How Italy’s ageing population, overburdened health system spiked its Covid-19 death rate

According to an article in The Telegraph, Italy’s high death rate is due to its demographics, an overburdened health system and how fatalities are recorded by hospitals.

A police car sits at the bottom of the Spanish Steps in Rome | Photo: Geraldine Hope Ghelli | Bloomberg

New Delhi: As the world reels under the threat of the coronavirus pandemic, Italy has been one of the worst affected countries since day one, with an enormously high fatality rate. According to Worldometers, of the 37,702 closed coronavirus cases (cases which had an outcome) in Italy presently, 15,887 resulted in death. This puts the death rate at a soaring 42 per cent.

As opposed to this, China has recorded a coronavirus death rate of just 4 per cent. While America has reported more cases of coronavirus, the number of deaths is nearly half of that of Italy.

According to an article in The Telegraph, the country’s high death rate can be attributed to its large percentage of older population, an overburdened health system, and how the fatalities are recorded by hospitals.

‘Hospitals in Italy have been “very generous” in recording fatalities’

Walter Ricciardi, the scientific advisor to Italy’s health minister believes this high death toll is connected to the country having a very high older population. Italy is said to have the second oldest population in the world, after Japan.

“The age of our patients in hospitals is substantially older — the median is 67, while in China it was 46,” Ricciardi told The Telegraph. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality,” he added.

According to a paper published in the journal JAMA network on 17 March, 40 per cent of the coronavirus infections and 87 per cent of deaths in Italy had been in patients over 70 years of age.

Older people are more susceptible to coronavirus infections and are less likely to recover than younger people. This combined with the fact that older people are likely to have other illnesses, which makes recovery tougher.

Ricciardi further said that hospitals in Italy have been “very generous” in how they record coronavirus-related fatalities.

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity — many had two or three,” Ricciardi said.

According to the World Health Organization (WHO), co-morbidity is “the presence of one or more additional diseases or disorders occurring concomitantly with a primary disease or disorder.” Multimorbidity is defined as the presence of two or more chronic medical conditions in one individual.

So while this doesn’t mean that the coronavirus infection did not contribute to a person’s death, it only shows that many of those counted in the death toll may have had other pre-existing health issues.

‘The health system was overwhelmed’

An ageing population with health issues, however, isn’t Italy’s only problem. Italy’s health system is struggling to keep up with the burgeoning coronavirus cases.

“Doctors in Italy haven’t been dealing with one or two patients in care… but up to 1,200,” Dr Mike Ryan, health emergencies programme executive director at the WHO told The Telegraph. “The fact they’re saving so many is a small miracle in itself,” he added.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said health workers contracting the infection is also a reason behind the high death toll.

“There are three factors involved in Italy: one is that it is a much older population, two the health system was overwhelmed, and three there has been a significant loss of health workers because of a high coronavirus infection rate among them,” he said.

Not just this, the poor air quality in some regions of Italy combined with high smoking rate — which directly impacts the lungs — may have further aggravated the problem.

According to the article, a majority of deaths in Italy have been in the northern Lombardy region, which is known to have very poor air quality.

Other countries

Italy’s seeming failure to cope with the coronavirus cases is often cited as an example to be wary of, for other countries. However, McKee said it might be early to be making these comparisons.

“It’s too early to make a comparison across Europe,” he said. “We do not have detailed sero-surveillance of the population and we do not know how many asymptomatic people are spreading it,” he added.

According to Worldometers, the United Kingdom has had 3,605 deaths due to the Coronavirus.

Referring to the state of the epidemic in the UK, McKee said, “Italy is ahead of us in the epidemic – and it’s not clear how many health workers [in the UK] are having to self isolate. That’s another big concern.”

“Based on Italy’s experience, there is a real concern for the UK,” he said. “Compared to almost every other European country we have a relative shortage of ventilators and medical staff.” he added.

(This copy has been updated to reflect changes.)