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tomerico

Italy has an older population, hence more susceptible to deaths and spreading of the virus:

- Average age of death due to Coronavirus in Italy is 82 [1]

- In Italy, 3.65% of the population is 80 or older [2].

- In Korea, 1.75% of the population is 80 or older [3]

[1] https://www.epicentro.iss.it/coronavirus/bollettino/covid-19...

[2] https://www.populationpyramid.net/italy/2019/

[3] https://www.populationpyramid.net/republic-of-korea/2019/

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Something that is not much talked about is the fact that many people apparently die from a sepsis (bacterial) that is caused by the primary infection.

In Italy, it is almost customary to pop medication that contains antibiotics whenever you feel a bit under the weather. I lived in Italy, I experienced this first hand even from my more educated friends.

Because of this Italians have an antibiotics resistance of 26.8% [1].

I do not have data for South Korea but in Germany, where I live, antibiotics are not available over the counter. You always need to see a professional and then they are much more expensive that e.g. in Italy.

The resistance rate here in Germany is 0.4% [1]. That's 67 times (!) lower than in Italy.

[1] https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&He...

This is fascinating, I didn't know that data about antibiotic resistance was available like this, and definitely had no idea there was such huge variation between countries.

Surely this should be considered a major public health emergency in itself?

Are the countries with high percentages taking steps to limit antibiotic use? Coming from the UK the idea of letting people buy antibiotics as easily as painkillers seems crazy.

And what the hell is going on in Greece!?

> Surely this should be considered a major public health emergency in itself?

Indeed. There's an episode of Sam Harris's podcast with Matt MCarthy from last summer. The episode title is The Plague Years, and they go into quite a bit of detail on this sort of thing and ruminate about how low on the radar it is for most people (if it even registers at all), despite the seriousness of the situation.

3.65% / 1.75% ~ 2.09, so the difference in age profile might explain a factor 2 in the mortality ratio of Italy vs South Korea.

The actual ratio is currently 7.9: 827 out of 12462 cases in Italy (6.6%), 66 out of 7869 cases in South Korea (0.84%).

Maybe co-morbidities or general health per age is better in S. Korea.

It's all the kimchi.

How long can the virus survive in a container of kimchi? I truly would like to know.

If you factor in collapse of medical services -- Italy ran out of ventilators / ICU beds--the gap becomes clearer. You have to look at over 60 as more likely to be hospitalized, putting strain on medical system.

This doesn’t account for it because South Korea didn’t even have the number of serious cases that Italy has.

The real answer is simply that the number of tests is not equal to the number of cases.

The number of positive tests is a factor of the number of tests done, and how selective the testing was allowed to be. It is only loosely related to the number of infected people (technically it is the lower bound).

>The real answer is simply that the number of tests is not equal to the number of cases.

Ye olde "3.6 roentgens. Not great but not terrible" factor.

https://m.youtube.com/watch?v=Mg5HOnq7zD0

My comment was directed at age structure of population accounting for difference in mortality, complicated by effective collapse of medical care in certain regions of Italy that meant severe cases that could have been managed because critical and then fatal without ventilation support.

>>"The real answer is simply that the number of tests is not equal to the number of cases."

I think you are right, but, assuming all the deaths are reported, the obvious implication is that the mortality rate is a lot lower than 3%

If fact, looking to Germany, I would say that it's around 0.2, 0.3 %

That would be the good news, the bad news is that it's extremely contagious, probably because nobody is immune to this thing.

Of course, I'm only a random guy in the Internet, so take it with a grain of salt.

I think the current most credible estimate is 0.8%-1%. That's what the UK government has been planning for, for example.

Makes sense, it's difficult to calculate without knowing the number of tests that are being done in every country.

As far as I can tell from the media, Italy has not run out of intensive care units yet. See e.g. this:

https://www.washingtonpost.com/world/europe/italy-coronaviru...

Here are two reports that would indicate that the standard of care has been substantially reduced

https://www.theatlantic.com/ideas/archive/2020/03/who-gets-h... "Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air."

----

https://www.euronews.com/2020/03/12/coronavirus-italy-doctor... "Another nurse working in Lombardy, the Italian region the worst hit by COVID-19, told Euronews the situation was "dire" and far worse than it is being portrayed in the media.

Speaking to Euronews on the condition of anonymity, she said: "We have hundreds of cases in our hospital. Half of our operating block has been dedicated to COVID-19 patients. The situation is dire. Anesthetists – despite them playing it down a little bit on the media – have to choose who they attach to the machine for ventilation, and who they won’t attach to the machines"

---

A first person report from Seattle ICU doctor https://www.facebook.com/marie.e.will/posts/1016307125424515... "Remdesivir might work, some hosps have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, pts improve much more rapidly than expected in usual ARDS. Recommended course is 10d, but due to scarcity all hosps have stopped it when pt clinically out of the woods - none have continued >5d.

