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So many question marks, we still do not know in depth Sars-CoV-2 and Covid-19. We had never heard of them until a year ago. And science takes time. “Looking at the data on the deaths of Covid-19 asks us many questions. We do not sleep at night with this high lethality that seems to characterize Italy and Europe. We travel to conferences, we know what the Asian medical situation is, and the discrepancy” Del The impact of Covid-19 “makes us reflect. There is something that escapes us. We have to look to the East to understand it. Like Marco Polo, we have to make a scientific ‘journey’ in that direction to learn what we lack.” This is the reflection of Giovanni Landoni, professor who coordinates the research activity in anesthesia and resuscitation at the Irccs San Raffaele hospital in Milan and at the Vita-Salute San Raffaele university, first author of a study – in a study carried out with Russian colleagues – in which we try to explain the extreme variability that characterizes Covid mortality in different countries of the world and the gap between the East and
West on this front.
What we don’t know about the coronavirus
Why are Asian countries beating the western world in controlling the Covid-19 pandemic? To weight could be more factors ranging from the average age of the populations, culture and past experience with emergencies of this type. Even smoking and DNA could play a role. Not just blocking, in short. “It has been said ‘China hides data, uses authoritarian methods’, but these differences are not only with the Asian giant, but with several other countries on that continent. Countries where people live in contexts more overcrowded than ours and have medical standards lower than ours – Adnkronos Salute observes – So why? On the one hand there is a whole cultural aspect that is there for everyone to see and that must be explored to understand how to improve our strategies. ‘Unknown: we threw two or three hypotheses that all have a point of support, but we are not saying that they are certainly the correct arguments. Certainly there is that we do not understand something behavioral “, which makes the difference between us and them.
Among the researchers’ suggestions there is one that also questions genetics, Landoni continues, or rather “prothrombotic genetic models”, which “are less common in Asia than in the rest of the world.” On this the researcher explains: “Talking with the experts in coagulation they say that we are two different worlds from this genetic point of view. There are a whole series of ‘prothrombotic genes’ that I always say have allowed us to survive so many wars (it means bleeding less) but they make us die from ‘MicroClots’ related to Covid-19 “, that inflammatory syndrome that mainly attacks the endothelium, the inner wall of the vessels, at the pulmonary level, and consequently involves thrombotic manifestations in a significant percentage of cases, which worsens the outlook.
Is this enough to explain the mortality differences with Asia? Probably not, and then looking at mortality by age group, there are differences, but not sensational, between the various areas. Therefore, the factor of the average age of the population is certainly still predominant, much higher in Italy and in Europe in general “. The numbers will be analyzed later, with all the necessary information at hand. But in the meantime” let’s do what Marco Polo – invites Landoni – In this phase we may have to learn from the East. It makes sense to look to the East if you think it’s about blocking, privacy, high-tech software, and respect for the rules, because then there is something to learn. But even if we believe that there are alternative explanations, be it food or smoking or other factors that escape us. Because even in this case we must understand. And it is important to discover and learn what we still lack. We have to live with this virus for a long time. Certainly all this winter, which has not yet come to life ”.
The success of the East in the fight against the coronavirus
The strategy of living with the virus was a general defeat at first in many countries. Instead, China, Vietnam and Taiwan immediately understood that living with the virus would not be feasible. They have set the ambitious goal of eliminating it completely.
What happened in Vietnam is still almost inexplicable, seen here. The country has many exchanges with the epicenter of the pandemic, China. The pool testing technique may have helped contain the infection. In the summer after the discovery of an outbreak in Da Nang, 1.3 million inhabitants, the government declared a two-week lockdown on the city, accompanying it to mass tests on the population with a sampling method: pool tests allow analyze buffers in groups, for example of five, to save reagents and speed up times: if the group is negative, go to the next one; if positive, swabs are tested individually. A statistical success. Only thirty-five people from Covid-19 have died in Vietnam. Only 35 people have died in Vietnam since the start of the pandemic.
In the Far East countries, the timely closure of borders and the strict regulation of travel also had an impact. Rigorous contact tracking was never skipped, and then specific quarantines and widespread use of the mask, which in this region has been a tradition for decades, also thanks to previous epidemics like Sars and Aviaria.
