Italy, Numbers, and Confusion: Why Is Italy the Hotbed of COVID-19

Stripped of the panic, SARS-CoV-2 and COVID-19 — the new betacoronavirus that originated in China, and the disease the virus caused — are really fascinating, an exciting and important scientific detective story that someone, someday, will get to tell without ritualized stomping by various political factions. Probably not today, but someday.

Just in passing, let's make it easy for the Chinese propaganda arms, both in China and in New York, and note that this is, indeed, a virus from China. Specifically, it's a virus that originated in 中华人民共和国湖北省武汉市 (the city of Wuhan, the province of Hubei, in the People's Republic of China). My preferred abbreviation will continue to be 功流感 (gong1 liu2 gan3) "work influenza" or "kung flu."

Accept no substitutes.

Now, here's one of the most interesting puzzles: Of all the locations with clusters of kung flu infections, Italy is the most active. Astonishingly so, with (as of 3/22/2020 @ 12:13 PM Eastern Daylight Time Z-4) 53,578 confirmed cases, and 4825 deaths. (As always, go to the Johns Hopkins COVID-19 Dashboard for up to date numbers.)

There was a story yesterday asking this very question in The Telegraph.

They identified several things that might be contributing to this:

  • Demographics: Italy is, on average, a country full of old people. According to the CIA World Factbook, Italy is the fifth-oldest country in the world. We know that COVID-19 is more likely to cause death in older people.
  • Comorbidity, that is, association with other diseases: Italy's aging population, as well as being old, also has lots of old people with heart disease, COPD, long histories of smoking, high blood pressure, and diabetes.
  • There's a geographic factor here as well: most of the deaths are coming from heavily industrial Lombardy, which also has a long history of bad air pollution.
  • The most interesting one is that the Italian National Institute of Health thinks the cause of death is being over-identified as COVID-19.

This one is sure to start an argument in the comments, but here's the direct quote:

“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."

And, of course, there's another point: people in Italy apparently really didn't want to be accused of being racist and so didn't respond quickly. At the same time, the Chinese government was busily encouraging Italians to hug Chinese people to fight racism.

So here's the question: how do you decide which cases should be counted as COVID-19 deaths? And are Italian doctors being overaggressive with cause of death or not?

As always with this sort of thing, the question is which way to bet. That's the best you can do. The way to bet here is that it's a combination of demographics, smoking, pollution, and over-diagnosis.

Make of that what you will.

Guessing that Italy represents the way the United States is going to go is not nearly as good a bet, though; we're on average younger, fewer of us smoke, and our population is more spread out.