OPINION: A Few Questions About Whether Italy's COVID-19 Mortality Rate Is Inflated

An elderly patient is attended in one of the emergency structures that were set up to ease procedures outside the hospital of Brescia, Northern Italy, Tuesday, March 10, 2020. For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. (Claudio Furlan/LaPresse via AP)

Italy’s mortality rate due to coronavirus — the ratio between deaths and known cases — has been one of the key data points pandemic watchers have used to insist quarantines may last for months and tens of thousands may end up dead in America alone.

But according to Professor Walter Ricciardi, scientific adviser to Italy’s minister of health, Italy’s coronavirus deaths may have been skewed by how doctors in the country report data. In short: Italian doctors are reporting deaths caused by coronavirus even if the patients were already sick from other things. From the Telegraph (emphasis mine):

According to Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, the country’s mortality rate is far higher due to demographics – the nation has the second oldest population worldwide – and the manner in which hospitals record deaths.

“The age of our patients in hospitals is substantially older – the median is 67, while in China it was 46,” Prof Ricciardi says. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality.”

But Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.

“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.

“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.

Did you catch that? Only 12 percent of the deaths that have been attributed to coronavirus in Italy (in hospitals?) are  DIRECTLY caused by the virus. Which leads to a few questions: is it reasonable to think many of those who died were already dying of their pre-morbidities? And, when they passed, if they had contracted the virus (if, more on that below), did Italian doctors in many cases report coronavirus as the cause of death even if their pre-morbidities may have been what ultimately killed them?

To my mind — and I’m no doctor so feel free to dismiss — if the answer to both of those are yes, that possibly means Italy could have vastly overstated the numbers of deaths from coronavirus, which Italy has recently been reporting near a thousand in a single day’s time period.

My question then becomes, since we know Italy was very open about letting its older patients remain untreated as they became overwhelmed by young coronavirus patients, have Italian doctors also been attributing deaths to coronavirus to elderly that died because treatments for other ailments stopped and they became part of the number of deaths counted as being caused by the pandemic even if they didn’t actually contract the virus itself? (Technically they would be victims of the pandemic. Just maybe not victims of the virus itself…) I’ve looked a bit and the answer to that last question is hard to discern.

And I don’t have the answers, I’m just asking questions. But they’re maybe important questions as people wonder when they can start going out again and businesses brace for a recession. None of this is to suggest Italy hasn’t taken the brunt of the virus’ decimation in Europe, and studying what’s going on there, and trying to aid them, isn’t crucial at this time.

But the reporting issue put me in mind of this tweet I saw a few days ago, which was extraordinarily misleading at a time when we need to be extraordinarily accurate. If you click the story link, you find that this soccer coach was also battling leukemia.: