Why do so many Covid-19 Italians die?

Once again, Italians wonder: why does Covid-19 kill more people here than almost anywhere else?

The answer lies in part in demographics, public health experts say. Italy has one of the oldest populations in the world, only after Japan. Almost one in four Italians is over 65, an age group much more likely to succumb to the disease.

Another factor: Multigenerational homes are especially common in Italy, which can expose older people to infection from their younger relatives.

Since the pandemic began, 95% of deaths from the virus in Italy have been more than 60 years old and 86% more than 70. Deaths in many other countries have also been concentrated among the elderly, but proportionally there are more in Italy.

The death toll in Italy also looks bad per capita. The country has recorded 15.9 coronavirus deaths per 100,000 residents over the past two weeks, compared to 6.3 in Spain, 6.9 in Germany and 8.3 in France, according to the European Center for Prevention and Control. Diseases.

In March, images of army trucks carrying the bodies of Covid-19 victims outside the overflowing city of Bergamo became a symbol of Italy’s tragedy and a warning to the rest of the world. world.

After Italy suppressed the first wave with the help of a long and strict blockade, few Italians thought that the high number of deaths would be repeated. Virus infections were reduced to slaughter in the summer. Millions of Italians adopted the use of masks. Hospitals and government seemed more prepared.

Italy’s infections remained modest even in early autumn, when a second wave of infection swept through Spain, France and the United Kingdom. But when winter begins, Italy is back in March – the hardest hit in Europe.

On Friday, the Italian government announced another closure, during the Christmas and New Year holidays, for fear that hospitals would overflow and deaths would rise further in January.

From December 24 to January 6, bars and restaurants will have to close and there will be restrictions on travel and movement across the country. On specific days, such as Christmas Eve and weekends, most stores must also remain closed.

“Among our experts there are strong fears that the infection curve may increase during the Christmas holidays,” Italian Prime Minister Giuseppe Conte said on Friday in explaining the new rules.

Despite policies aimed at accommodating the elderly, the virus has re-spread to homes and hospitals, affecting many people over the age of 65.

However, age alone does not explain the extreme struggle in Italy. Antonella Viola, a professor of pathology at the University of Padua, is also to blame for a nationwide health care system that had expanded and had few staff before the pandemic.

“Yes, the population is old and fragile and there are pre-existing conditions. But this may not be so different from the rest of Europe, “said Dr Viola.” There is a clear problem in the way local health care is organized. There are too few doctors. GPs have too many patients to care for them properly ”.

In the spring, hospitals in parts of northern Italy that were severely beaten did not have enough beds to care for all seriously ill Covid-19 patients. To prevent recurrence, the government tried to increase the number of intensive care beds across the country.

But many hospitals have struggled with the influx of Covid-19 patients this fall anyway because they didn’t have enough doctors and nurses to care for them, in part as a result of decades of spending cuts.

And little has been done to improve care outside of hospitals. Many Italian regions have long neglected local health care networks, including GPs, public health experts say. Thus, many Covid-19 patients staying home have received little or no support. Many seriously ill people arrive at the hospital too late, if they succeed.

Even in the rich northern region of Lombardy, which has some of the best hospitals in Europe, the local network of doctors and smaller clinics is poorly equipped to care for Covid-19 patients who stay at home, especially in areas remote rural or mountainous.

“It is a system that prioritizes hospital care. We have excellent specialist care, such as ICUs and transplant units, “said Guido Marinoni, Lombardy’s representative for the Italian association of doctors.” But everything to do with local medicine and prevention is he placed second. That has become clear. “

Since the onset of the pandemic, about 3.5% of Italians who tested positive for the virus have died, according to official data collected by Our World in Data, a non-profit research project based at the University of Oxford, a higher percentage than in any other major European country. In Germany, about 1.7% of those who tested positive succumbed.

According to experts, the actual death rate among infected people is significantly lower, as many virus carriers are never tested.

While Italy spent $ 3,650 on health care per capita in 2019, Germany spent $ 6,650, according to data from the Organization for Economic Co-operation and Development. The average expenditure among OECD countries was $ 4,224 per person.

“Germany is better equipped and better prepared overall,” said Luciano Gattinoni, an Italian professor of anesthesiology and intensive care who currently teaches at the German University of Göttingen.

Write to Margherita Stancati to [email protected]