The case fatality rate is the ratio between number of deaths from a certain disease and total number of people diagnosed with the disease in question. In Italy, the COVID-19 CFR is now approximately 0.1 (see JHU data). According to what recently confirmed by A. Borrelli (executive of the Civil Protection Department) during one of the daily press conferences, the denominator of the above-mentioned ratio must by multiplied AT LEAST by 10 (by now, it’s rather clear how the number of total confirmed cases has been enormously underestimated). Consequently, the CFR already becomes equal to 0.01 (at the most). Borrelli has also manifestly declared that, in estimating the number of deaths, no distinction is currently carried out between patients died WITH COVID-19 (patients who simply tested positive, perhaps even post mortem) and patients who died OF COVID-19. As a consequence, since the number of deaths is still estimated by following the criterion just expounded, even the denominator could soon undergo a reduction. The question is: in your opinion, if the corrections should entail a COVID-19 CFR comparable to the one of a seasonal flu, what should we infer? Could the current Italian (and global) scenario be regarded as compatible with such a value?
The current estimates of numbers of COVID-19 cases and deaths are very inaccurate. The sensitivity and specificity of the diagnostic tests for COVID-19 are not yet known in vivo. There are reports of very high sensitivity and specificity in vitro. However a number of confounding factors (e.g. the stage of illness and the way the swab was taken) mean that the false negative rate of these tests may be high in clinical practice.
The numbers of cases reported will also depend on strategies used for screening. Many countries are only screening symptomatic patients presenting to healthcare facilities. Others are attempting to screen a significant proportion of the population.
I believe the total number of cases of COVID-19 is significantly higher than that being reported. There are many confounding factors (both political and diagnostic) that make the initial number of deaths reported as being due to COVID-19 extremely difficult to interpret.
The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.
Another important factor to consider when trying to interpret variation in mortality rates between countries is differences in cultural interpretation of quality of life. This impacts the social and medical ethics and the delivery, limitation and withdrawal of life sustaining therapies.
In many Western cultures quality of life is valued far more than quantity of life. In those setting limitation and even withdrawal of life sustaining therapies are a common mode of death.
In many Eastern cultures quantity of life is valued more than quality of life. In these settings treatment limitations and withdrawals of therapy are rare. Admission to intensive therapy units and prolonged organ support are common. Mode of death is often cardiac arrest.
These differences are magnified when there are limited resources particularly in Western countries. The social and medical acceptance of treatment limitations is increased; this may significantly increase case fatality rates.
Dear Carmine Cataldo
In my previous article, visible in below indicate address, in which were showed the negative correlation between season flu vaccine and SARS-CoV.2. In brief, a recent military study (https://www.sciencedirect.com/science/article/pii/S0264410X19313647?via%3Dihub), titled "Influenza vaccination and respiratory virus interference among Department of Defense personnel during the 2017-2018 influenza season", report a research addressed on the "phenomenon of vaccine virus interference of the influenza vaccine" showing that military personnel who received the flu vaccine were at 36% increased risk for coronavirus with varied benefit in preventing some strains of the flu. Examining non-influenza viruses specifically, the odds of both coronavirus and human metapneumovirus in vaccinated individuals were significantly higher when compared to unvaccinated individuals (OR = 1.36 and 1.51, respectively)”. Thus, while influenza vaccination offers protection against natural influenza infection, reducing also risk for non-influenza respiratory viruses, providing temporary a non-specific immunity against these viruses, the flu vaccine's "interference" with the naturally biological process, may increase risk of contracting other non-influenza viruses, but also to condition their severity (i.e. coronavirus).
This phenomenon, of vaccine-associated virus interference in which vaccinated individuals may have a increased risk for other respiratory viruses, it's long known. This data can explain a greater severity in elderly population, that are also those most vaccinated. Same consideration must be taken for subjects who receive the flu vaccine as current service members, school teachers, and medical professionals.
https://www.researchgate.net/post/The_novel_Coronavirus_in_N_Italy_Lombardia_COVID19_2019nCoV_SARSCoV2_shows_a_fatality_rate_compatible_with_SARS_Why2
Question is, why different countries of Europe fared differently statistically? Was it due to poor testing and lock-down strategy, population dynamics, or health infrastructure differences or different mutant SARS-CoV-19 or some other X-factor?
Comparing the total number of deaths due to COVID-19 in Europe, UK has the highest deaths, followed by Italy, France, and Spain.
The case fatality rate is diluted by number of tests done and is >10% in most of the Europe except Norway, Denmark, Finland, Austria,and Zcheck Republic.
The Italian outbreak of COVID‐19 cases is a public health emergency and there is a worldwide tremendous interest in the evaluation of the Italian epidemic evolution. Indeed, from February 2020, Italy is facing an explosion of COVID‐19 cases. In particular, the Italian observed case fatality rate (CFR) is much higher than the other countries. Recently, it has been hypothesized that the extensive number of intergenerational contacts – typical of Italian culture – could contribute to explain the high number of deaths observed in Italy. However, through an analysis performed for all the Italian regions, here it is shown that the deaths are localized in specific regions and that the CFRs of different Italian regions are overlapping with the rates of European countries. Moreover, through a correlation analyses between CFRs and different social habits, it is shown that no positive correlation is observed between social behaviours and CFRs. In conclusion, this analyses clearly rejects the possibility that social habits and intergenerational contacts can contribute to explain such a profound effect on the number of deaths observed in Italy during COVID‐19 outbreak and more effort should be addressed to evaluate the real amount of positive cases. This article is protected by copyright. All rights reserved.
The Italian outbreak of COVID‐19 cases is a public health emergency and there is a worldwide tremendous interest in the evaluation of the Italian epidemic evolution. Indeed, from February 2020, Italy is facing an explosion of COVID‐19 cases. In particular, the Italian observed case fatality rate (CFR) is much higher than the other countries. Recently, it has been hypothesized that the extensive number of intergenerational contacts – typical of Italian culture – could contribute to explain the high number of deaths observed in Italy. However, through an analysis performed for all the Italian regions, here it is shown that the deaths are localized in specific regions and that the CFRs of different Italian regions are overlapping with the rates of European countries. Moreover, through a correlation analyses between CFRs and different social habits, it is shown that no positive correlation is observed between social behaviours and CFRs. In conclusion, this analyses clearly rejects the possibility that social habits and intergenerational contacts can contribute to explain such a profound effect on the number of deaths observed in Italy during COVID‐19 outbreak and more effort should be addressed to evaluate the real amount of positive cases. This article is protected by copyright.
The Italian outbreak of COVID‐19 cases is a public health emergency and there is a worldwide tremendous interest in the evaluation of the Italian epidemic evolution. Indeed, from February 2020, Italy is facing an explosion of COVID‐19 cases. In particular, the Italian observed case fatality rate (CFR) is much higher than the other countries. Recently, it has been hypothesized that the extensive number of intergenerational contacts – typical of Italian culture – could contribute to explain the high number of deaths observed in Italy. However, through an analysis performed for all the Italian regions, here it is shown that the deaths are localized in specific regions and that the CFRs of different Italian regions are overlapping with the rates of European countries. Moreover, through a correlation analyses between CFRs and different social habits, it is shown that no positive correlation is observed between social behaviours and CFRs. In conclusion, this analyses clearly rejects the possibility that social habits and intergenerational contacts can contribute to explain such a profound effect on the number of deaths observed in Italy during COVID‐19 outbreak and more effort should be addressed to evaluate the real amount of positive cases.
