Coronavirus: Europe death rates start to level off

Italy’s high toll may be due to doctors recording any virus patient who dies as a COVID-19 fatality, despite underlying conditions.

Pope Francis meeting with Italy's Prime Minister Giuseppe Conte in The Vatican. Picture: The Vatican.

Coronavirus death rates across Europe’s hardest hit countries appear to be slowly levelling off, while scientists are watching how Germany has kept its death rate much lower than its neighbours.

On Monday, Spain recorded another 537 deaths to take its tally to 7,340, and in Italy there were 812 deaths, bringing their death toll to 11,591.

For both countries, the exponential curve for both infections and deaths has started to level and most of those who have died have been elderly and with underlying health conditions.

In Italy, there have been calls from car manufacturers to restart production next week, subject to government approval.

Fiat Chrysler wants to reopen three plants in Melfi, Mirafiori and Atessa. The Agnelli family wants to reopen its Ferrari plant on April 14.

In the United Kingdom, the number of deaths is expected to peak in the coming weeks while the number of infections is tipped to fall. On Monday there were 180 deaths – again a number lower than anticipated – to bring the total death toll to 1,415.

Epidemiologists say five per cent of London’s population of 10 million and as many as two million across the country could already have had the virus in a mild or asymptomatic form.

However the nursing federation says one in five nurses are off sick with suspected coronavirus symptoms and doctor groups believe one in four doctors are similarly infected.

UK Prime Minister Boris Johnson, who continues to direct the country’s response to the pandemic from isolation at 11 Downing Street, has ordered 17m tests to identify the presence of coronavirus antibodies to help work out who has had the virus.

While he is recovering from the virus, it has emerged his chief Adviser Dominic Cummings has now gone into self-isolation with COVID-19 symptoms. Prince Charles, meanwhile, has now come out of seven days of quarantine.

At this point, with an enforced lockdown, the number of deaths in the UK has been far lower than the original expectation of around 20,000 or even the more recently updated forecast of 5,700 deaths.

Scientists have told Westminster that possibly two thirds of deaths that have occurred so far have been from people who would have died of their underlying conditions.

But in preparation for the coming weeks when hospitals may be overrun, the makeshift Nightingale Hospital at the Excel conference centre in London is ready to take in 500 patients and can be expanded to take 4000. Other temporary hospitals are opening in Manchester and Birmingham.

Statisticians are looking to Germany for clues as to what the virus outcome might be.

Italy’s numbers appear worryingly high, but experts say that is because every person who dies with coronavirus is recorded as dying from it.

“Only 12 per cent of death certificates (of people listed as dying from coronavirus) have shown a direct causality from coronavirus,” said Professor Walter Ricciardi, scientific adviser to Italy’s health ministry.

“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.’’

He said while 12 per cent of death certificates have shown a direct causality from coronavirus, the other 88 per cent of deaths had least one comorbidity – and many had two or three. Each year in Italy there are 17,000 deaths from influenza.

In Germany, on the other hand, any underlying health conditions – often heart disease – are usually noted as the cause of death, rather than the coronavirus.

Germany has also tested a broader spectrum of the population – including children and those who showed the mildest of symptoms at the earliest stages, including contacts of known infections – rather than the Italian and British methods of mainly testing the very sick who have been hospitalised.

Germany says they have found 63,000 infections, of which there have been 545 deaths, a death rate of 7 per 1m population.

In Italy their 11,000 deaths equates to around 178 deaths per 1m of population.

Australia’s rate per 1m of population is 0.7 and the UK’s is 18. Spain is 157.

The age profile of infections also illustrates how Germany has tested a wider age range of the population than others – its median age of those infected is 46.

Eight in ten Germans with the disease are under 60 and are able to withstand the virus much more robustly. In Italy the median age is 63, in the UK it is 64. But again, in Italy and the UK the figures reflect the median age of the very ill coronavirus patients, and isn’t indicative of the infections throughout the whole country.

German hospitals haven’t been overwhelmed with cases; and like the UK and Australia, the Germans are trying to shield their older populations from contracting the disease.

Interestingly, German researchers also believe the virus was imported into the country from fit and healthy skiers who had been in the Italian alps and so could shrug it off more easily.

Meanwhile the French Minister of Research, Frédérique Vidal, said clinical test results on four possible coronavirus treatments will be known at the end of the week.

The clinical trials of four possible treatments began a week ago, and involve more than 3,000 volunteers across Europe. The trials will determine the best treatments among the ebola drug Remdesivir, the anti HIV treatment Lopinavir-Ritonavir, the long standing malaria drug Hydroxychloroquine, and interferon-beta.