Patterns of COVID-19 related excess mortality in the municipalities of Northern Italy

Abstract

The Coronavirus Disease 2019 (COVID-19) spatial distribution in Italy is inhomogeneous, because of its ways of spreading from the initial hotspots. The impact of COVID-19 on mortality has been described at the regional level, while less is known about mortality in demographic subgroups within municipalities. We aimed to describe the excess mortality (EM) due to COVID-19 in the three most affected Italian regions, by estimating EM in subgroups defined by gender and age classes within each municipality from February 23 to March 31, 2020. EM varied widely among municipalities even within the same region; it was similar between genders for the ≥75 age group, while in the other age groups it was higher in males. Thus, nearby municipalities may show a different mortality burden despite being under common regional health policies, possibly as a result of policies adopted both at the regional and at the municipality level.

Non-COVID-19 patients in times of pandemic: Emergency department visits, hospitalizations and cause-specific mortality in Northern Italy

“…Our findings indicate that the reduction of ED visits and hospitalizations started two weeks before the beginning of the national lockdown, after school closures and the first Italian case hospitalized for COVID-19 in Codogno [ 1 ], when no cases of local transmission had been still recorded in BMA. As already reported [ 2 , 6 , 19 – 23 ], a possible explanation is that the population response is likely to be more affected by the national level authority risk message than the real local situation. Several possible reasons have been put forward to explain, at least partially, a reduction in ED visits and hospitalizations [ 6 , 7 ], such as lifestyle changes or fear of the contagion, as well as the increasingly stringent lockdown measures and the postponement of elective procedures, or the sense of civic responsibility of the population [ 7 ].…”

“…The first case of local transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Italy was confirmed in a thirty eight-year-old man in the municipality of Codogno (Lombardy region) on February 19 th , 2020 [ 1 ], while on February 21 st , a resident of Vo’, a small town near Padua (Veneto Region), died of pneumonia due to SARS-CoV-2 infection. [ 2 , 3 ] In the following weeks, an exponential growth in the number of cases and deaths in the neighboring regions of northern Italy was observed. As a consequence, the national government enforced as containment measures a complete country lockdown on March 10 th , 2020: at that stage the confirmed cases in Italy were 10,149 and 631 deaths [ 4 ].…”

Non-COVID-19 patients in times of pandemic: decreased emergency department visits and increased out-of-hospital mortality in Northern Italy

“…Our findings indicate that the reduction of ED visits and hospitalizations started two weeks before the beginning of the national lockdown, after school closures and the first Italian case hospitalized for COVID-19 in Codogno [1], when no cases of local transmission had been still recorded in BMA. As already reported [2, 6, 18-20], a possible explanation is that the population response is likely to be more affected by the national level authority risk message than the real local situation [21]. Several possible reasons have been put forward to explain, at least partially, a reduction in ED visits and hospitalizations [6, 7].…”

“…Italy was the first Western country affected by the pandemic. The first case of local transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Italy was confirmed in a thirty eight-year-old man in the municipality of Codogno (Lombardy region) on February 19 th , 2020 [1], while on February 21 st , a resident of Vo’, a small town near Padua (Veneto Region), died of pneumonia due to SARS-CoV-2 infection [2,3]. In the following weeks, an exponential growth in the number of cases and deaths in the neighboring regions of northern Italy was observed.…”

Severe acute respiratory syndrome coronavirus‐2: implications for blood safety and sufficiency

“…Compared to all reported COVID-19 cases, patients with a fatal outcome have higher rates of comorbidities including hypertension, diabetes, chronic vascular disease and chronic lung disease [102,104,105]. It is currently not possible to accurately estimate the total number of SARS-CoV-2 infections due to asymptomatic infections which would typically not be reported nor diagnosed, underreporting of symptomatic cases and lack of attribution of COVID-19 as cause of death [108][109][110]. As a consequence, it is not possible at present to estimate the infection fatality rate (IFR) for all infections (reported and unreported).…”