I decode this as they have half the amount of Remdesivir they need, only treating for 5 days when recommended course is 10.

The other thing that appears to be going on, and it's also hinted at in report from Seattle, is that old patients are being moved to hospice or "comfort care" who would not have been three months ago because of lack of supplies/personnel/equipment.

Going through your links:

#1 provides no numbers and no details beyond a claim that "They lack machines to ventilate all those gasping for air."

#2 does not even go that far: it speaks of "a huge turnover issue and leaving hospitals at near capacity" (near, not above, contradicting #1)

#3 is from an intensivist in Seattle, Washington, not from Italy.

I chose the Washington Post link because it provides numbers: "Lombardy has just 737 intensive-care beds available for coronavirus patients. More than 600 are filled. [...] The region is racing to bring more beds online; it added 127 on Thursday."

(Lombardy is the region with most cases.)

This is consistent with the claim in your link #2 that hospitals are near capacity (and not above it, as suggested by your link #1).

The point of all this pedantry is simply that I don't think saturation can be invoked yet to explain the high Italian mortality rate.

Addition:

Here's a slightly older Italian source (March 11) which puts nation-wide ICU capacity in Italy at 5090, with 887 in use:

https://www.linkiesta.it/it/article/2020/03/11/italia-corona...

#3 was to show what can happen in one hospital. These patients are hard to transfer. Lombardy is about 9200 sq mi. (about 100 miles square). If you need a ventilator you may not be able to withstand a 50 mile ambulance ride. But I concede I cannot offer conclusive proof that Italy is out of ventilators.

Lombardy started transferring intensive care patients to other regions a week ago:

https://ilmanifesto.it/lombardia-paziente-trasferiti-fuori-r...

from the translation it does not appear they are moving Covid-19 patients: "For the first time, Lombard hospitals have had to resort to the Remote Health Relief Operations Center (CROSS), which intervenes when a region is no longer able to cope with the number of patients and must seek help from other regions. The Civil Protection has ordered that a number of ICU patients in Lombardy for other diseases be transferred to hospitals in neighboring regions."

Note this is first time it's been triggered which indicates it's a difficult and risky process.

Article also notes "The people in charge of intensive care in Lombardy have sent a dramatic appeal to Governor Attilio Fontana: "Healthcare facilities are under greater pressure than any possibility of adequate response", the doctors write. "Despite the enormous commitment of all healthcare personnel and the deployment of all available tools, correct management of the phenomenon is now impossible."

This sounds like a system that's out of ICU beds.

see also https://jamanetwork.com/journals/jama/fullarticle/2763188 "As of March 8, critically ill patients (initially COVID-19–negative patients) have been transferred to receptive ICUs outside the region via a national coordinating emergency office."

> Speaking to Euronews on the condition of anonymity

This should imply heavy fines. Creating panic while covered by anonymity is very easy and it brings no value to society. If officials later on try to bring real numbers nobody listens.

A large number of South Korea infections are even younger due to how it spread.

Italy: Above 80: 1,532 (18.4)% vs age 20-29: 296 (0.0)%

South Korea: Above 80: 243 (3.1)% age 20-29: 2,261 (28.7)%

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

Of note, neither country has had anyone under 30 die. Deaths in the 80+ age range are 8.23% in South Korea and 13.2% in Italy.

PS: South Korea saw 2 deaths under age 50 where Italy has seen 1. So this age is by far the largest factor.

I'm not sure how the media should report on deaths over 80, or even over 90.

It's not that old people aren't worthy of protection, but when you're 85 in the US you have a 10% chance of dying in the next year for any and all reasons.

So saying this disease kills 15% (for example) of 80+ year olds without context sounds horrific, but contextualized in the actual risks of just being very old to begin with, sounds much less scary.

If Italy, for example, were to report on the number of fatal infections in people younger than the natural life expectancy, the fatality rate would drop in half.

you could also say that for people 80 and above, this epidemic will more than double their already significant chances of dying this year...

That's a really hard thing to say this early. For all we know many 80+ people are asymptomatic and most older people aren't negatively affected at all by covid 19. It seems really dangerous to conflate actual mortality rate with mortality rate among the confirmed cases. Those numbers will be drastically different with diseases that have many asymptomatic carriers.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

80+ age category has a 21.9% death rate in confirmed cases.

Of those in that group what % had a pre-existing condition? That is, is it age or age + illness? My sense is it's the latter.

I don't have the numbers ready, but my guesstimate is that about 100% had the pre-existing condition of old age.

My parents are in the range

And they live in Italy

Still the heat wave in 2003 killed 18 thousands people in a month and 15k in France in only half a month.

Old people are vulnerable to many things, unfortunately

> It's not that old people aren't worthy of protection, but when you're 85 in the US you have a 10% chance of dying in the next year for any and all reasons.

