If I read Figure 2 of … the impact of influenza on excess mortality … correctly, the excess mortality due to flu in Italy during the peak weeks of the flu epidemic of 2016–2017 was about 800 deaths/day. This is way more than what is happening with Covid-19 now. How come the health system is so stressed now?

Is it due to geographical distribution (Lombardy!) which Italy could not compensate by moving resources? Or is it a different distribution of deaths vs. being in intensive care? Or what?

  • I’m marking Brian’s answer as a solution (Mark’s one also seems important, but he would not follow-up on my questions…). – Ilya Zakharevich Mar 26 '20 at 1:01

The big difference in Italy today is that many younger, otherwise healthier patients need critical care and more generally that patients need critical care for a long time. These patients are not necessarily dying after they get care, but the extent to which the surviving patients require ventilators and supplemental oxygen is nothing like a seasonal flu and is likely inflating the death rate substantially among those who could otherwise be treated.

From NEJM: https://www.nejm.org/doi/full/10.1056/NEJMp2005492

Contributing to the resource scarcity is the prolonged intubation many of these patients require as they recover from pneumonia — often 15 to 20 days of mechanical ventilation, with several hours spent in the prone position and then, typically, a very slow weaning. In the midst of the outbreak’s peak in northern Italy, as physicians struggled to wean patients off ventilators while others developed severe respiratory decompensation, hospitals had to lower the age cutoff — from 80 to 75 at one hospital, for instance.


You're misreading the study. It's not measuring the number of deaths due to influenza, it's measuring the excess mortality rate during the flu season. This covers not just direct deaths from infection, but secondary deaths such as someone getting the flu, recovering, and then dying from a heart attack caused by the stress of being sick. It can even include highly indirect deaths, such as someone isolating themselves to avoid infection, and dying because they fell down, broke their leg, and couldn't contact anyone for help.

Excess mortality rate is calculated by estimating how many deaths there would have been in the absence of a given cause (eg. a flu season) and then comparing that to the actual number of deaths.

  • Are you essentially saying that the excess mortality of SARS-CoV-2 is actually much more than the official numbers of “immediately attributable” deaths? Can there be guesstimates of “how much larger”? – Ilya Zakharevich Mar 23 '20 at 23:35

Adding another possible explanation (supporting what Mark said): according to an article in L’Eco di Bergamo, the excess mortality from Covid-19 seems to be about 2.2 times more than the official mortality numbers. (Mostly due to the shortage of testing and the rules for ascribing reasons for death. The data is restricted to the most affected region only.)

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