English translation of Italian health institute analysis of COVID-19 deaths up to 17 March

The following is translated from a study by the Istituto Superiore di Sanità (Italian Institute of Health, ISS) on the characteristics of 2,003 patients who died after testing positive for COVID-19 in Italy

The report is based on data updated to 17 March 2020 1.

1. Sample

The geographical distribution of deaths is as follows:

2. Demographic data

The average age of patients who were COVID-19 positive at the time of death is 79.5 years (median 80.5, range 31-103, Range InterQuartile – IQR 74.3-85.9). 601 are women (30.0%).

Figure 1 shows that the median age of those who were COVID-19 positive at the time of death is more than 15 years higher than that of all patients who contracted the infection (median age of patients who died – 80.5 years; median age of patients with infection – 63 years). Figure 2 shows the number of deaths by age group. Women who died after contracting COVID-19 infection are older than men (median ages: women – 83.7; men – 79.5).

Figure 1. Median age of deceased and diagnosed COVID-19 positive patients

Figure 2. Number of deaths by age group

3. Pre-existing pathologies

Table 1 presents the most common pre-existing chronic pathologies (diagnosed before contracting infection) in deceased patients. This figure was obtained in 355/2,003 deaths (17.7% of the sample total). The average number of pathologies observed in this population is 2.7 (median 2, Deviation Standard 1.6). Overall, 3 patients (0.8% of the sample) had no pre-existing conditions, 89 (25.1%) had one pre-exiting condition, 91 (25.6%) had two pre-existing conditions and 172 (48.5%) had thee or more.

Table 1. Most common diseases observed in patients who died as a result of COVID-2019 infection

4. Symptoms

Figure 3 shows the symptoms most commonly observed before hospitalization in deceased COVID-19 positive patients. As shown in the figure, shortness of breath and fever represent the most common symptoms. Less common are cough, diarrhoea and coughing up blood or blood-stained mucus. 5.2% of people did not present any symptom upon admission.

Figure 3. Most common symptoms in COVID-19 positive deceased patients

5. Complications

Respiratory failure was the most commonly observed complication in this sample (97.2% of cases), then acute kidney damage (27.8%), followed by acute damage to heart muscle (10.8%) and secondary infection (superinfection) (10.2%).

6. Treatments

Figure 4 shows the treatments administered in COVID-19 positive deceased patients during hospitalisation. Antibiotics were the one most used (83% of cases). Least used was antiviral treatment (52%), plus in some cases (27%) steroid therapy (27%). The common use of antibiotic therapy can be explained by presence of secondary infections (superinfections) or is compatible with initiation of empirical therapy in patients with pneumonia, pending laboratory confirmation of COVID-19.

In 25 cases (14.9%), all 3 therapies were used.

Figure 4. Therapies administered in COVID-19 positive deceased patients

7. Time

Figure 5 shows, for COVID-19 positive deceased patients, the median times, in days, that pass from the onset of symptoms to death (8 days), from the onset of symptoms to hospitalization (4 days) and from hospitalization to death (4 days). The time elapsed from hospitalization to death was 1 day longer in those who were transferred to resuscitation than those who did not they were transferred (5 days against 4 days).

Figure 5. Median hospitalisation times (in days) in COVID-19 positive deceased patients

8. Deaths under the age of 50

Up to 17 March, seventeen COVID-19 positive patients under the age of 50 had died. In particular, five of these were under 40 years old and all were males, aged between 31 and 39, years with serious pre-existing conditions (cardiovascular, renal, psychiatric conditions, diabetes, obesity).

Download the original report (PDF) here.

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