Some of the people that die from this would have died anyway, but for the most part this is on top of that 10% chance. Same for young people, there's something like a 0.2 chance of death every year and this is basically doubling that.

Fatality numbers won't reflect those who developed permanent lung damage or had to go into intensive care.

Best not to suggest anything that might down play the seriousness considering how infectious this virus is. (Otherwise it may encourage risky behavior.)

but what about the risks of over-selling this disease? Look at Italy for example. I've read self-reports from healthcare workers claiming 200% hospital capacity. I can only image the needless death resulting from such panic.

Mind you that isn't covid 19 putting them over-capacity. In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds. So it seems incredibly unlikely anything but panic is to blame for such absurdly high over capacity.

Your 10% premise is wrong because you're conflating intensive care capacity and regular hospital beds. You can't just put Covid patients in with the general hospital population and it isn't trivial to convert other hospital beds to the requirements of Covid while ensuring you keep everyone else in the hospital safe from infection. Lombardy does not have anywhere near enough intensive care capacity to handle the cases they've already seen, much less anything further.

You can see that in the death rate, it's happening because they can't care for the volume of older intensive care patients properly. They don't have the medical infrastructure capacity to do it. That's why Italy and other European nations such as France have an extreme variance in mortality rates, despite France and Italy both having similarly old populations. Germany is even older than Italy and I'm skeptical we're going to see anywhere near a 6% mortality rate there (their rate is very low so far). Italy's mortality rate has been abnormally high from the first few thousand cases in, when it quickly began overloading their healthcare system in Lombardy.

A quick google suggests around 15% of hospital beds are ICU and covid 19 cases that end up in the hospital, only 5% end up in ICU. So that's an interesting line of thinking but it lacks supporting evidence that covid 19 is overwhelming ICU.

https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

edit to address your edit: The mortality rate is often wildly inflated with new diseases. That's because most people don't seem to understand real mortality rate vs confirmed cases mortality rate. Obviously when a disease is new the confirmed cases will be confirmed against the people showing serious symptoms. Then when you pretend deaths/confirmed cases == mortality rate you end up with a wildly inflated mortality rate. Until we understand how many people are asymptomatic we won't have a real mortality rate that is reliable.

The ICU beds are also taken by all the other sick people. Only a minority is actually free. And people don’t end up in the ICU because they panic: I spoke to several Italian hospital doctors and they are overwhelmed by the troves of patients who can’t breathe.

I just read an article that claimed Lombardy has 737 ICU beds available for covid 19. Given Italy has a 3.18 beds per 1000 people that means they have less than 3% of their hospital beds available for covid 19 patients. That's absurd. In relation the USA has roughly 14% of their beds as ICU beds according to a reference from https://www.sccm.org/Communications/Critical-Care-Statistics

You seem to think that for some reason, ICU beds go unused except in a situation like this? ICU capacity is probably built to meet some fraction of demand in normal circumstances. Those beds weren't all unused before this outbreak started.

737 ICU beds available isn't the same as the total number of ICU beds. Normal health problems that need hospital treatment (strokes, heart attacks, car accidents, etc.) are still happening during this outbreak (well, car accidents are probably reduced now with Italy's lockdown protocols).

Someone else posted else thread that in UK at any time 80% of all ICU beds are in use. It is likely a similar percentage in Italy.

Right: we do have those ICU beds because people are in them.

Toolz, I just don't understand your math. You seem to assume that a neonatal ICU bed is just as good for a 55-year-old man as an adult one, and that no one is going to have any other ICU-needing illnesses for the duration of this epidemic. That's quite puzzling. Can you support these ideas?

Percentage of ICU beds varies widely. Minnesota, for instance, a state in the US, has about 500 ICU beds [1] and over 10,000 hospital beds total [2]. ICU beds are already heavily used and sometimes there simply are not enough, before COVID-19 has even shown up. Average inpatient stays right now are 4.21 days in Minnesota [3]; I can't find a reliable number for length of stay for COVID-19 patients, but it is longer.

There is plenty of evidence that in Italy COVID-19 has overwhelmed ICU beds. They are trying to transport people to ventilators via helicopter. We do have at least twice the ICU bed capacity in the US (compare info from [4], [5]). But many other people need these ICU beds -- it's not like other illnesses will just stop for our convenience.

[1] https://minnesota.cbslocal.com/2020/03/08/talking-points-pre... [2] https://www.ahd.com/states/hospital_MN.html [3] https://www.mnhospitals.org/mn-hospitals/quick-facts [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/ [5] https://link.springer.com/article/10.1007/s00134-012-2627-8

Edited to add: remember, included in most totals of ICU beds are neonatal and pediatric ICU beds, which won't help much with COVID-19.

> In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds.

Do you have a source for this comment? This WaPo story from 6 hours ago says differently:

https://www.washingtonpost.com/world/europe/italy-coronaviru...

