The Italian anomaly: Why Italy makes the coronavirus seem far deadlier than it actually is

This NASA handout image obtained 23 March, 2005 shows a grey veil of haze covering the Po River Valley of northern Italy and stretching out over the Adriatic Sea in this satellite image from 17 March. The snow-capped Alps to the north help to restrict air flow between northern Italy and the rest of continental Europe, meaning that air pollution in the northern part of the country often gets trapped and can take days to disperse. Many of Italy's major cities and industrial centers are located in this valley, further adding to the problem. AFP PHOTO/HO/NASA (Photo by HO / NASA / AFP)

I was hoping to stop writing about the Corona pandemic, but sadly, the amount of misinformation out there is so enormous and the impact on our society is so severe, that I feel obliged to perform my civil duty to remind people to use their critical thinking faculties, rather than succumbing to hysteria.  “Two weeks behind Italy.” Is the anthem of the Coronadoomers. These people are convinced that the virus kills about 4% or more of those it infects, that the elderly die first and young people die later, that it will cause long-term organ damage in the survivors, andsoforth. Because they are so afraid of this virus, they are willing to surrender all their civil liberties, in hopes of being protected from this virus.

Of course, if they are eager to stay inside, then that is their right. What frightens me, is that their hysteria will affect the lives of other people. Indirectly, their hysteria causes unemployment, economic damage and psychological problems. At a very direct level, the current situation is leading to a shortage in blood donation, because all the places where people would normally donate blood are not closed. American doctors are warning that the blood shortage they are faced with, will be killing people. Because America exports blood to other countries, other countries may end up suffering consequences too.

So, today it is my obligation, to dispell the nightmare of every coronadoomer out there: The fear that the high death toll seen in Northern Italy, will somehow be repeated in the rest of Europe, or even the rest of the world, in the absence of some sort of complete lockdown. To understand how Italy ends up with anywhere up to 800 deaths per day attributed to the corona virus, there are three things you need to understand:

  1. Italy has the second oldest population in the world.
  2. Italy is recording every death in a manner that differs from how other countries record deaths from this virus. As a consequence, people are counted as “coronavirus deaths”, who would not be counted as such in other countries.
  3. The extremely high death rate, even for a country with such an old population, is an artifact of a number of unique problems that Italy, particularly the province of Lombardy, is dealing with. In particular, the main problem that Lombardy is dealing with, is the highest air pollution in Europe.

When I go to show to you how these three different factors combine to cause the high rate of deaths recorded by Italy, you will understand that we do not genuinely have to fear that the scenario that has unfolded in Italy, would somehow replicate itself in the United States or other parts of Europe.

Second oldest population in the world

Coronaviruses are not new. There are a number of coronaviruses that are known to circulate in the human population. Most people assume those viruses are comparatively harmless, but in specific groups of elderly the already existing coronaviruses are actually known to be very deadly. With existing Coronaviruses, it is known that upon infecting nursing homes, they can have death rates of up to 8%. As the age goes up in confirmed infections (a small minority of the total number of infections), we see a hockeystick in the death rate:

In Italy, 23% of the population is aged 65 or older. There is just one country in the world, with a share of the population above 65 higher than Italy. That nation, is Japan. Because Italy has such a high share of people aged 65 or older, the death rate seen in Italy is inevitably going to be higher than in other nations. The average age of those who died from this virus in Italy, is 79.5 years. As a consequence, countries with younger populations simply can’t expect to see the kind of death rate Italy has suffered.

Italy records deaths in a different manner from the rest of the world

The Oxford Centre for Evidence-Based Medicine explains that in Italy, deaths are being recorded as “coronavirus deaths”, without an attempt to determine whether those deaths were genuinely caused by the virus. The mere presence of the virus, is sufficient for the death to be included in the statistics. The Centre reports:

Sarah Newy reports  Italy’s death rate might be higher because of how fatalities are recorded.  In Italy, all those who die in hospitals with Coronavirus will be included in the death numbers.  In the article, Professor Walter Ricciardi,  Scientific Adviser to, Italy’s Minister of Health, reports,  “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.”

Recording the numbers of those who die with Coronavirus will inflate the CFR as opposed to those that died from Coronavirus, which will reduce the CFR.

17th March 2020: Report from the Italian National Institute of Health: analysed 355  fatalities and found only three patients (0.8%)  had no prior medical conditions. See Table 1 in the paper; (99% who died had one pre-existing health condition):

  • 49%  had three or  more health conditions
  • 26% had two other ‘pathologies’,
  • 25% had one.

The most common problems in the 355 who died were:

  •  76% high blood pressure.
  •  36%  diabetes,
  •  33%  ischemic heart disease.

So, out of all the deaths that are recorded, just 12% are cases where the doctors bothered to directly attribute the death in a causal manner to the coronavirus. In the other cases, the doctors observed this virus in the patients and registered it. Then once the international media gets a hold of these numbers, these 88% of people in whom doctors did not make a direct causal link to the virus, are reported as if they were coronavirus deaths.

