Italy simply pays the price of a very elderly and weak population, coupled with a decades-long shrinking of public healthcare. Even in Lombardia, one of the best regions for healthcare, intensive-care units in public hospitals were instructed "in peace time" to run close to capacity as much as possible, in order cut beds and save money. This is how we ended up with less than a third of the capacity of Germany, and when shit hit the fan, it wasn't enough.
(Also, Germany is kinda fudging the numbers. They don't record deaths as Covid-related unless covid was absolutely the only health issue a patient experienced. That's not how victims are recorded in most other countries.)