Why Does Italy Have a Higher Death Rate than China from the Coronavirus?

The photo of numerous urns in Wuhan was captured on Twitter.

(Editor’s note: As we go through the coronavirus pandemic, and have been “safer at home” and practicing social distancing in Los Angeles since March 16, I’ve wondered about several questions. Over the next few days, I’ll share the questions and the answers I could find.)

Why does Italy have such a high death rate compared to China?

As of April 5, China listed 81,708 cases and 3,331 deaths; Italy had 128,948 reported cases and 15,887 deaths (visit:worldometers.info.)

There could be two answers: 1) how the death rates are reported and counted; and 2) China may have not reported an accurate number.

An April 1 BBC report (“Coronavirus Why Death and Mortality Rates Differ”) said “the lack of widespread, systematic testing in most countries is the main source of discrepancies in death rates internationally.”

The story noted there are two kinds of fatality rates. The first is the people who die who have tested positive for the disease, which is called the “case fatality rate.”

The second or the “infection fatality rate” is: Of all the people who are actually infected, how many will die?

“’The case fatality rate is how many people doctors can be sure are killed by the infection, versus how many people the virus kills overall,” Carl Heneghan, an epidemiologist and director of the Centre for Evidence-Based Medicine at the University of Oxford told the BBC.

For example, say there are 100 people who have been infected with Covid-19 and 10 of them go to the hospital and test positive. Of that 100, the other 90 are not tested. If one of the 10 in the hospital die, the case fatality rate is one in 10, or 10%. But the infection fatality rate would be just one in 100, or 1%.

If countries only test patients who go to the hospital, such as the United Kingdom, the death rate will be much higher than countries who do widespread testing such as Germany or South Korea.

What goes on a death certificate? If a person has diabetes, a heart condition and coronavirus, what does the doctor list?

In Italy, anyone who has coronavirus and dies is counted as a Covid-19 case: the same is true in the United States, Germany and Hong Kong.

This has been reported as a virus that seems to strike the elderly particularly hard. Nearly a quarter of the Italian population that died was 65 and older, compared to 11 percent in China. According to Professor Walter Ricciardi, scientific adviser to Italy’s minister of health, his nation has the second oldest population worldwide.

According to a March 23 story in The Telegraph (“Why Have So Many Coronavirus Patients Died in Italy?”), “there are other factors that may have contributed to Italy’s fatality rates . . .and includes a high rate of smoking and pollution – the majority of deaths have been in the northern region Lombardy region, which is notorious for poor air quality.”

According to the BBC, if you compare China and Italy, the ages from 0 to 69 have about the same death rates.

The more recent controversy has been whether China reported its death toll accurately.

On April 1, Fortune reported (“China Intentionally Underreported Total Coronavirus Cases and Deaths, U.S. Intelligence says”), “China has concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths it’s suffered from the disease, the U.S. intelligence community concluded in a classified report to the White House, according to three U.S. officials.”

“The outbreak began in China’s Hubei province in late 2019, but the country has publicly reported only about 82,000 cases and 3,300 deaths, according to data compiled by Johns Hopkins University.”“Stacks of thousands of urns outside funeral homes in Hubei province have driven public doubt in Beijing’s reporting,” the story said.

(As of April 5, there were 336,830 cases reported in the United States and 9,618 deaths.)

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