What has caused the high COVID-19 mortality rate in Italy?

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People wear masks as they walk in Milan, Italy, Feb. 24, 2020. Six people have died and 222 have tested positive for the novel coronavirus nationwide in Italy, Angelo Borrelli, chief of Civil Protection Department and Extraordinary Commissioner for the Coronavirus Emergency, told a press conference at 6 p.m. local time on Monday. (Photo by Daniele Mascolo/Xinhua)
People wear masks as they walk in Milan, Italy, Feb. 24, 2020. Six people have died and 222 have tested positive for the novel coronavirus nationwide in Italy, Angelo Borrelli, chief of Civil Protection Department and Extraordinary Commissioner for the Coronavirus Emergency, told a press conference at 6 p.m. local time on Monday. (Photo by Daniele Mascolo/Xinhua)

Italy has been the hardest-hit country since the outbreak of COVID-19 in Europe, with the highest mortality rate and the most confirmed cases in the region. Local medical analysts say there are multiple factors behind the tragic data.

On Friday, 627 patients died of COVID-19 in a 24-hour span in Italy, the highest leap in fatalities in a single day in the country, bringing its COVID-19 death toll to 4,032, according to official statistics from Italy’s Civil Protection Department. In the previous 24-hour span, 427 people had died in the country.The current COVID-19 morality rate in Italy stands at about 8 percent, which is higher than the global average. According to the World Health Organization, as of midnight Thursday, there were 209,839 confirmed cases of coronavirus and 8,778 deaths worldwide, with the global average mortality rate standing at some 4 percent.

Local medical experts told Xinhua that factors such as untested mild cases and a high proportion of the elderly population are among the factors behind the high mortality rate in Italy.Fabrizio Pregliasco, a researcher at Department of Biomedical Sciences for Health at the University of Milan, said that many mild or non-symptomatic cases have not been confirmed due to the insufficient diagnostic capacity in the early stage of the coronavirus outbreak.

He said that if the number of unconfirmed cases is included in the cumulative number of confirmed cases, the mortality rate in Italy may be close to that of elsewhere.

Currently, Italy has been intensifying its testing capacity steadily. According to the Italian Ministry of Health, the country had performed more than 180,000 tests nationwide as of Thursday, which are among the highest in the world.

Silvio Paone, a viral disease researcher at Rome’s La Sapienza University, agreed with Pregliasco, saying another factor is the larger elderly population in Italy.

According to a report released by the Italian National Bureau of Statistics in February 2019, Italy’s total population was about 60.39 million as of January 2019, and the population aged over 65 was 13.8 million, accounting for 22.8 percent of the total population. Italy ranks the second in the world in terms of aging, only behind Japan, according to the World Bank data for 2018.Italy’s Civil Protection Department chief Angelo Borrelli repeatedly stressed at regular press conferences held in Italy that the majority of deaths were among the elderly. He provided a report on March 9, saying that about 31 percent of the deaths were aged 70-79, about 44 percent aged 80-89, and about 14 percent aged over 90.

In another report published by Italy’s Superior Institute of Health (ISS) on March 13, the statistics on deaths from the coronavirus showed that the average age of deaths in Italy was 80. If considered by age, the mortality rate of Italian patients infected with coronavirus would not be higher than that of other countries.In addition, the ISS report said that 46 percent to 47 percent of those deaths had two to three or more other diseases. The institute pointed out that among those deaths, most cases had suffered hypertension, ischemic heart disease or diabetes before.

Director of the ISS Silvio Brusaferro said that research confirmed that the elderly and the people with other diseases are more vulnerable to COVID-19, and should be the focus of the coronavirus prevention and control effort.

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