> Giulio Gallera, Lombardy’s health chief, said Thursday that the region would reach its capacity in “five, six or seven days,” even if it tried to add more beds in hospital “cellars.” In an interview with Italy’s La7 channel, Gallera described the possibility of adding 500 intensive-care beds at Milan’s expo center, the kind of rapidly assembled zone that China created in the hard-hit Wuhan area.

lombardy has 7280 confirmed cases [1] lombary has a population of 10MM (wikipedia) italy has 3.18 hospital beds per 1000 [2]

the math for that adds up to 31,800 hospital beds 7280 confirmed cases is 22% - so my sources were off or wiki is wrong as originally I recall reading lombardy has a 16MM population.

I will say that your article claims they haven't run out of ICU beds yet but that number is surprisingly high for ICU needs to cover covid 19. The article implies 600 ICU cases from covid 19 - that's over 12% ICU from confirmed covid 19 cases, which is more than twice what china reported.

It's also very surprising how few ICU beds they have allocated towards ICU....

The USA has something like 14% of hospital beds as ICU beds [3] but Italy appears to only have have less than 3% of their beds available for covid 19 ICU

[1] https://www.statista.com/statistics/1099375/coronavirus-case... [2] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [3] https://www.sccm.org/Communications/Critical-Care-Statistics

Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season most of those beds are already filled. The hospitals may be extrapolating the growth rate of the disease and realizing how soon they will have problems. Or given the nature of the outbreak it could be that even within Lombardy there are areas with much higher concentrations of cases, like there are more cases, inc. per capita, in Wuhan than other cities in Hubei.

What's not plausible is ICU beds being taken up by people who don't have the disease (maybe miild-to-moderate flus or bad colds) and are just panicking. Emergency room lines, sure. Test shortages, absolutely. But hospitals will not put someone who's just scared and doesn't even need to be admitted at all into the ICU.

> Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season

Remember that there's a difference between hospital beds and ICU beds.

In the UK, we maintain 80% utilisation of our ICU beds all year round[0], with very little change in the number of beds available in real number terms. We have ~4100 total ICU beds, which can be expanded to ~5000 if all operating theatres, etc are shut down and used as ICU equivalent instead.

While getting past flu season will help the total number of beds, it does nothing for the ICU.

This is the other reason why it's increasingly important to https://www.FlattenThesCurve.com and employ social distancing techniques. The rate of patients being admitted into ICUs needs to be slowed as much as possible. Once we're out of capacity, every additional patient has a much higher probability of dying than the overall fatality statistics indicate.

[0] https://www.england.nhs.uk/statistics/wp-content/uploads/sit...

There's a typo, it's https://www.flattenthecurve.com/

The NHS regularly has to cancel routine operations in order to free up space for flu patients during the flu season, which might be one reason why the bed usage seems so uniform. Obviously if they're already doing that for flu it leaves less slack in the system if something else comes along.

Italy has about 12.5 ICU beds per 100,000 people. ICU beds are not the same as hospital beds.

https://www.statista.com/chart/21105/number-of-critical-care...

Maybe you shouldn't transfer every confirmed case into hospital since most cases will do just well ... unless they don't. (Not questioning the danger of this virus.)

1. Not every hospital bed is the same as a bed for a highly infectious disease

2. Other things still happen to people and those people need to have their hospital beds.

3. I'm not a hospital planner but I think there may be other things that determine capacity than just hospital beds. I worry that the hospital bed metric is actually a bad metric. Obviously adding hospital beds implies adding people to staff those beds, but also adding people probably also means adding all sorts of other infrastructure to support those people.

As a developer it reminds me of a project that goes way off schedule, you don't bring the project back on track just by adding developers because of the overhead more developers add to your system. Probably most hospital administrators have never actually experienced operating at capacity, so estimations of what would happen could be off and are being corrected now.

Hospitals worldwide have very little spare capacity and even less spare ICU capacity. A normal hospital bed isn’t going to help much. They are very likely to be overwhelmed, especially in countries that have not been able to delay initial spread due to lack of testing and containment.

This probably won’t kill millions (though it could worst case) but hospitals being overwhelmed would lead to an exponential rise in deaths, and many deaths from other causes as other treatments are abandoned. The situation is serious and will require significant measures to bring it under control, it is not yet being taken seriously enough in the US.

Are ICUs even helpful against the disease? I wonder if any triage experiments are being run with randomization.

When you have ADRS ICU treatement is pretty much the only thing keeping you alive. "Randomized trial" in this context means russian roulette - if you don't get a ventilator you'll die almost certainly.

Evidence [0] (partly based on COVID-19, parly on MERS) also says that NIV has a significantly worse outcome than ventilation. People are already getting NIV in some hospitals because they ran out of tubed ventilators.

[0] https://www.who.int/docs/default-source/coronaviruse/clinica...

