Please can someone explain why the death toll in Italy is escalating so much?

[Thelowquietsea]

I'm aware that there's a large number of elderly in Italy, they live intergenerationally, in fairly tight cities.

But they've been in lockdown for weeks. Why is the death toll jumping so significantly?

We are following exactly the same trsjectory as Italy.

350,000 Chinese people live in Northern Italy too, very strong links to Wuhan with all the factories in Milan.

All travelling back and forth due to Chinese New Year in January.

It wouldn't have been so bad across Europe either if half term hadn't had happened in February, the long incubation period meant it was spreading like wildfire around the ski resorts and other tourist areas. Then everyone travelled back across Europe.

Italy was the perfect storm of population, customs, Chinese population/links and timing.

Slightly off topic but how do you arrest someone while practising social distancing?

@littlebitwooway The police where I live have been arresting people as normal by handcuffing and putting in the police car if they disobey authority, i.e refuse to cooperate or show ID. Some of them do wear face masks and gloves but I've seen some without.

If the person is just out when they shouldn't be they are only given a fine. I think it's just one of those jobs where they are, unfortunately, at a higher risk.

For demographics look at the worldometer website

@screamer1

this is the latest report (in English) from the ISS:
www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf

@dkl55 does that specifically breakdown for Italy though? Can't seem to find that.

"Demographics:
Mean age of patients dying for COVID-2019 infection was 78.5 (median 80, range 31-103, IQR 73 -85).
Women were 942 (29.4%). Figure 1 shows that median age of patients dying for COVID-2019 infection was
more than 15 years higher as compared with the national sample diagnosed with COVID-2019 infection
(median age 63 years). Figure 2 shows the absolute number of deaths by age group. Women dying for
COVID-2019 infection had an older age than men (median age women 82 - median age men 79).

Deaths under the age of 50 years
To date (March the 20th), 36 of 3200 (1.1%) COVID-19 positive patients under the age of 50 have died. In
particular, 9 of these were younger than 40 years, 8 men and 1 woman (age range between 31 and 39
years). For 2 patients under the age of 40 years, no clinical information is available; the remaining 7 had
serious pre-existing pathologies (cardiovascular, renal, psychiatric pathologies, diabetes, obesity).

Pre-existing conditions:
Overall, 1.2% of the sample presented with
a no comorbidities, 23.5% with a single comorbidity, 26.6% with 2, and 48.6% with 3 or more."

Diseases N %
schemic heart disease 145 30.1
Atrial Fibrillation 106 22.0
Stroke 54 11.2
Hypertension 355 73.8
Diabetes 163 33.9
Dementia 57 11.9
COPD 66 13.7
Active cancer in the past 5 years 94 19.5
Chronic liver disease 18 3.7
Chronic renal failure 97 20.2

Number of comorbidities N %
0 comorbidities 6 1.2
1 comorbidity 113 23.5
2 comorbidities 128 26.6
3 comorbidities and over 234 48.6

ISS report from yesterday.

Doesn't mention smoking which i suspect ain't helping them survive at all:(

19% smokers in the UK versus 24% in Italy. I don't think it's a decisive factor tbh.

worldpopulationreview.com/countries/smoking-rates-by-country/

I don't think people are taking the lockdown seriously enough. I know someone in Bergamo and they said people are still going out depite the restrictions.

They have introduced more measures this evening, no exercising outside and no using vending machines.

@CarlottaValdez
Here is the demographic breakdown for Italy:

The measures introduced tonight we're mainly economic. Non essential production is to cease.
Everyone knows a twat who doesn't follow Lockdown. But the vast majority of Italians are doing so. People are obviously going out- to buy food, medicines, pay bills, etc.

19% smokers in the UK versus 24% in Italy. I don't think it's a decisive factor tbh.

I read that 60% of Italian men aged 60 and over smoke though. I’m not sure what our figures are. Either way we are following Italy’s trajectory on the deaths so I’m not sure any of these are any correlation anymore which really is quite scary

The lead in time between becoming infected and death, on average, around 19/20 days.... On average it takes 5 days for someone to show symptoms, another 7 to develop full-blown pneumonia, and another 7 to die.

Obviously this only applies to those who do die, but this would imply that, I’m not an expert and I may have this wrong, but I wouldn’t expect the death rate to peak until at least 19-20 days after significant transmission was reduced following substantial social distancing measures being put in place. Italy put in place its lockdown 13 days ago I believe.

It's the demographics of who is on the CPAPs that i am interested in. My friend in the US has a friend whose 12 year old on one due to Covid 19

@DoctorNicoleWatterson that’s a great explanation thanks

There was a Telegraph article about this. It cited higher smoking rates and that Italy has one of the oldest populations in the world. There also seems to be a question with how deaths are recorded:

^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,” he says. Other experts have also expressed scepticism about the available data. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, says that countries do not yet have a good indication of how many mild infections they have.
If further testing finds more asymptomatic cases spreading undetected, the mortality rate will drop^

@Derbygerbil i think you are right and hope the peak is around the corner... but the life list before then is so awful to contemplate

We must put our lockdown in place before Easter otherwise people wiĺl be holidaying and spending days out all over the place. I think it's going to be bad today particularly but that's unstoppable now. I dread to think what our numbers will be in two to four weeks time.

www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/

It's important to remember that in Italy (and many other countries, def the UK) we have no idea what the number of deaths means in the context of the total number of people actually infected. Italy isn't testing broadly enough to pick up the vast numbers of mild/asymptomatic cases so it's CFR is effectively a % of people who are ill enough to seek help.

The numbers dying are horrific either way of course.

All this stuff about higher rates of smoking, multi-generational living etc just sounds like worried people trying to reassure themselves that it won't happen here. Unfortunately the graphic posted by MotherOfAll at the bottom of page 4 says it all. We are following almost the exact death rate as Italy. And we have far fewer ICU beds. That's why we must stay home.

@LeeMiller, thanks for that link about the comorbidities.
They say hypertension is a silent killer, and so it proves.

I have impression (from Imperial College model) that even if ventilators were available for everyone in need of one, only half of those would survive. Gives people a 50% chance at best.

UK has lower rate of detected hypertension than Italy, 55% vs. 64% of all age popn, might be helpful to UK.

You don't see Italy on this version of the map, it's 17.7% compared to UK's 15.2%.

Don't ask me why one map says 55% for UK & another says 15.2%... I'm still digging! The important info is that UK is lower than Italy for %popn with high blood pressure.