes to around 8 standard deviations. That doesn’t make sense, what did I miss?

jml7c5 7y ago

Moderators: is it possible to have "(in Italy)" added to the title? It's not clear this can be extrapolated to other countries. (In fact, they reference South Korea as a benchmark for the true value.)

zmmmmm 7y ago

All the statistics seem like a mess for this - we know every single region is doing different amounts of testing with many only testing highly symptomatic people, yet all these are being combined together. Then different protocols for what counts as different levels of severity etc. It will be interesting when people have had more time to sort through the data and clean it up properly what the real estimates of mortality and transmission actually are. Right now everything seems plausible right through from 50% of the population already had it and is immune through to the death rate being drastically under-estimated and we are about to experience an apocolyptic event for humanity ....

chvid 7y ago

So if the mortality rate of the decease is what it is in Germany or Korea - about 0.5% but the number of dead is 4x the official 10.000. Then about 8 mio - ca 15% - of Italy’s population has had it. Is that really correct?

cycrutchfield 7y ago
Korea's CFR is 1.6%. Germany is 0.9%. Both are climbing over time as the time lag from detection to death is on the order of weeks.
- Symmetry 7y ago
  Korea's used to be, what, .6% when they stabilized the number of infections? At the time I was hoping the true IFR was that low but as you say this thing can take a long time to kill people and given what a good job Korea's done with staying on top of their testing I'm not holding out hope that the IFR is below 1%.
elorant 7y ago
It could be, but then the R0 should be greater than 3. Which is kind of scary.
- nicoburns 7y ago
  Here in the UK, I personally know a lot of people who suspect that they have it, but aren't in official numbers because their symptoms are mild and access to tests is poor. 15% doesn't seem beyond the realm of possibility. Beyond a certain point I think it's actually less scary it's more people have it, no? Because it means that the serious cases are a smaller proportion.
  - goatlover 7y ago
    But that also means it will spread faster and peak higher, which creates a larger burden on hospitals.

eeemmmooo 7y ago

Has anyone seen any data on how this has made the average daily deaths in the US rise? I know that number probably isn’t updated real time like the Covid-19 numbers. I think that would really show how much this is affecting us if the numbers go up drastically over the expected amount of deaths per year. I have found the averages from last year, but haven’t seen any more up to date data on that. https://www.cdc.gov/nchs/fastats/deaths.htm https://www.cdc.gov/nchs/fastats/deaths.htm

ChrisCinelli 7y ago

I think there are already a few good probable explanations here. However without more clear data it is hard to find the real drivers.

raincom 7y ago

Good one. Always compare the current death rates with the death rates from the prior year or two. That will explain anomalies in reports by various countries.

hanoz 7y ago

The stats for this are all over the place. Speaking for the UK, no distinction at all is made between died of cononavirus and died with coronavirus. We've had a University of Oxford study claiming that 50% of us have already been infected (a figure so outlandish you might wonder if it was rather a University in Oxford) in which case we should expect the died with figures to be a great deal more already, and what's more that herd immunity should be taking the pressure of the system any week now. But I can't help but feel this belief in hidden large denominator is wishful thinking.

nicoburns 7y ago
50% does seem outlandish, but from what I can see, the numbers infected are a lot lot higher than officially reported. I would go as far as to say that the majority of cases aren't being reported, because almost nobody without severe symptoms has access to testing.

ChrisCinelli 7y ago

Good ideas here of why it could be happening. Let me add another: fear and hopeless. These kind of emotions may make people more prone to get sick with other illnesses and depress the immune system so it does not fight back as it really could.

ChrisCinelli 7y ago
Some references: - https://www.medicalnewstoday.com/amp/articles/324090 https://www.medicalnewstoday.com/amp/articles/324090 - https://psychcentral.com/news/2014/05/22/study-probes-how-emotions-affect-immune-system/70192.html https://psychcentral.com/news/2014/05/22/study-probes-how-em... - https://www.simmsmanncenter.ucla.edu/center_events/healing-and-the-mind-emotions-and-the-immune-system/ https://www.simmsmanncenter.ucla.edu/center_events/healing-a...