Permanent lung damage? Link please?

It's far too early to draw any conclusions, but the HK Hospital Authority has suggested that they are seeing reduced lung function in some "recovered" patients.

https://www.scmp.com/news/hong-kong/health-environment/artic...

I think it's best not to overstate like the media currently has been (at least here in the USA) which is that everyone should be panicky and worried if they'll be alive next week.

You will not feel this way when you're 80

The problem is that this disease forces everyone to pretend they are 80. Give the old the care they need but don't drag down the young.

Also when 85+ year olds die for other reasons, they don't all occupy ICUs for days or even weeks as in the case of COVID-19.

An additional factor in why the death rate is so high in >75 year olds is that most deaths happen when ICUs are overwhelmed, and older ages get triaged into not getting a ventilator. There is a much higher rate for them naturally, but this amplifies the disparity even more.

I'm surprised to hear someone be so blunt about their ageism. This thing has brought about a great deal of it already, with many saying, " it only affects the elderly" as if that's a worthwhile argument for not being too worried. Reminds one of indifference to AIDS in the 80s because it "only affects homosexuals"

A large number of South Korea infections are even younger due to how it spread.

Another possibility is that Italy doesn't have a handle on who is or isn't infected so what they report are the obvious infections, who tend to be older.

In many (technically former) "red zones", especially in Lombardy, they tested also asyntomatic family members of infected people, or their contacts. I'm not sure how inaccurate it is, but I have no idea what has been done in SK.

South Korea traces the movement of everyone who tests positive, puts the movements online and tests those who were exposed to someone positive (this is in the article I believe). It's a massive effort but with the world economy at a stand-still, what else do people have to do?

North Italy has a population of 27 people btw so the 10K that are registered as positive as a drop in the bucket.

I guess I'm lucky enough to know one of these 27 people.

Fine, 27M(million)

"Why must I always explain" Bob Dylan

It is possible you are right. IIRC, 17% of those tested were positive in Italy. That's a very high percentage. Very likely the actual infected number is much higher.

Yup, you probably only have to look at the counts of infected tourists coming back. In Norway that is 89 from Italy, and 112 from Austria (25% of the total infected as of writing...)

Is Norway testing everybody coming back into the country?

No. In fact they just revised their testing criteria and will not test most people who are asked to quarantine at home. Testing is expected for people who have acute respiratory illness, people who are hospitalized, health care workers handling these cases, and immune-compromised people with mild symptoms.

True, same here, in The Netherlands. Of the first 500 reported cases, around 25% were tourists returning from the Alps region (northern Italy, western Austria), and around 50% were traced to secondary infections from those first 25%. The other 25% were unexplained, hence we're now in the endemic spread phase.

FAFAIK, we've never had a policy to pre-emptively test every returning tourist, and even now we don't test everybody. The current policy is to test new cases only if they have no relation to an already-established case. For example, people living in the same house as a known Corona case will not get tested. If they start showing symptoms, they're automatically assumed to have contracted it.

>Another possibility is that Italy doesn't have a handle on who is or isn't infected so what they report are the obvious infections, who tend to be older.

This is very likely the case, as can be seen in the positive test outcome rates.

16.7% in Italy vs. 3.6% in South Korea

Italy has run around 60k tests.

South Korea are testing around 15k people/day and have tested 234k people in total. They've even setup drive-through testing centers where anyone can drive through, get tested, and get results via SMS in under a day.

The result of this is likely a much larger number of asymptomatic or mild cases in the South Korean numbers, which based on the China data, tend to be a lot younger.

https://www.cdc.go.kr/board/board.es?mid=&bid=0030

https://github.com/pcm-dpc/COVID-19/blob/master/schede-riepi...

This makes sense. Now that Italy has ramped up testing to 13k per day we should see a correction in due course.

So if we assume a similar death rate, we could use the deaths to estimate how many are actually infected in Italy?

Yes, not only in Italy, but in most other places. This article explains well how deaths (or hospitalizations) are correlated to actual infections (most of which go unnoticed), and also why reduction of social interaction is effective but its effects take a while to show:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

Nice - or as satisfying as something can be under the horrible circumstances - this is exactly what I've been arguing here.

Yup. Meanwhile, the New York Times has run an article about how northern Italy is "a warning to the world" with the eye-catching claim that "about 50 percent of the people who tested positive for the virus required some form of hospitalization": https://www.nytimes.com/2020/03/12/world/europe/12italy-coro... Between this and other reporting, I'm starting to wish they hadn't opened up their paywall for coronavirus articles.

It’s unlikely that 14,000 infected 20-29 year olds where missed as a significant fraction end up in the ICU. Which means even if the ratio is off, the breakdowns are still significantly different.

The numbers for 20-29 are probably not comparable. South Korea has been testing a lot of people per day. Italy, like many other countries, is overwhelmed, so there are probably many healthy-feeling infected 20-somethings who haven't been tested and aren't counted.