In contrast to what you might think, attributing a cause of death to one particular pathogen, tends to be rather difficult. As people age, the proper functioning of their immune system declines and all sorts of viruses and bacteria become capable of maintaining a presence in their lungs. As the respected scientist Ioaniddis notes:

In an autopsy series that tested for respiratory viruses in specimens from 57 elderly persons who died during the 2016 to 2017 influenza season, influenza viruses were detected in 18% of the specimens, while any kind of respiratory virus was found in 47%. In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.

Other studies have argued that under situations of quarantine the virus appears to spread primarily in hospital settings. Authors of one study wrote: 

These findings indicate that the death risk in Wuhan is estimated to be much higher than those in other areas, which is likely explained by hospital-based transmission. Indeed, past nosocomial outbreaks have been reported to elevate the CFR associated with MERS and SARS outbreaks, where inpatients affected by underlying disease or seniors infected in the hospital setting have raised the CFR to values as high as 20% for a MERS outbreak.

So to help you understand what is going on, let me sketch an example of the kind of plausible situation you can expect to occur in parts of Italy right now. Your 80 year old father in Milan has smoked for decades and developed COPD, Chronic Obstructory Pulmonary Disorder. He is suffering severe symptoms and ends up on the intensive care. While your father is present on the intensive care, overstressed intensive care workers struggle to maintain proper hygiene procedures. Your father ends up exposed to the new Coronavirus as a consequence. Your father dies as a consequence of COPD. However, upon examination, the doctor finds evidence of the presence of Coronavirus, so your father’s death is recorded as part of the Coronavirus statistics. Some nerd on Reddit then observes the latest update of the death toll in Italy and begins to claim that without a total lockdown, the United States will end up where Italy is right now, within two weeks.

Italy is different from the rest of the world

What few people seem to realize, is that Italy suffers from a number of problems, that make Italian elderlu far more susceptible to suffering lung problems, than elderly elsewhere in the world. Let us take the Italian mortality numbers once again. As the days have gone by, the ratio of deaths in Lombardy, as a percentage of the total deaths in Italy, has not changed to any significant degree. Lombardy is intensely overrepresented among Coronavirus associated deaths in Italy. On March 20, 380 deaths of the total 627 that day in Italy were in Lombardy.

Why is Lombardy so hard hit? Well, the capital city of Lombardy is Milan. And Milan has a particular reputation…

 

Milan suffers from extreme air pollution.

In 2018, the World Health Organization reported that Milan has the second highest rate of air pollution of all European cities. The most polluted city in Europe was said to be Turin, another Italian city. The third most polluted city in all of Europe according to the World Health Organization, was Naples.

In 2008, ten years earlier, Milan was named the most polluted city in all of Europe. The Telegraph reported that infant mortality rates in Milan are much higher, because of the extreme level of air pollution. It was estimated by the WHO in 2004, that 9% of non-accident related deaths of people above the age of 30 in Italian cities, are attributed to air pollution.

The problem that Northern Italy in particular suffers is that it is a densely populated wealthy industrialized area, located in a valley. As a consequence, the pollution tends to stay “stuck”. Maps produced by the European Union, also reveal that Milan suffers this problem. Here is a map of PM 2.5, fine particular matter, for all of Europe:

That small dark red spot in Northern Italy, is the capital city of Lombardy, Milan. What you have to understand, is that this area of Italy is unique in Europe, when it comes to how long the local population has been exposed to high levels of air pollution. Year after year, Milan is recorded as the most polluted city in Europe. Italians on social media insist on telling us that if we don’t embark on full lockdowns just like they have, we will soon be suffering from the same situation as them. I would like to tell them to clean up their dirty air. There are a number of other contributing factors, that the Centre for Evidence Based Medicine has pointed out. Italy has the highest rate of antibiotic resistance in the world.

Please spread the word

If you’ve read this article. I’m asking you here to not just read the information, but to spread it. You can link to my post if you want, or you can take the information and publish it in your own format, I honestly don’t care. What is really important right now, is that the hysteria happening around the world right now is addressed. Our civil liberties are under assault. Authoritarians from all around the world have seen an opportunity to increase their control over our lives.

There are things that you and me took for granted, that might disappear and never return. Small businesses that depend on a stable functioning society, are unable to cope with this kind of instability. A second hand bookstore, a vintage clothing store, a coffee shop, these small business owners are bankrupted. The ability to go to a nightclub, the ability to to take your girlfriend out to the cinema, to sit together with a group of friends in the forest, without having to worry what new decree the government might issue this time, without having to worry that someone might give you a fine or a jail sentence, these are the type of things that you and me took for granted, things that today’s teenagers might now lose.

The thing you need to understand, is that throughout history, it is much easier to peacefully surrender freedom and human rights to a government, than to peacefully regain those rights. Who remembers for example, all the new powers that governments gave themselves after 9/11? After bin Laden and ISIS were defeated, did any government announce that they would now stop spying on the general public?

