Thursday, April 2, 2020

COVID-19: Case fatality rate in Italy

Hello everyone, this post explains the factors behind the higher case fatality rate in Italy compared to the other COVID-19 infected countries.

As of today, there are 937,941 coronavirus cases in the world with 47,273 deaths; that comes down to a mortality rate of around 5%. On the other hand, China, the former epicenter of the disease has a COVID-19 case fatality rate of approximately 4%; while Italy has a much higher rate of 11.897%.

Although it is still too early to try to elaborate on the reasons behind this stark discrepancy, I have listed below the three most plausible reasons:

1.  Italy has different demographics, nearly one-fourth of its population comprises of elderly people age 65 years and above. And as we know, this disease is much more fatal in that age group.

2. A universal clear definition of COVID-19 related deaths is not available yet. So the definition Italy has adopted is, “Deaths occurring in patients who test positive for SARS-CoV-2 irrespective of the underlying comorbidities.” Now if a person with ESRD contracts this infection and dies later, he will be labeled as a COVID-19 related death even though his death might have been due to uremia.

3. Earlier in January and February, there was widespread testing of both symptomatic and asymptomatic contacts of infected people in Italy. However, on February 25, the Italian Health Ministry recommended prioritized testing for patients with severe infection requiring hospitalization. Hence, testing of asymptomatic contacts and people with mild symptoms became grossly limited. This reduced the denominator value in calculating the case fatality rate, thereby increasing the net rate magnitude.

Please comment below what do you think is the reason behind the critical situation in Italy.

Thank you :)


Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA. Published online March 23, 2020. doi:10.1001/jama.2020.4683


  1. What about USA & Spain then?
    What are your views on that?

    1. We will cover that too if time permits. We wrote an article on South Korea


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