Except if the increased rate of death is from the medical system being over capacity.... this still wouldn't be a good test of quality of their responses, but more just revealing the capacity of their medical system.

The infection in Italy started in hospital or in retirement home (I don't remember which), so the first infected were people > 70.

In South Korea it started in a cult, where most people were young < 40, and moslty women (which have less CFR than man for COVID-19).

And the rest was South Korean lack of regard for privacy (they have a map for each case where you can trace where and when a given infected person was - so you can check if you were near him/her) and technological superiority.

> The infection in Italy started in hospital or in retirement home (I don't remember which), so the first infected were people > 70.

Italy's patient #1 is 38 (see the article). Patient #0 has not been identified.

> In South Korea it started in a cult, where most people were young < 40

That would be the Shincheonji Church of Jesus:

https://en.wikipedia.org/wiki/Shincheonji_Church_of_Jesus#As...

I don't know what their age profile is, but the outbreak began with a 61-year old ("Patient 31"), and several people mentioned here are above 50 (the founder is 88):

https://www.nytimes.com/2020/03/10/world/asia/south-korea-co...

About 80% of South Korean cases were less than 60 years old, with a peak in the 20s [1]. It is widely rumored that Shincheonji prefers to recruit young people who are easier to exploit.

[1] https://coronaboard.kr/#age-card

My guess is that there are a lot of unreported cases in Italy while in Korea authorities seem to ran more vigorously tests. So the latter might have much more accurate numbers than the former.

More rigorous tests than Italy, seriously?

Yes and yes

> More rigorous tests than Italy, seriously?

SK leads the world. 3,692 / 1MM pop vs Italy 826 / 1MM pop.

Source: https://www.vox.com/science-and-health/2020/3/12/21175034/co...

You say "rigorous tests" OP said "vigorously tests". Very different meaning. The test in both countries is essentially the same, and thus the same rigor (in terms of sensitivity and specificity). The vigor by which the testing was performed (in terms of #people tested as a % of total pop) is WAY WAY higher in S. Korea.

South Korea used to be at about the same development index as Italy maybe...20 years ago? Today it's tied with Israel (as of 2018) and above Spain, France, and Italy.

The PPP is also about 10% higher than Italy and has about half the unemployment rate.

Most importantly it has one of the most advanced healthcare systems in the world. https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...

South Korea also has 4x as many hospital beds per 1000 people as Italy does.

They still suffered a shortage of hospital beds in the hard-hit area around Daegu, so much so that some people died while waiting.

Italy and other countries with fewer hospital beds will have to resort to what China did: build makeshift hospitals, fast.

https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...

Afaik they’ve already started with that in one the affected regions.

Yeah, I also heard that China is sending to Italy the materials they don't need anymore, since they started dismantling the temporary hospitals in Wuhan. That would be very helpful.

>temporary hospitals

were not hospitals at all, just isolation units for temp quarantine

That seems the obvious explaination.

Please don't conflate case fatality rate with actual fatality rate. South Korea has almost certainly just had more time and "medical bandwidth" to find more of the minor and asymptomatic infections that make up potentially 80%+ of the total, and turn them into cases by diagnosing them.

I thought that actual fatality rate is always higher than measured in case of exponentially growing pandemics. Just imagine the case where it takes 20 days for people to die. Your calculations of fatality rate this early in the disease would be conservative.

A far bigger factor in a disease like this, where 80%+ of people have mild illness, is all the people that were never recorded as cases because their symptoms were too mild or were non-existent.

People want to use CFR as a measure of how worried they should be, or as some kind of comparison between countries, and it's totally inappropriate for either purpose.

If they are never recorded does that not mean they infect more people and that results in sicker population creating more burden to the health system - resulting in more deaths?

The statistics always seem to go up no matter what kind of interpretation.

The point is that deaths - the numerator of the case fatality rate - are basically always recorded, whereas cases - the denominator of the case fatality rate - represent only a subset of the people that are infected.

When the health system is severely overburdened, that subset because a smaller and smaller proportion, as scarce resources are used for testing of people presenting at hospitals rather than population-based testing.

People who are asymptomatic or have minor symptoms don't present at a hospital, so they don't get tested, so they never get recorded as a case (which, by definition, requires a test and a diagnosis).

The real population fatality rates are guaranteed to be lower than the CFR unless you believe that every person who is infected is being tested and diagnosed, and it's my opinion that they'll be much lower.

It's also easier to leave Italy and spread the disease because it doesn't have a DMZ in the North and lots of migrant workers and other EU nationals, free to leave at any time. Some have fled the lockdown using ferries through Croatia or Greece and then on to their home countries. When the North was quarantined, many Italians irresponsibly fled to the South, prompting the authorities to issue a country wide lockdown. Good luck trying to escape by ferry from Korea to Japan, Russia or China in the middle of a pandemic. North Korea is out of the question. Also Koreans are likely to obey the rules imposed during a healty emergency crisis (they also has a MERS epidemic in 2015), while Italians are more likely dismiss them as nonsense.