Authority becomes someone’s job. If it’s someone’s job to make sure that you are not wandering outside for no good reason, that person will insist on defending their job. The current measures are said to last until june 1 in my country. But rest assured, if the shoddy science on which this hysteria is based is not debunked, then they will simply extend and renew these measures. When summer is over, they will tell us that the virus will start killing old people again in winter, so we will once again be told that we are not allowed to go outside.

What is at stake here, is the liberty that people gave their lives to protect. We must defend this liberty. If we do not defend the liberty that you and me enjoyed when we were teenagers, then we can only face today’s teenagers with our heads hanging in shame, as we had surrendered everything that we inherited, in a matter of mere weeks. We must not surrender without a fight. The people who did this to us, who are undermining the rule of law, those people must be held accountable.

7 Comments

  1. I’m from Rome, Italy. You completely miss the main point and it is not related to deaths but on the burden the hospitals are undergoing in Italy.

    If 10% of infected people need hospital care, and 0,8% needs ICU (ventilators and other special, intensive care equipment) you need to have them available…

    … and probebly you don’t have them ready now. And can’t have them if the coronavirus spresad in exponential form.

    The lockdown is also for this reason.

    • My friends who are surgeons in hospital are experiencing an overwhelming tide of subjects needing care at the same time. One of them had his father in law die at home out of respiratory complications. It might be true that in the year balance we may have not more than 10% deaths differential compared to 2019 but all is happening in 3 weeks. Where you have a welfare state with an NHS seen as a common good people expect their overlords to step in for everybody. In anarchy there would be price gauging and intensive care scarcity to drive the diligence of the individuals.

      • Something I don’t think many are considering with the honestly oversimplified and naive “flatten the curve” model is what happens when a country does curtail movement considerably, yet nonetheless is unable to push that curve below the line of hospital capacity.

        At that point you’re not just flattening, but also fattening the curve. Instead of having weeks of non-functioning hospitals, you have months. And that will happen because the shelter in place protocols are designed by medical professionals without sufficient input from sociologists or economists or others who know that society simply won’t accept being put on pause for a year and a half, or even six months. People will die en masse from poverty. Most of the pundits, experts, and frankly us online types are ignorant and out of touch with the realities of being poor. They don’t get to socially distance like we do. The poorer one is, the more reliant on community one is. We are inherently more individualistic and we have a hard time imagining the other half of society.

        It’s good to consider the expert opinion of epidemiologists of course, but that isn’t the only field worth considering. It has become bigger than that ever since containment went out the window due to early denial and ignorance.

        We haven’t seen the whole game play out; Italy may have simply ripped off the bandage quickly, and their shrieks of pain dissuade the rest of us. But eighteen months from now Italy may be on the way to recovery while our bandage has started to get infected and sepsis sets in. And we will still have to rip it off eventually, and then the disease will re-emerge and the same thing will happen regardless. But by then many will die from collateral damage as well.

        • I agree, but apparently now it’s the time for scientists and epidemiologist to shine. Others have to shut up. You’ll find Italy to be often a precursor of many social and political phenomenons. You’ll see Italians being the first (I give you maximum 2 months) to question and reject lockdown measures. By simply stopping following the rules

    • According to Dutch experts, Italians send people to the ICU who we would not send to the ICU, simply because they are very old and already have low chances of survival:

      https://www.nu.nl/coronavirus/6039677/deskundigen-coronacijfers-nederland-niet-te-vergelijken-met-andere-landen.html

      In other words, Italians, who have a Catholic conservative culture, are putting elderly people through what we in the Netherlands would consider a lot of unnecessary and undignified suffering with no real chance of success. This is just one more reason why the situation you face should simply not be compared to ours. Italians need to stop forcing their mentality down everyone else’s throats.

  2. I agree, Dutch elders will die a more dignified death holding their family hands. https://youtu.be/rfkbv_WQtn0?t=59 the woman in this video clearly states (although poorly translated by the Brits) that there’s zero chance of wakeing up from intubation and pharma coma. Attaching the patient to a ventilator appears to be more of a death sentence. And yet ALL the countries are rushing to gather or produce more. Not just the Catholic ones. Also, since when Italians are ruling other people minds?

  3. Have you seen Greg Cochran’s response to Ioannidis’ article (https://westhunt.wordpress.com/2020/03/20/john-ioannidis/)? The most salient criticism is that “only 1% will get infected” is implausible on its face and not justified anywhere in the article – as though Ioannidis plucked it out of thin air.

    Also, a subsequent blog post (https://westhunt.wordpress.com/2020/03/25/just-another-flu-in-bergamo/) bears directly on the question of the Italian death rates. In short: the spike in *total* death rate dwarfs the official figures on covid-19 deaths. This suggests that covid-19 deaths are being greatly understated in Italy rather than overstated.

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