CriticalCathed 7y ago

This is beyond a spurious claim.

whb07 7y ago

Can anyone actually tell me what was the cause of death if an 85 yo already had 3 diseases prior to this virus? If a person has a terminal disease and has N months to live, but dies sooner from a car accident, the net deaths did not increase. This person was on the death queue. edit: bring the silent downvotes. Also, a number of my family have tested positive for this virus.

nkozyra 7y ago
Pretty important to capture the terminal catalyst to help understand the lethality of a pathogen. "They would have died anyway" is true of anyone and tends to mask critically important information.
- whb07 7y ago
  It’s true of everyone given 150 years. Sure, but an 85 yo with 3 diseases was on the front of the queue. We need to test for those who had it and didn’t die. All evidence is pointing at orders of magnitude that had it but didn’t show

justlexi93 7y ago

Numbers are spiking up in every country, it is really scary to go out nowadays. I think that the virus won't be gone soon as some people tend to ignore the lockdown. America is now the epicenter of pandemic.

buboard 7y ago

it's bad science to pick out one small sample of the most affected town (especially when arguably they could have considered the entirety of deaths) and extrapolating that "death rate is 4 times" . There is no statistical testing here, no confidence intervals, nothing. The 4x number is unsubstantiated. The hypothesis that the numbers are misreported seems to be true, but statistical tests are missing.

kbutler 7y ago

Nembro should have had - under normal conditions - about 35 deaths. 158 people were registered dead this year by the municipal offices. That is 123 more than the average. In the hypothesis - not at all remote - that all citizens of Nembro have caught the virus (with many asymptomatic, therefore), 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate on the Diamond Princess cruise ship The author appears to be using the total dead (158) rather than the excess dead (123) for this calculation. That suggests that rather than the 1% "exact match", the lethality rate should be 0.78%.

graeme 7y ago
Good catch. Though I looked up the population of Nembro. Wikipedia has it at 11,518. So would the rate actually be a bit over 1%? Bergamo’s was about 0.5% by the same metric incidentally.

gentleman11 7y ago

Is anybody familiar with the authors or the website? These findings are shocking if true, but how do we verify their numbers or decide if the source is reliable?

mohankumar246 7y ago

I believe in asian countries where sickness(which can spread) is stigmatized(i definitely believe it is in India..), people will be hesitant to get tested/treatment. There has been several news reports of medic professionals being asked to vacate rental homes, miscreants calling out names in front of patient's home. Not sure why they do them. This will just cause people with symptoms to not get tested.

mbrubeck 7y ago

Problems attributing deaths to COVID-19 will probably be common worldwide. Radio Free America had this similar report about excess deaths in Wuhan being far out of line from the confirmed COVID-19 deaths: https://www.rfa.org/english/news/china/wuhan-deaths-03272020182846.html https://www.rfa.org/english/news/china/wuhan-deaths-03272020... (Note: This article is much more speculative and weakly-sourced than the Italian one. Also, be aware that RFA is funded and overseen by the US government.)

joantorres 7y ago

Epidemic Modeling 101: Or why your CoVID19 exponential fits are wrong “Over the past few weeks, a terrible affliction has been spreading across the world. Otherwise healthy and productive members of society have been infected with this devastating illness that causes them to fire up Excel, Python or R and start extrapolating the latest numbers of confirmed CoVID19 cases in their town, state, country or even the world!” https://medium.com/data-for-science/epidemic-modeling-101-or-why-your-covid19-exponential-fits-are-wrong-97aa50c55f8 https://medium.com/data-for-science/epidemic-modeling-101-or...

sershe 7y ago

Let me get this straight (all of these are straight from the article): 1) Nembro, in the province of Bergamo, is the municipality most affected by Covid-19 in relation to the population. 2) hypothesis - not at all remote - [is] that all citizens of Nembro have caught the virus ... Given the decline seen in the last few days after the peak, flock immunity has likely been attained in Nembro. 3) 158 deaths would equate to a lethality rate of 1%. That is precisely the expected and measured lethality rate ... So, the worst hit city in the worst hit region, with collapsed medical system and elderly population; the absolute upper bound on possible deaths; and we get 1% until herd immunity? This, again, is the upper bound of ultimate worst case, based on the article. Isn't this a huge revision DOWN from the previous 2.5-3-6-8-15% numbers people are throwing around? EDIT: what's up with the silent downvotes? I'm quoting the central number and assumptions directly from the article and asking a question. Should I take it as "you are right but I dislike it"?