Why is Italy's coronavirus fatality rate so high?

KONFRONTASI-The numbers are dizzying and horrifying. Four hundred and thirty-three dead. Six hundred twenty-seven dead. Seven hundred ninety-three dead.

For weeks now, the daily briefings by Italy's civil protection agency have been providing grim updates on the number of people killed by COVID-19, the highly infectious respiratory disease caused by the new coronavirus, deepening a sense of gloom in a country that has become the deadliest centre of the pandemic.

Despite a series of near-draconian measures gradually rolled out to halt the spread of the virus, including a nationwide lockdown and the shutdown of all non-essential businesses, Italy has been unable to "flatten the curve" - slowing the spread of the contagion in a bid to prevent an already overburdened healthcare system from being overrun.

The country's latest tally reported a total of 6,078 deaths from 63,928 infections, with a world-leading fatality rate of more than 9 percent.

In contrast, in China, where the outbreak originated, the mortality rate stands at 3.8 percent. In Germany, which has reported more than 24,000 cases and 94 deaths, it is at 0.3 percent.

But there may be several reasons for Italy's alarming mortality rate.

"The numbers we have are not representative of the entire infected population," said Massimo Galli, head of the infectious disease unit at Sacco Hospital in Milan, the main city in the worst-hit region of Lombardy where 68 percent of the total national fatalities have been reported.

Galli explained that as the emergency situation rapidly deteriorated over the past month, Italy focused its testing only on people showing severe symptoms in areas with high epidemic intensity - the result, experts say, is that the currently available numbers produce a statistical artefact, a distortion.

"This causes an increase in the fatality rate because it is based on the most severe cases and not on the totality of those infected," Galli said.

The coronavirus may take up to 14 days before an infection flares into symptoms, such as fever and dry cough, and during that incubation period, asymptomatic patients may potentially transmit it. Experts believe it is this so-called "stealth transmission" that has driven the rapid spread of the outbreak, infecting communities that remain unaware until they develop symptoms and get tested.

As of March 15, Italy had carried out about 125,000 tests. In contrast, South Korea - which implemented a strategy of widespread testing - has conducted some 340,000 tests, including for those showing mild or no symptoms at all. It has recorded almost 9,000 infections to date, with a mortality rate of 0.6 percent.

Italy's 'social contact matrix'

While the new coronavirus can infect people of all ages, older adults, whose immune systems have declined with age, appear to be more vulnerable to becoming severely ill after contracting the virus.

In Italy, 85.6 percent of those who have died were over 70, according to the National Institute of Health's (ISS) latest report. 

With 23 percent of Italians over 65 years old, the Mediterannean country has the second-oldest population in the world after Japan - and observers believe age distribution could also have played a role in raising the fatality rate.

Another possible factor is Italy's healthcare system itself, which provides universal coverage and is largely free of charge.

"We have many elderly people with numerous illnesses who were able to live longer thanks to extensive care, but these people were more fragile than others," Galli said, adding that many patients at Sacco Hospital - one of Italy's largest medical centres - who died due to coronavirus were already suffering from other serious diseases.

According to the ISS's latest report tracing the profile of COVID-19 victims, 48 percent of the deceased had an average of three pre-existing illnesses.

Experts also pointed to Italy's "social contact matrix" as another possible reason, although indirect, behind the wider spread of the coronavirus among older people.

"Elderly Italian people, while most of them live by themselves, are not isolated, and their life is characterised by a much more intense interaction with their children and younger population compared to other countries," said Linda Laura Sabbadini, central director of the Italian National Institute of Statistics.

"When such an external shock [such as the coronavirus outbreak] takes place, it's important that these interactions decrease, hence isolating elderly people should have immediately been a priority."

'Forever unprepared'

However, such explanations arising from the peculiarities of the Italian experience - ranging from strong familial ties in a geriatric society to issues surrounding testing practices - should not make other nations complacent, experts warned.

"Other countries should watch closely," said Pierluigi Lopalco, epidemiologist and professor of hygiene at the University of Pisa.

"What we are watching in Italy is the same movie we have already seen in China, where Italy is Hubei and Lombardy is Wuhan," he said, referring respectively to the Chinese province that was sealed off by the authorities, and its capital where the new coronavirus was first detected late last year.

