Doubled mortality rate during the COVID-19 pandemic in italy: quantifying what is not captured by surveillance
Open accessAbstract
Objectives It is important to quantify the true burden of coronavirus disease 2019 (COVID-19) in different countries, to enable informed decisions about imposing and relaxing control measures. COVID-19 surveillance data fails in this respect, as it is influenced by different definitions, control policies and capacities. This article aims to quantify excess mortality and estimate the distribution between COVID-19 and non-COVID-19 causes of death.Study design Observational study and mathematical modelling.Methods Publicly available data from multiple institutional sources were used and an in-depth analysis was carried out of deaths from all causes between 2015 and 2020 in Italy at the national, regional and local level. Excess mortality over time and space was first explored, followed by an assessment of how this related to COVID-19 surveillance and, ultimately, assuming a fixed male:female ratio, a model was developed and applied to estimate the proportions of COVID-19 and non-COVID-19 excess mortality in 2020.Results In Italy, the mortality rate doubled in March and April 2020 compared with data from 2015 to 2019 (+109%, when considering municipalites with >10.000 inhabitants), with excess mortality reaching >600% in large municipalities in northern areas. Notified COVID-19 deaths accounted for only 43.5% (regional range: 43-62%) of excess mortality. It is estimated that more than two-thirds of excess deaths that were not captured by surveillance are non-COVID-19 deaths, which could be a result of the excess burden on the health systems, in addition to reduced demand and supply of other non-COVID healthcare services.Conclusions The impact of COVID-19 during the early stages of the pandemic is much larger than official figures have reported. Monitoring excess mortality helps to capture the full effect of the COVID-19 pandemic, which differs between regions in Italy and which might have resulted in significant indirect effects on the well-being of the population. In addition, the COVID-19 pandemic has also resulted in significant indirect effects on the well-being of the population.
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The Italian data suggest that at least some of the excess deaths were indirect deaths.
“In Italy, the case fatality rate for acute myocardial infarction increased 3-fold during the first wave, while hospitalizations for these conditions decreased by 48% (Odone et al., 2021), suggesting that at least some of the excess deaths were indirect deaths.”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Odone et al., 2021
There was greater disconnect between estimates in hard-hit countries such as the UK, Spain, Italy, and Belgium.
“However, there was greater disconnect between estimates in hard-hit countries such as the UK, Spain, Italy, and Belgium (Kontis et al., 2020; Kontopantelis et al., 2021; Odone et al., 2021).”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Odone et al., 2021
In Italy, the case fatality rate for acute myocardial infarction increased 3-fold during the first wave, while hospitalizations for these conditions decreased by 48%.
“In Italy, the case fatality rate for acute myocardial infarction increased 3-fold during the first wave, while hospitalizations for these conditions decreased by 48% (Odone et al., 2021), suggesting that at least some of the excess deaths were indirect deaths.”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Odone et al., 2021
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- Authors
- Odone, A., Delmonte, D., Gaetti, G., & Signorelli, C.
- Affiliations
- University of Pavia (IT)
- Institute of Materials for Electronics and Magnetism (IT)
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Odone, A.
- Venue
- Public Health
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 190
- Pages
- 108-115
- ISSN
- 0033-3506 (ISSN-L)
- PMC
- PMC7703200
- OpenAlex
- W3107551400
- Cited by
- 34
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 10 · 2021: 12
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Epidemiology › Data-Driven Disease Surveillance
- Keywords
- COVID-19 pandemic, excess mortality, mortality surveillance, underreporting of deaths, health system burden, Italy, regional variation in mortality
- MeSH terms
- COVID-19, SARS-CoV-2, Cause of Death, Cities, Female, Humans, Italy, Male, Models, Theoretical, Mortality, Population Surveillance, Pandemics
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