There are also cultural differences, Italians like to hang out in groups, outside, personal space is much smaller, people hug and kiss and touch all the time. Also they're not really the most disciplined nation, lots of them simply ignored the safety rules, continued to go out, there were even some cases where infected people run away from quarantine.

And additionally the spread of virus is not uniform as it depends on social circles, so it's very hard to compare the situations using just general population stats. In South Korea one of the early patients infected more than a thousand other people, while some patients infected no one else or only a few. It's totally random event, and a few patients like that can create a huge differences in the spread of the disease. In Italy they've had the bad luck that early on virus got into hospitals and retirement homes, so the most sensitive population was massively affected.

I think there is another factor as well: have a look at train stations during rush hour on East Asia currently vs. Europe. 1) the density is significantly higher but 2) nearly everyone is wearing surgical masks now. I think that mask wearing is an effective measure to slow down the spread, acting at the sender side rather than the receiver (which Western people tend to focus on). You can see a similarly lower exponential spread in other Asian nations compared to Europe and I think that masks plus a lesser degree of body contact can explain this largely.

Part of the problem is that pretty much everybody in East Asia already owned at least one mask.

In Europe pretty much nobody owned a mask prior to COVID-19. And masks have been sold out for weeks. If masks were easily available you'd see people wearing them I'm sure.

At least in The Netherlands there are still plenty of masks to be found. You won't find the surgical masks anymore but masks for construction work is still plenty available.

I think most europeans look down on wearing masks as something stupid, most europeans also think hand sanitizer is stupid. (This just applies to my dutch family and friends over there, I am currently in Thailand and always wearing a mask and hand sanitizer)

This is partly an effect of cultural issues related to immunity and how it's perceived in most europe countries.

Even putting aside the whole deliberate sharing germs and force building body resistance, wearing a mask is seen as anti-social, somewhat selfish, weak and alarming.

People's reactions to a mask is really ranging from "you shouldn't wear it at all, we're among friends (at work)" to "if you're that ill you shouldn't get out of your home and take a sick leave". There few middle ground, accepting wearing a mask just in a case, or for some benign infection.

You can't know who has the virus so everyone has to wear the mask to prevent the spread.

Except no one seems to wear them fully correctly, and a lot of people don't have the proper rating of mask. Not to mention theres a limited supply of masks.

Did they infect 1000 people, or were they the index case for a group of 1000?

They seem to have infected hundreds at minimum, a few thousand potentially. They are the index case for up to 80% of the infections in South Kore. https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTER...

>In South Korea one of the early patients infected more than a thousand other people

Really? That's horrifying. Any links about that?

https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTER...

The part of Italy hit also has air quality, per aqi searches, that is comparable to the region in China that was hit hard.

Have people looked that it is not age, but baseline damage to your lungs that is the main factor in serious cases? Older people will have more exposure to local air pollution, just from having lived longer. That existing damage can be what contributes to complications, right?

I wonder if and how long-term smokers are skewing the stats.

That hinges a lot on if I'm right. Which is still unlikely, as much as I'm find of my own opinions. :)

Source? Right now air in Wuhan [0] seems to be significantly worse than Milan [1]. Both cities are under some level of quarantine, but it has been stricter and going on for much longer in Wuhan. Chinese sources say that the air in Wuhan is much better than it was before the quarantine. We can assume that the difference between the two cities would be even larger during normal activity.

Edit: Milan is much closer to Seoul [2] than to Wuhan.

[0]: https://www.airvisual.com/china/hubei/wuhan

[1]: https://www.airvisual.com/italy/lombardy/milano

[2]: https://www.airvisual.com/south-korea/seoul

I used those sites and looked at daily historical. I grant that China was strictly worse. But Milan is strictly worse than everywhere else getting hit.

Edit: and the air being better after the quarantine would support my hypothesis. It wasn't that that helped, but the better air. (Which is still very bad)

The daily historical on that website goes back to February 12th. Wuhan has been in lockdown since January 23.

I'm now on my phone, but the site I used went back longer. I'll compare when I can.

And again, China was worse. Italy is just worse than all places I checked that had a lot of cases, but not as many severe cases.

For reference, this is the site I found that went back farther. Milan is not constant days of 150, as Hubei is. That said, it is littered with many high value days. Contrasted with Seattle, which has been steady below 60 for the time period.

Take this over to Australia [below], and you can see that even they had terrible air as recently as mid January.

Contrast to Norway [also below], which has hovered on fine air quality for the entire time. Same for Japan, all told.

Basically, the worse your air quality, the more severe cases you are seeing. To a marked degree.