"I am afraid we will be re-watching the same film again in other countries in the coming weeks," warned Lopalco, who is part of a taskforce leading the epidemiological response in Puglia, in southern Italy.

Citing the epidemic curve of other countries, Lopalco suggested that the difference between them and Italy is timing: they are simply at an earlier stage.

"After China, Italy is the first country where the epidemic erupted; hence, we are dealing with the effects of an advanced-stage epidemic."

While many countries are gradually adopting stricter measures to implement social distancing, they have so far resisted taking the same drastic steps as Italy due to significant worries about the economic effects of such moves.

Italian doctors at the centre of the country's battle with the pandemic have warned that the reluctance to act quickly and decisively could have important consequences.

"If I were the head of any country's health ministry I would be terrified, and I would move extremely fast to adopt strict measures to contain it," Galli said, stressing that "in these situations, we all are forever unprepared: it is impossible to be fully ready to handle such events".

Coronavirus prompts 'hysterical, shameful' Sinophobia in Italy

KONFRONTASI-The deadly outbreak of a new coronavirus in China has triggered a "hysterical" and "shameful wave of Sinophobia" in Italy, according to members of the Chinese Italian community and a rights group, with Italians and tourists of Chinese and Asian origin reporting acts of violence, discrimination and harassment.

The incidents include assaults, calls for sexual violence, insults and boycott of businesses.

Italy's Tria says EU forecasts are inaccurate, incomplete

KONFRONTASI-Italian Economy Minister Giovanni Tria on Thursday condemned latest European Commission economic forecasts for Italy, which were worse than Rome’s own data, saying the EU analysis was wrong and limited.

“The European Commission’s forecasts for the Italian deficit are in sharp contrast to those of the Italian government and derive from an inaccurate and incomplete analysis (of the budget),” Tria said in a statement.

Italy's Renzi to resign after referendum rout

KONFRONTASI-Italian Prime Minister Matteo Renzi is set to resign on Monday after suffering a crushing defeat in a referendum over constitutional reform, tipping the euro zone's third-largest economy into political turmoil.

His decision to quit after just two-and-a-half years in office deals a blow to the European Union, already reeling from multiple crises and struggling to overcome anti-establishment forces that have battered the Western world this year.

Italy rescues 13,000 refugees off Libya in peak season

KONFRONTASI-Italy's coastguard and vessels from other European nations have pulled 13,000 refugees from barely seaworthy and overcrowded boats off the Libyan coast in the mere space of four days.

Traffickers are taking advantage of the calm summer weather, piling refugees on to flimsy boats when the sea is more placid so that the southern wind can push them into international waters.

However, the flimsy rubber dinghies that are often used become highly unstable in high seas.

At least 11 killed, dozens injured as trains collide in Italy

KONFRONTASI-At least 11 people died and dozens were injured when two passenger trains collided head-on in southern Italy on Tuesday, a spokesman for the fire service said.

The crash happened on a single stretch of track in countryside between the towns of Corato and Andria. Both trains were made up of four carriages.

An aerial image showed carriages smashed and crumpled by the force of the impact, with debris flung out amongst olive trees which flanked both sides of the track.

Apple to pay Italy €318 million euros to settle tax fraud probe

KONFRONTASI - US-based computer tech giant, Apple has agreed to pay Italy 318 million euros (USD 348 million) to settle a tax dispute after the company came under investigation for suspected fraud.

According to Italy’s tax agency on Tuesday, the company's Italian subsidiary and a number of its senior executives have been under investigation for fraud.

Fraud charges were leveled against Apple after it failed to comply with its obligations to declare its earnings in Italy between 2008 and 2013, AFP reported.

Italy rescues thousands of refugees off Libyan coast

KONFRONTASI-Nearly 4,700 refugees have been rescued off the coast of Libya, as they tried to reach Europe but one woman was found dead, Italy's coastguard said.

The coastguard said in a statement issued on Saturday that it had coordinated 20 rescue operations involving numerous vessels which picked up 4,343 migrants from rubber boats and barges.

In one of the inflatable boats a woman's body was found, the coastguard said, without specifying the possible cause of death.