Covid-19 mortality rates, experts report, “are not the same between different countries and range from less than one death per million recorded in Taiwan, Vietnam and Thailand to 1,112 deaths per million in Belgium.” The difference in average mortality per million is “remarkable between Asian and European countries (2.7 versus 197 deaths per million population).” The truth is that the later a particular country was hit by the epidemic, the smaller the impact on mortality during the first 50 days, the hardest.
Attributing the difference to the number of tests carried out “is not realistic, since in most countries the percentage of the population analyzed is similar (between 10% and 25%)”. This pandemic, experts say, “has profoundly affected modern society and the economy, since it has been necessary to identify alternative ways of working, traveling and communicating.” And there are aspects that need to be understood further, the study authors are convinced.
How the virus spread around the world
The virus spread rapidly from the eastern world to Europe and America. Despite the adoption of similar containment measures, no Asian country appears in the top 20 in terms of mortality per million inhabitants. Thus, the researchers clarify, an attempt was made to examine “the reasons why Asia has performed better than the rest of the world in managing Covid-19.” First, they note that “the Asian population is younger than the European and North American. The average age of the population in Asia is 31, compared to 42 in Europe and 35 in North America. In Italy , particularly beaten early and severely, is 45.5 years old, one of the tallest in the world. ” This may partially offer a first explanation.
Furthermore, experts still speculate that “the high prevalence of active smokers among the Asian male population may have played a role. In fact, a contradictory negative correlation between active smoking and a progression to a more severe clinical condition has been previously reported. Although the mechanisms underlying this phenomenon have not yet been fully understood. ” But it is slippery ground, very slippery. Hypotheses, for now not confirmed and unexplained. Even a French study from months ago suggested that smokers were much less likely to develop a symptomatic or severe infection than the general population. However, there is no protective effect of tobacco smoke, which contains many toxic agents. Only nicotine or other nicotine receptor modulators could have a protective effect, not currently proven. In fact, smoking is an aggravating factor in cardiovascular, respiratory and cancer diseases.
Data on deaths in Italy are not overestimated
Data on deaths in Italy are not overestimated. It is good to reiterate, the ISS has explained it clearly; in fact, it is likely that they were underestimated in the months of March and April. During that time, many patients died without being examined and therefore their information was not entered into the Surveillance System. The estimate made in the joint ISS-Istat report on excess mortality is that in the months of March and April, deaths directly or indirectly linked to COVID-19 are approximately double the measures in the Surveillance System. However, this underestimation of deaths was considerably reduced and almost dropped to zero from May to late summer. In recent months, Surveillance Systems are experiencing a further increase in deaths. It will soon be possible to assess any excess mortality in the fall / winter months by comparing it to the mortality data from Istat.
What is the excess mortality compared to previous years in Italy and in other European countries? An OECD report analyzed excess mortality (that is, the increase in the number of deaths compared to previous years) in some European countries over a 10-week period starting in March. This report showed that the total number of deaths registered in Spain registered an increase of 61% compared to the number of deaths registered on average during the same period in the previous 5 years. The UK had 56% more deaths than in previous years. Italy and Belgium registered increases of 40%. Germany, Denmark, and Norway reported around 5% additional deaths over a 10-week period. However, the OECD emphasizes that these data should be interpreted with caution because the first phase of the epidemic varies from country to country and therefore a longer observation period is necessary to interpret the data.
In conclusion, why do people die so much from Covid in Italy?
Why is the fatality from coronavirus in Italy so high? According to Graziano Onder, geriatrician at Gemelli and responsible for the ISS coronavirus mortality report, in Italy people live a long time, but many older people have various types of pathologies that worsen the prognosis in case of infection by the Sars-CoV-2 virus . “In our country, however, 90% of deaths are due to and not due to Covid. Older people and with more diseases killed by the virus anyway. We need to be attentive to the current tragedy to take responsibility and respect the rules ”.
There is a question of classification of deaths, which cannot be omitted: “With us – says the doctor – all those who die and test positive for hyssop are classified as deaths from Covid, it is not like that in other countries.” And then Italy has the oldest population in Europe “.” The fault is not the national health service, which is anything but inferior to others “
However, for example, it remains difficult to understand why fewer people die from Covid in Germany than in Italy. Different (hypothetical) classification of deaths is not enough. The health status of the population and the health model do not differ that much. “The average age of Covid victims is over 80 years old and it is true that in Italy people live longer but with fewer years in good health. For this reason – explains Onder – I say that we must treasure this tragic experience by recalibrating our care system for the elderly, involving more local medicine ”.
