WHY IS MORTALITY SO HIGH IN ITALY
and what does it mean for other countries
(thread)
1/ Mortality in Italy is one of the highest, hovering around 7%, while for other countries we see 0.5%-3.5%.
2/ Let's see the factors that contribute, to know which might apply to your country.
and what does it mean for other countries
(thread)
1/ Mortality in Italy is one of the highest, hovering around 7%, while for other countries we see 0.5%-3.5%.
2/ Let's see the factors that contribute, to know which might apply to your country.
3/ One factor is that the virus has been in Italy for months. People take time to die. Countries which see a low mortality might have many "in trajectory" to death, which don't show up yet in the stats.
4/ This is, by the way, why age of death goes down over time.
As a general rule (exceptions apply), older people die faster.
We have few young deaths because (1) young people die less and also because (2) young people take longer to die.
As a general rule (exceptions apply), older people die faster.
We have few young deaths because (1) young people die less and also because (2) young people take longer to die.
5/ There have been early reports that Italy didn't use chloroquine but they now do. I have no idea how much this factored in regarding the first deaths.
6/ Healthcare system is not a negative factor. Northern Italy has one of the best healthcare systems in the world. If it's swamped, is only because of the sheer number of patients. Any healthcare system would be overwhelmed with an uncontrolled outbreak.
7/ Mortality is high in Lombardy also because the system is overwhelmed by the number of patients – which means less care can be given to each, on average.
If you think this won't apply to your country – perhaps, but it only depends on how well you implement social distancing.
If you think this won't apply to your country – perhaps, but it only depends on how well you implement social distancing.
8/ I stress the last point. How many beds your hospitals have is largely irrelevant. Having 50 or 200 ICU beds in a hospital doesn't matter much if it receives 400 patients over two weeks (a guess for the time it takes for a patient to rotate out).
9/ Healthcare systems and hospitals are mostly inelastic. Which means that if they resist under overload mostly depends on the load, not on their internal characteristics.
This is why social distancing is so, so important.
This is why social distancing is so, so important.
10/ Countries with lot of beds and low initial mortality (eg Germany) should be especially wary of not falling into complacency.
This is an advantage if and only if the total number of cases is limited through social distancing
No healthcare system can withstand a full outbreak
This is an advantage if and only if the total number of cases is limited through social distancing
No healthcare system can withstand a full outbreak
11/ Finally, age. As of a few days ago, the average age of death in Italy was 81.
However, if your country's population is younger, it will be only marginally better for you, as the average age of death tends to lower over time, especially if hospitals get overwhelmed
As seen…
However, if your country's population is younger, it will be only marginally better for you, as the average age of death tends to lower over time, especially if hospitals get overwhelmed
As seen…
12/ As seen above, in the long-term, the most important factor is number of cases.
That determines the absolute number of deaths and whether the healthcare system gets overwhelmed, further raising mortality.
Number of cases is the single number we should focus on.
That determines the absolute number of deaths and whether the healthcare system gets overwhelmed, further raising mortality.
Number of cases is the single number we should focus on.
13/ The final implication: the most important action to lower the final number of deaths is to reduce the number of cases. This should be done by implementing strict social distancing as early as possible (any new case today means 2-4 deaths down the road)
14/ Additional reasons for the high mortality here.
15/ I got asked why I said that hospital capacity is inelastic.
Of course, there is some elasticity: a few more beds can be added and equipment procured.
But this elasticity is negligible respect to the growth of an uncontained outbreak.
Of course, there is some elasticity: a few more beds can be added and equipment procured.
But this elasticity is negligible respect to the growth of an uncontained outbreak.
16/ I got asked: isn't Italy having the outbreak because of the high quantity of Chinese workers?
No. Prato area, one of the largest Chinese communities in Europe, has a low Covid incidence (see 👇).
Also, no Chinese case near the epicenters.
No. Prato area, one of the largest Chinese communities in Europe, has a low Covid incidence (see 👇).
Also, no Chinese case near the epicenters.
17/ Do people in Lombardy die more because they smoke a lot?
No.
22.5% people aged 14+ smoke in Lombardy (source: ISTAT, 2011).
24.5% of people aged 15+ smoke in Germany (source: Statistisches Bundesamt, 2013)
No.
22.5% people aged 14+ smoke in Lombardy (source: ISTAT, 2011).
24.5% of people aged 15+ smoke in Germany (source: Statistisches Bundesamt, 2013)
18/ Interesting data point, worth more examination: Italian lung cancer rates are abnormally high.
More information in the tweet below and in the replies to it.
More information in the tweet below and in the replies to it.
19/ As @amlivemon et al remarked, pollution in Northern Italy is bad (relatively to Europe), but not that bad compared to China. It probably is part of the reason why mortality is so high.
(Showing that we don't need to wait for climate change to take action to lower pollution.)
(Showing that we don't need to wait for climate change to take action to lower pollution.)
20/ Some asked about the past smoking habits of the elder in Germany and Italy. Difficult to find good data. Also, what really matters is dose distribution across population.
That said, here is what I found (if you have better data, please send me).
That said, here is what I found (if you have better data, please send me).
