By Peter Andrews, Irish science journalist and writer, based in London. He has a background in the life sciences, and graduated from the University of Glasgow with a degree in genetics
In Italy, the proportion of infected people dying from the novel coronavirus — 10 percent according to the latest figures — seems through the roof. Unsurprisingly, there is more to this terrifying figure than meets the eye.
You do not need to be an expert to calculate the mortality rate. It is one number divided by another — the number of people who have died from the virus divided by the total number of confirmed cases. In the case of Italy, 7,503 dead divided by 74,386 infected gives a mortality rate of roughly 10 percent. But that does not mean that one in ten people who contract the virus will die, despite what the scaremongering media would have you believe.
The first reason why is that the first, smaller number — the number of deaths from Covid-19 — is impossible to underestimate. People are either alive or dead, and usually as soon as a person dies they will quickly find their way into the national statistics.
But the larger number, the confirmed cases, must by definition be an underestimate. It would be impossible for every person in a country positive for the coronavirus to have been already tested and added to the confirmed cases. The virus can be dormant in people for up to two weeks, and young people can experience very mild or even no symptoms at all, and still be positive for the virus. Since that figure is by definition too low, the mortality rates being reported are by definition too high.
Failing to test
Another factor is that governments are being pushed well beyond their capabilities for mass testing and contact tracing, some more than others. With typical efficiency, Germany is on top of their testing situation, and as such have picked up many milder cases. Therefore they have a high number of confirmed cases relative to the true number of infected people in Germany.
This is keeping the mortality rate in Germany down at 0.5 percent, baffling experts who are expecting apocalyptic scenes at the hospitals, the likes of which have so far only materialized in Italy. Perhaps the cases will soon mount up in Germany, and their mortality rate will climb toward the four or five percent that seems to be the European average. But due to the asymptomatic people (a majority according to the best research) even that is an exaggeratedly high rate.
Apply this principle to Italy, whose civil protection chief Angelo Borrelli told La Repubblica newspaper on Monday that “It is credible to estimate that there are 10 positive cases for every one officially reported.” If this were true, and as many as 640,000 people are infected in Italy, their actual mortality rate would in a stroke become one percent instead of ten percent. The scale of the problem begins to look quite different in that context.
Cause of death
Yet another reason for Italy’s inflated mortality rate is how deaths are being recorded there. Professor Walter Ricciardi, an adviser to the Italian minister of health, told the Telegraph on Monday that “the way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.’’
A thought experiment may elucidate this. Imagine that one thousand people, all over the age of 75, died in hospitals in northern Italy last week. All of them had tested positive for the coronavirus at some point during the past few weeks.
The vast majority of Covid-19 fatalities, 99 percent according to Italian research, have had a pre-morbidity, if not two or three. These are underlying health issues,like heart disease, cancer or various infections. Some might have been comatose, with life support machines and artificial breathing the only thing keeping them alive anyway.
Eventually, their bodies gave out, and they simply could not fight on any longer. But does that mean that in the absence of the coronavirus, those one thousand people would still be alive? In other words, is it really true to say that all of these people died of Covid-19? But amidst this crisis, when health systems and governments have tunnel vision for this one ailment, all one thousand are chalked off as victims of the plague.
More spanners in the works
A recent article in the Guardian wrestling with Germany’s apparently too-low mortality rate concludes that because they are not conducting widespread testing of dead bodies for the coronavirus people could be dropping dead inside their own homes of Covid-19 and going unrecorded. This seems unlikely to be much of a factor, but there may be other reasons why Italy has so far been an outlier in coronavirus casualties.
Many have pointed to Italy’s elderly population as the catch-all reason for their unnaturally high death rates. But that idea is a non-starter. Germany has the next oldest population in Europe, and Germans are not as healthy as Italians (who live long lives precisely because they are healthy), and yet Germany has the lowest death rate of the ten worst affected countries. Age cannot explain away the disparity.
Another factor is doubtless the unpreparedness of Italy’s health system, and the dearth of beds and equipment that is now spawning rumors about doctors being forced to jettison some patients to make room for others. Germany is better equipped, but may not have been put to the test yet, as the virus is yet to explode there as it has in northern Italy.
Crisis around the corner?
Experts are still saying that the reason for all of these disparities is simply that some countries are further along the epidemic curve than others. This could explain why so many more have died in China and Italy and so few in Germany and the UK, for example, but it cannot explain the wild fluctuations in the mortality rates.
None of this is meant to take away from the severity of the crisis in Italy, or that which may be just around the corner for the rest of the world. But the key point to take away from this is that the 10 percent mortality rate being reported from Italy is grossly misleading. It is being waved around by the mainstream media as a bit of old-fashioned sensationalism at best, and a calculated tool of propaganda at worst. A figure like 0.3 percent barely higher than the common flu, simply does not have the same power in getting people to swallow unprecedented legislation that gives the state tremendous new powers in a host of new areas … all in the name of public health of course.
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