Why do so many Italians die of Covid-19?

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

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

Another factor: multigenerational homes are particularly common in Italy, potentially exposing older people to infections from their younger relatives.

Since the pandemic began, 95% of those killed by the virus in Italy are over 60 years old and 86% are over 70 years old. Deaths in many other countries have been concentrated among the elderly, but proportionally more in Italy.

Italy’s death toll also looks bad per capita. The country recorded 15.9 coronavirus deaths per 100,000 residents in 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 Disease Prevention and Control.

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

After Italy suppressed the first wave with a long and strict blockade, few Italians believed that the large number of deaths would be repeated. Virus infections slowed down until the summer. Millions of Italians have adopted the mask. Hospitals and the government seemed better prepared.

Italy’s infections remained modest in early autumn, when a second wave of contagion swept through Spain, France and Britain. But as winter began, Italy returned to where it was in March: the worst-hit place in Europe.

On Friday, the Italian government announced another blockade, for the Christmas and New Year holidays, for fear that hospitals could overflow and deaths would increase even more in January.

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

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

Despite policies aimed at housing the elderly, the virus has spread again to nursing homes and hospitals, affecting many people over the age of 65.

However, age alone does not explain Italy’s grim situation. A national health care system that was overworked and understaffed before the pandemic is also to blame, said Antonella Viola, a professor of pathology at the University of Padua.

“Yes, the population is old and fragile and there are pre-existing conditions. But that can’t 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. Family doctors have too many patients to take proper care of each of them. “

In the spring, hospitals in severely affected areas of northern Italy did not have enough beds to treat all patients with severely ill Covid-19. To avoid duplication, the government has tried to increase the number of intensive care beds across the country.

But many hospitals struggled with the influx of patients with Covid-19 this fall anyway because they did not have enough doctors and nurses to care for them, partly a consequence of decades of spending cuts.

And little has been done to improve out-of-hospital care. Many Italian regions have long neglected local health care networks, including family doctors, public health experts say. Thus, many Covid-19 patients staying at home did not receive any support at all. Many seriously ill people come to 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 rural or mountainous areas. removed.

“It is a system that gives priority to hospital care. We have excellent specialized care, such as intensive care and transplant units “, said Guido Marinoni, a representative of Lombardy for the association of Italian doctors. “But everything related to local medicine and prevention was placed in second place. It became clear. “

Since the beginning 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 nonprofit research project based at Oxford University – a higher percentage than in Any other great European country. In Germany, about 1.7% of those who gave positive results gave up.

The actual death rate among infected people is significantly lower, experts say, because many virus carriers are never tested.

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

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

Write to Margherita Stancati at [email protected]