Preprint Review Version 2 This version is not peer-reviewed

Excess Mortality from COVID-19: Lessons Learned from the Italian Experience

Version 1 : Received: 4 April 2020 / Approved: 6 April 2020 / Online: 6 April 2020 (15:17:12 CEST)
Version 2 : Received: 3 May 2020 / Approved: 4 May 2020 / Online: 4 May 2020 (18:38:16 CEST)

How to cite: Pasquariello, P.; Stranges, S. Excess Mortality from COVID-19: Lessons Learned from the Italian Experience. Preprints 2020, 2020040065 (doi: 10.20944/preprints202004.0065.v2). Pasquariello, P.; Stranges, S. Excess Mortality from COVID-19: Lessons Learned from the Italian Experience. Preprints 2020, 2020040065 (doi: 10.20944/preprints202004.0065.v2).

Abstract

There is much discussion among clinicians, epidemiologists, and public health experts about why case fatality rate from COVID-19 in Italy (at 13.3% as of April 20, 2020, versus a global case fatality rate of 6.9%) is considerably higher than estimates from other countries (especially China, South Korea, and Germany). In this article, we propose several potential explanations for these differences. We suggest that Italy’s overall and relative case fatality rate, as reported by public health authorities, is likely to be inflated by such factors as heterogeneous reporting of coronavirus-related fatalities across countries and the iceberg effect of under-testing, yielding a distorted view of the global severity of the COVID-19 pandemic. We also acknowledge that deaths from COVID-19 in Italy are still likely to be higher than in other equally affected nations due to its unique demographic and socio-economic profile. Lastly, we discuss the important role of the stress imparted by the epidemic on the Italian healthcare system, which weakened its capacity to adequately respond to the sudden influx of COVID-19 patients in the most affected areas of the country, especially in the Lombardy region.

Subject Areas

COVID-19; case fatality rate; Italy; testing; health care system; demographics; comorbidites; epidemiological trends

Comments (2)

Comment 1
Received: 4 May 2020
Commenter: Saverio Stranges
Commenter's Conflict of Interests: Author
Comment: Typos fixed, revision of write-up, data updated to April 20, 2020
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Comment 2
Received: 14 May 2020
Commenter: Paolo Pasquariello
Commenter's Conflict of Interests: Author
Comment: Version v2 also includes a new version of the iceberg model, one based on newly available epidemic understanding and outcomes, which supersedes the one reported in version v1.
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