EXPLAINED: Why is Italy’s Covid-19 death toll so high?

All available data shows that Italy is currently suffering a particularly high number of Covid-related deaths. But why? And how accurate are the figures? Here's what the experts say.

EXPLAINED: Why is Italy's Covid-19 death toll so high?
Italy has seen more than 50,000 Covid-19 fatalities since the pandemic began. AFP

After data compiled by Johns Hopkins University appeared to show Italy has the third-highest Covid lethality rate in the world, calculated at 3.8 percent, some Italian media reports have suggested this may mean the virus is somehow “worse”, or more lethal, in Italy than elsewhere.

But some Italian health experts questioned the study’s findings, warning that the apparent lethality rate figure “means nothing” because of the way it is calculated.

While Italy is no doubt recording a high number of Covid-related deaths at the moment, does it really have one of the world's highest lethality rates?

Data expert Matteo Villa, a researcher at the Italian Institute for Political Studies in Milan, slammed suggestions by the Italian press that the virus is more lethal in Italy as “terrible”.

“They are using the apparent mortality rate, which as we know means nothing, to argue that in Italy the virus is worse than elsewhere,” he wrote on Twitter.

So what is the “apparent lethality rate”, and what’s the problem with it?

“The index is calculated on the basis of the ratio between deaths and number of positives, and everyone knows that during the so-called first wave, the number of people traced as positive in Italy, the first Western country hit, was dramatically underestimated,” Alberto Zangrillo, Vice Rector of the San Raffaele University Hospital in Milan, said in an interview with Italian news agency Adnkronos.

Italy’s apparent lethality rate (tasso di letalità apparente) in April was estimated at around 12 percent, a figure which researchers said was “almost impossible”. Limited testing at the time was thought to be skewing the figures.

While patients in a serious condition were being tested, it's thought that milder cases often went undetected until testing was later expanded.

Because this “assumed” lethality rate has been viewed as unreliable from the beginning, it has been little-used by researchers in Italy and is not usually mentioned at the health ministry’s press conferences about the coronavirus situation.

Instead of the assumed lethality rate, Italian researchers often look at the “excess” mortality rate to get an idea of what a more plausible number of Covid deaths is likely to be.

READ ALSO: Italy recorded more than 11,000 'excess deaths' in March

A recent report from the Italian Health Ministry showed the total number of all deaths in the country (not only those from Covid) is far higher than the usual figure recorded at this time of year.

The number of “excess” deaths is derived by comparing the number of deaths in Italy in a recent period to the statistical average for that period over the preceding five years.

At the moment, Italy is recording the highest death toll in Europe.

Last week, when a Covid-19 death was recorded in Europe every 17 seconds according to the World Health Organization, Italy had the highest toll on the continent with 753 victims in one day.

The worst-ever daily toll in Italy was 969 deaths, on March 27th.

On Monday Italy joined the United States, Brazil, India, Mexico and the United Kingdom in passing the symbolic 50,000-death mark.

More than 12.000 of those were within the previous 30 days alone.

Why is Italy seeing so many Covid-related deaths?

Health experts say the country’s aged population is one of the main factors.

“In Italy, the percentage of over-70s is 17%, compared to about 10% in the rest of Europe,” Zangrillo said. “And it is known that Sars-CoV-2 affects especially the elderly population in a lethal way.”

According to the latest data from Italy's Higher Health Institute, the average Covid-19 victim is 80 years old. Nearly all have some kind of preexisting condition, and often more than one. Only 1.1 percent of the dead have been under the age of 50.


Villa explained that, in a way, this does mean that in Italy the virus “is worse than elsewhere”.

“We are second in the world for risk of death, just after Japan and just above Greece, Portugal and Germany.”

“But it is because we are old.”

“Obviously the number of Covid-19 deaths is an interaction between the risk of death and the frequency of contagion of the people most at risk,” he added.

“And it also depends on the saturation of the hospital system.”

Instead of comparing Italy’s data with that from the US, UK, or most other European countries, Villa says we should be comparing Italy with “Japan and Germany; countries with almost identical risks.”

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Covid face mask rule on flights in Europe set to be eased

The mandatory EU-wide mask requirement for air travel is set to be dropped from Monday, May 16th, but airlines may still require passengers to wear masks on some or all flights

Covid face mask rule on flights in Europe set to be eased

Europe-wide facemask rules on flights are set to be ditched as early as next week in light of new recommendations from health and air safety experts.

The European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) dropped recommendations for mandatory mask-wearing in airports and during flights in updated Covid-19 safety measures for travel issued on Wednesday, May 11th.

The new rules are expected to be rolled out from Monday, May 16th, but airlines may still continue to require the wearing of masks on some or all of flights. And the updated health safety measures still say that wearing a face mask remains one of the best ways to protect against the transmission of the virus.

The joint EASA/ECDC statement reminded travellers that masks may still be required on flights to destinations in certain countries that still require the wearing of masks on public transport and in transport hubs.

It also recommends that vulnerable passengers should continue to wear a face mask regardless of the rules, ideally an FFP2/N95/KN95 type mask which offers a higher level of protection than a standard surgical mask.

“From next week, face masks will no longer need to be mandatory in air travel in all cases, broadly aligning with the changing requirements of national authorities across Europe for public transport,” EASA executive director Patrick Ky said in the statement. 

“For passengers and air crews, this is a big step forward in the normalisation of air travel. Passengers should however behave responsibly and respect the choices of others around them. And a passenger who is coughing and sneezing should strongly consider wearing a face mask, for the reassurance of those seated nearby.”  

ECDC director Andrea Ammon added: “The development and continuous updates to the Aviation Health Safety Protocol in light of the ongoing Covid-19 pandemic have given travellers and aviation personnel better knowledge of the risks of transmission of SARS-CoV-2 and its variants. 

“While risks do remain, we have seen that non-pharmaceutical interventions and vaccines have allowed our lives to begin to return to normal. 

“While mandatory mask-wearing in all situations is no longer recommended, it is important to be mindful that together with physical distancing and good hand hygiene it is one of the best methods of reducing transmission. 

“The rules and requirements of departure and destination states should be respected and applied consistently, and travel operators should take care to inform passengers of any required measures in a timely manner.”