Under the lens the way of counting the victims, the parameters of comparison, but also the campaign on the fourth dose, not very effective. The Istituto Superiore di Sanit also responds to the Courier on antiviral drugs and the measures taken
Why Italy matters so many deaths from Covid compared to other countries? a question that has been chasing us since the first wave, but that we might not have expected in this part of the summer.
In Italy there are currently about 174,722 deaths from Covid and this figure, albeit re-measured on the population, places our country among the worst in Europe and in the Western world: better than us Spain, Belgium, UK. Worse: the USA, Brazil and the states of Eastern Europe (see the graph below which expresses the total deaths per million people in selected countries).
A necessary premise that the wave of deaths linked to the last rise of the summer infections, however, was the one with the peak (exceeded in early August) lowest of allexcept for the (similar) plateau period of last April.
What do these numbers tell us? More than talking about the total number of deaths it would be better to talk about lethality rate, that is the percentage ratio between deaths and infections by Covid certificates, which for Italy at 0,81% (see graph below). Also in this case France (0.45%), Germany (0.46%) and the United Kingdom (0.80%) do better than our country and only Spain, but above all the USA and the countries of Eastern Europe, do (a lot ) worse than ours.
It should be noted that the two numbers, the data on deaths and the lethality rate, in turn depend on how the deaths from Covid are counted and recorded eh positive. For example, if we only took into account the summer wave, we should remember that many people infected with Covid did not register and therefore did not enter the count.
How are the deaths from Covid currently classified in Italy?
To answer this and other questions, Corriere Salute contacted the Istituto Superiore di Sanit (ISS) in the person of Graziano Onder, geriatrician.
Since May 2020 we have adopted the classification according to international parameters, the rule provides that only those in which the infection is recognized as a plausible cause of death are classified as “deaths from Covid-19”.
They are people who may have also died of other infections, such as pneumonia or flu, but in this case it was Covid?
They are very fragile and very vulnerable people in which any event can lead to very severe consequences, in their case the event was Covid.
Why does Italy count so many deaths compared to other European countries?
The comparison between the various countries should not be done only on the basis of the absolute number of deaths or the rate of lethality, because each country counts deaths in a slightly different way. Furthermore, the number of victims must be contextualized on the basis of epidemic waves, which may not coincide in time between the different States. The real parameter on which to make international comparisons is that of excess mortality: how many more deaths we had compared to the average of the years in which we did not have Covid. This is a more standardized and comparable figure. Currently monitoring goes up to June when, for example, Italy was much better positioned than other countries.
In fact, the pandemic in June in Italy was in its downward phase (the lowest) and the excess mortality (data taken from Eurostat, see table above) was measured in negative -1.1% than expected, better than France or Germany. If we take for the excess mortality at the Italian pandemic peak of winter (early February) excess mortality was estimated at 7.7%in any case better than France and Greece, but worse than Germany (3.2%) or Austria (minus 2.5%), but these countries were emerging from a heavy lockdown.
In short, the numbers are difficult to interpret because they seem to give absolute results, but in reality they hide myriads of factors to be analyzed and which intersect.
Who are the dead of this summer wave?
The deceased of this wave are people who have a very high average age – replies Onder -, about 85 years and a high burden of pre-existing chronic diseases (4-5 chronic diseases on average), so they are very fragile people in whom any type of event that can be even trivial, such as a flu, can cause very serious consequences, on the other hand they can be people who may not be able to develop sufficient immunity from vaccination: these two factors cause them to die as a consequence of Covid infection.
This consideration is even more important when looking at deaths by dividing them by age group. We know that Covid is especially dangerous for the elderly: indeed the lethality rate calculated by age group (source ISS) reports:
0.8% – 60/69 years;
2.7% – 70/79 years;
7,6% – 80/89;
14.1% – 90 years and over.
As you can see, very high especially from 70 years upwards. In Italy, while the primary vaccination campaign (the first two doses) had great success, with 84.3% of the population reached, the boosters were not as successful: we are at 67.6% with the third dose and only 4.8% with the fourth. Just the elderly should undergo the fourth dose: most of the third doses in Italy have been made between December and Januarytherefore, vaccination efficacy in the summer and the consequent protection from severe disease have now drastically dropped.
The vaccine efficacy of 3 doses received for more than 120 days against severe illness (ISS data of 12 August) divided into age groups:
60.2% for 60-79 year olds;
79.0% for people aged 80 and over.
The same vaccine efficacy with the fourth dose sale a:
84.3% for 60-79 year olds;
89.9% for people aged 80 and over.
Faced with this, very few elderly people have joined the campaign for the fourth dose which started in different phases: in April frail and over 80 and (only) in August over 60. Here are the percentages of the fourth dose by age:
7.5% – 60/69 years;
13.4% – 70/79 years;
31.2% – 80 years and over.
We had an unexpected summer wave perhaps, but the campaign for the fourth dose did not work and for some age groups it even started late. Could you have done more and sooner?
Surely there may have been a perception that infections would drop in the summer. We have worked well on the primary course of vaccinations, but the figures for the fourth dose are very low. Above all, the new vaccination campaign will be key, the one that will start from September-October with the vaccines modified for the new variants.
The low adherence to the fourth dose is only one factor that could explain the number of deaths in our country, but there are others and they together give an idea of the reasons that could be at the basis of mortality, beyond the position of ‘Italy before or after the other states.
We wrote about vaccinations, another variable is anti Covid therapies.
We have few but effective antiviral drugs that work well. For example, the Paxlovid: despite being available, was it little prescribed?
Personally I do not have data in hand that allow me to say that it has been poorly prescribed – says the specialist -. also available to general practitioners who can prescribe it and a medicine that objectively has an important impact on the events of the disease. At this moment it is impossible to say whether or not it was prescribed to the victims. Certainly, however, some reasoning on this must be done. In Italy the best therapeutic means are available as in any other Western country. It is also true that it depends on the context: there will be doctors who have not prescribed it or who prescribe it in an inappropriate way, but it is impossible to generalize.
Staying on drugs, is it not possible that self-prescription (aided by the consultation of false and unreliable news on the internet) has worsened the prognosis of some people?
It is clear that the recommendation to contact the official channels to establish the therapeutic process. For example, Paxlovid should be taken by people at high risk in the early stages of the disease, when there are very subtle symptoms. On the contrary, cortisone taken in the initial stages of the infection can also be harmful. Do-it-yourself is dangerous: more than comparing protocols on the Internet, you need to consult your doctor.
Is there a pejorative factor in this specific wave linked to territorial or hospital healthcare?
No, I don’t think so: at this stage the hospitals are not overloaded. We had a problem with health facilities in the first wave, but not now.
In light of all the considerations expressed, the measures taken were correct, what to do in the autumn?
The measures given by the government are clear and important: even now the use of the mask is strictly recommended, especially indoors. Certainly it is no longer mandatory, but these are always recommendations of extreme caution and attention. In the autumn, Italy expects updated vaccines that will play a key role in reducing the impact of the infection on hospitalizations and deaths in the next epidemic waves. Whether or not the measures now recommended are obligatory will depend on what we are faced with.
August 22, 2022 (change August 22, 2022 | 15:56)
© Time.News