Edit: Just eyeballing, Milan is worse than Seoul. Agreed not as bad as Hubei. But between.

Seattle: https://air-quality.com/place/united-states/seattle/9e80e347

Hubei: https://air-quality.com/place/china/hubei/7991f3c2

Milan: https://air-quality.com/place/italy/metropolitan-city-of-mil...

Australia: https://air-quality.com/place/australia/victoria/def9c265

Norway: https://air-quality.com/place/norway/troms/a70875e7

Japan: https://air-quality.com/place/japan/tokyo/c8969bc2

No, the far more likely explanation is that the total number of cases reported for Italy don't reflect reality.

Because they are overwhelmed Italian hospitals basically send people home if they have a fever or other symptoms with no test administered, instructed to come back in case the symptoms worsen, only people having trouble breathing being admitted in the ICU.

Italy could easily have in reality 10 times the number of reported total cases or more.

Just look at how many people from other other countries got infected in northern Italy a few weeks ago. Italy had diagnosed a few hundred cases, yet suddenly hundreds and hundreds of people who were in the area and have returned home now have it in other countries. It's clearly far more highly prevalent than testing suggests.

> Because they are overwhelmed Italian hospitals basically send people home if they have a fever or other symptoms with no test administered,

Sources, please.

> only people having trouble breathing being admitted in the ICU.

Well, why would you put someone without respiratory failure in an ICU to egin with?

Also, Italy performs 1 test per 1000 people [1]. Surely there are more cases than the reported ones, but 10 times? I am no statistician, but wouldn't it require extreme bad luck to miss so many cases with such extensive testing?

[1] https://www.worldometers.info/coronavirus/covid-19-testing/

Did they test random people or only people with symptoms? If the latter then your distribution is heavily biased and a 10x difference is not an outlier, it's the expected outcome.

According to those stats 14% of people tested were positive and of those, about half had to be admitted to hospital. It's clearly very far from a random sample.

Also keep in mind that the false negatives for the tests is pretty high, because the tests require a significant viral load in the blood and in some cases it can take several days after the symptoms set in.

As posted else thread, the percentage of positive tests in Italy is almost 5 times larger than in Korea. This probably means that the infected population is much higher than what's being reported.

In the initial weeks of the crisis, the Italian government said that they would switch to only reporting symptomatic cases [1] ("because that what every body else is doing") instead of all positive tests. I do not know if they followed through, but that would make a large difference if Korea was reporting everything.

edit: as far as I understand, that only changes what they report in the official numbers that make the news. The actual medical data might contain the real numbers.

edit2: if they started doing what they said they would, the actual positive rate would be even higher. So the issue is likely that they are just not testing as much.

[1] https://www.wired.it/scienza/medicina/2020/02/28/coronavirus... (in Italian)

> This probably means that the infected population is much higher than what's being reported.

Agree, is the logical thing. The bigger the sample, the better the results.

Another possible option could be that caucasian people is more susceptible for some reasons than asian people. The reasons could be genetic or cultural (i.e previous exposition to similar viruses by gastronomy). Without more data, I would take the first option as closer to truth.

A big part of the answer is in the article: SK have tested 5 times more people so picked up more mild cases in their stats

Yeah, but they've also been able to significantly slow the spread, growing at what looks to be closer to 10% day-over-day (doubling every week). Most everywhere else is seeing 25-35% (doubling every 2-3 days).

New cases in SK are on a downward trend for around 10 days now. They achieved a reproduction value that is quite a bit below for at least the last 3 weeks.

These go hand in hand. In the US we cannot slow the spread because we refuse to test anyone who doesn't need acute care or who doesn't have documented contact with travelers or foreign nationals. The research from Helen Chu's lab at University of Washington shows that this means we missed the start of community transmission entirely in Washington.

Here, there are health care workers who can't get a test! They deal with people with significant health problems every day and could be spreading it all over -- but because they didn't travel, they can't get a test.

The massive shortage of tests doesn't help either.

There's plenty of blame, but I'd assign most of it to US politics.

https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...

SK has 12 hospital beds per 1,000 people vs 3 in Italy.

I can understand how it is more susceptible to death but I don't see the connection with spreading. Old people tend to move about much less and none of the references support that older people are in any way more responsible for spreading the virus.

I think much better explanation would be that Italy has a lot of tourism, it is basically a tourism hub for northern and eastern Europe. Tourism == a lot of people moving about, very frequently, then leaving the country. Almost all initial cases here in Poland seem to be connected with somebody coming back from vacation in Italy.

It's not just the deaths now, but the trajectory. Korea has this under control, Italy won't for another 1-2 weeks.

More susceptible to deaths I understand, but is an older population more susceptible to spreading of the virus? Is probability of "infection given exposure" (as opposed to being a carrier) also greater with age? (I know that's true for kids, but hadn't heard if that trend continues across all age ranges.)

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