Many people are curious as to who is dying in this CoronaVirusOutbreak from from COVID19 (SARS CoV2) There are intermittent reports of young healthy people dying. An article published March 23, 2020 in JAMA reports on the characteristics of those who “reportedly” died in China and Italy. There is also explanations as potentially why there is a higher death rate in Italy as compared to China which is there are a lot more older people in Italy. This viewpoint from this study came from physicians associated with the Italian National Institute of Health confirms. The Italian NIH explains possible reasons, including age, cause of death definitions, and testing strategy.
The overall case-fatality rate in Italy (7.2%) is substantially higher than in China (2.3%). When data were stratified by age group, the case-fatality rate in Italy and China appear very similar for age groups 0 to 69 years, but rates are higher in Italy among individuals aged 70 years or older, and in particular among those aged 80 years or older. This difference is difficult to explain. The distribution of cases is very different in the 2 countries: individuals aged 70 years or older represent 37.6% of cases in Italy and only 11.9% in China. In addition, a relevant number of cases in Italy are in people aged 90 years or older (n = 687), and this age group has a very high fatality rate (22.7%); data on cases in those aged 90 years or older were not reported in China. In addition, the report from the WHO-China Joint Mission on Coronavirus Disease 2019 Mortality, which presents data on 2114 COVID-19 related deaths among 55 924 laboratory-confirmed cases in China, reported a fatality rate among patients aged 80 years or older that was similar to the rate in the Italian sample (21.9% in China vs 20.2% in Italy).1
Electing to define death from COVID-19 in this way may have resulted in an overestimation of the case-fatality rate. A subsample of 355 patients with COVID-19 who died in Italy underwent detailed chart review. Among these patients, the mean age was 79.5 years (SD, 8.1) and 601 (30.0%) were women. In this sample, 117 patients (30%) had ischemic heart disease, 126 (35.5%) had diabetes, 72 (20.3%) had active cancer, 87 (24.5%) had atrial fibrillation, 24 (6.8%) had dementia, and 34 (9.6%) had a history of stroke. The mean number of preexisting diseases was 2.7 (SD, 1.6). Overall, only 3 patients (0.8%) had no diseases, 89 (25.1%) had a single disease, 91 (25.6%) had 2 diseases, and 172 (48.5%) had 3 or more underlying diseases. The presence of these comorbidities might have increased the risk of mortality independent of COVID-19 infection.
| Italian Deaths | Chart reviews | 355 | Percentage |
| Ischemic heart disease | 117 | 33.0% | |
| Diabetes | 126 | 35.5% | |
| Active cancer | 72 | 20.3% | |
| Atrial fibrillation | 87 | 24.5% | |
| Dementia | 24 | 6.8% | |
| Previous stroke | 34 | 9.6% | |
| No previous disease | 3 | 0.8% | |
| Single disease | 89 | 25.1% | |
| 2 diseases | 91 | 25.6% | |
| 3 diseases | 172 | 48.5% |
Time will tell and there are many reports of young healthy people dying but this virus appears to disproportionately have a higher mortality rate in older patients exponentially increasing in those patients over age 40 years and affecting particularly those with preexisting medical conditions.