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Pandemic effects go well beyond the official COVID 19 death rate
In the COVID-19 pandemic, various studies have found significant mortality in many regions. The death rate has also increased enormously in a COVID-19 hotspot in Italy. According to a new study, there were more deaths there in March 2020 than in the entire previous year.
Statistics on the infection and mortality rates of the coronavirus are published every day. But the health effects of the pandemic go far beyond the official COVID 19 death rate. This is also shown by a new study by researchers from Germany.
Only half of the deceased were reported as COVID-19 deaths
According to a study by the Charité - Universitätsmedizin Berlin, more residents died in the northern Italian municipality of Nembro in March 2020 alone than in the entire previous year.
According to a statement, only around half of the people who died in the spring were reported as COVID-19 deaths.
According to the experts, the study underlines that the health effects of the pandemic can go well beyond the official COVID 19 deaths - and a look at the overall mortality rate is important for assessing the situation.
The results were published in the specialist magazine "The BMJ".
85 out of 218 infected died
Lombardy in northern Italy is one of the most severely affected regions in Europe by the coronavirus pandemic.
Despite the high official COVID-19 deaths at the height of the wave of infections, however, the local impression was that these numbers could not fully explain the observed burden on the health system.
This is the case in Nembro, a small community with around 11,500 inhabitants in the province of Bergamo, where the first coronavirus cases were reported at the end of February. The number of confirmed infected there rose to 218 by April 11.
By April 16, 85 had died. Overall mortality decreased again in April, presumably mainly due to strict isolation measures.
Mortality examined regardless of the cause of death
A research team led by Prof. Dr. Tobias Kurth, director of the Charité's Institute for Public Health (IPH), examined local mortality regardless of the cause of death in order to better quantify the actual impact of the pandemic on the health system there.
The result of the study, which was carried out in collaboration with the Centro Medico Santagostino in Milan: during the strongest infection in spring 2020, the same number of people died as was known to have died in connection with the novel virus.
For the precise epidemiological calculation of the cause-independent death rate - the so-called overall mortality - the researchers used data from the period between early 2012 and mid-April 2020, which came from several sources: the Italian Statistical Office (ISTAT), the residents' registration office of Nembro and the COVID-19 -Dashboard of Lombardy.
"Nembro is a small town with a very stable population structure and little influx or outflow," explains Prof. Kurth.
"Together with the very good data sources, it offered particularly suitable prerequisites for a reliable descriptive epidemiological analysis on the question of what effects a confusing infection event during the COVID-19 pandemic can have on public health."
Massive increase in death rate
According to statistical analysis, just over 100 people have usually died in the community in recent years. For example, there were a total of 128 and 121 deaths in 2018 and 2019, respectively.
In contrast, 194 people died in Nembro in the three and a half months between January 1, 2020 and April 11, 2020, 151 of them in March alone. This translates to a total monthly mortality rate of around 154 deaths per 1,000 person-years in March 2020 - almost 11 times as many deaths as in March of the previous year when there were 14 deaths per 1,000 person-years.
According to the information, the largest increase in deaths during the wave of infections was recorded in people aged 65 years and over, especially in men. 14 of the deceased were younger than 65 years.
"Given the otherwise very stable overall mortality rate in Nembro, we can only evaluate this very massive increase in the death rate in March 2020 as a result of the coronavirus pandemic," said Marco Piccininni, scientist at the IPH and first author of the study.
However, of the 166 people who died during the wave of infections (late February to early April), only 85 tested positive for the SARS-CoV-2 coronavirus and were officially reported as COVID-19 deaths.
The consequences of the pandemic are much more serious
"This is an enormous discrepancy, which shows that the consequences of the pandemic for the health of the population in Nembro were significantly more serious than the reported COVID-19 deaths suggest," explains Piccininni.
The authors of the study see the reasons for this discrepancy primarily in two factors: First, it is likely that not all coronavirus infections were recognized as such - for example, because the test material was scarce and not all suspected cases were tested by laboratory diagnostics.
A second reason could be that patients with other illnesses had less access to health care: either because the capacity of the health system was already exhausted by COVID-19 cases or because they did not want to go to the hospital because of fear of infection.
"For a precise assessment of the health effects of the pandemic, we should not only look at the confirmed COVID 19 deaths," says Prof. Kurth.
"In order to be able to better adapt the existing containment measures to the situation on site, current data on regional overall mortality should also be taken into account. Unfortunately, data on overall mortality cannot be called up promptly everywhere. I welcome the fact that preliminary data for Germany have recently become available. ”(Ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Charité - Universitätsmedizin Berlin: Northern Italy: COVID-19 death numbers do not fully reflect the effects of the pandemic, (access: May 17, 2020), Charité - Universitätsmedizin Berlin
- Piccininni M, Rohmann JL et al .: Use of all cause mortality to quantify the consequences of covid-19 in Nembro, Lombardy: descriptive study; in: The BMJ, (published: 05.05.2020), The BMJ