tetano
Editor, Senior Moderator
ERJ Open Res
. 2020 Sep 28;6(3):00458-2020.
doi: 10.1183/23120541.00458-2020. eCollection 2020 Jul.
Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy
Sara Conti[SUP] 1 [/SUP], Pietro Ferrara[SUP] 1 [/SUP], Giampiero Mazzaglia[SUP] 1 [/SUP], Marco I D'Orso[SUP] 1 [/SUP], Roberta Ciampichini[SUP] 2 [/SUP], Carla Fornari[SUP] 1 [/SUP], Fabiana Madotto[SUP] 1 3 [/SUP], Michele Magoni[SUP] 4 [/SUP], Giuseppe Sampietro[SUP] 2 [/SUP], Andrea Silenzi[SUP] 4 5 [/SUP], Claudio V Sileo[SUP] 4 [/SUP], Alberto Zucchi[SUP] 2 [/SUP], Giancarlo Cesana[SUP] 1 [/SUP], Lamberto Manzoli[SUP] 6 [/SUP], Lorenzo G Mantovani[SUP] 1 3 [/SUP]
Affiliations
Abstract
Background: The real impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on overall mortality remains uncertain as surveillance reports have attributed a limited number of deaths to novel coronavirus disease 2019 (COVID-19) during the outbreak. The aim of this study was to assess the excess mortality during the COVID-19 outbreak in highly impacted areas of northern Italy.
Methods: We analysed data on deaths that occurred in the first 4 months of 2020 provided by the health protection agencies (HPAs) of Bergamo and Brescia (Lombardy), building a time-series of daily number of deaths and predicting the daily standardised mortality ratio (SMR) and cumulative number of excess deaths through a Poisson generalised additive model of the observed counts in 2020, using 2019 data as a reference.
Results: We estimated that there were 5740 (95% credible set (CS) 5552-5936) excess deaths in the HPA of Bergamo and 3703 (95% CS 3535-3877) in Brescia, corresponding to a 2.55-fold (95% CS 2.50-2.61) and 1.93 (95% CS 1.89-1.98) increase in the number of deaths. The excess death wave started a few days later in Brescia, but the daily estimated SMR peaked at the end of March in both HPAs, roughly 2 weeks after the introduction of lockdown measures, with significantly higher estimates in Bergamo (9.4, 95% CI 9.1-9.7).
Conclusion: Excess mortality was significantly higher than that officially attributed to COVID-19, disclosing its hidden burden likely due to indirect effects on the health system. Time-series analyses highlighted the impact of lockdown restrictions, with a lower excess mortality in the HPA where there was a smaller delay between the epidemic outbreak and their enforcement.
. 2020 Sep 28;6(3):00458-2020.
doi: 10.1183/23120541.00458-2020. eCollection 2020 Jul.
Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy
Sara Conti[SUP] 1 [/SUP], Pietro Ferrara[SUP] 1 [/SUP], Giampiero Mazzaglia[SUP] 1 [/SUP], Marco I D'Orso[SUP] 1 [/SUP], Roberta Ciampichini[SUP] 2 [/SUP], Carla Fornari[SUP] 1 [/SUP], Fabiana Madotto[SUP] 1 3 [/SUP], Michele Magoni[SUP] 4 [/SUP], Giuseppe Sampietro[SUP] 2 [/SUP], Andrea Silenzi[SUP] 4 5 [/SUP], Claudio V Sileo[SUP] 4 [/SUP], Alberto Zucchi[SUP] 2 [/SUP], Giancarlo Cesana[SUP] 1 [/SUP], Lamberto Manzoli[SUP] 6 [/SUP], Lorenzo G Mantovani[SUP] 1 3 [/SUP]
Affiliations
- PMID: 33015145
- PMCID: PMC7520169
- DOI: 10.1183/23120541.00458-2020
Abstract
Background: The real impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on overall mortality remains uncertain as surveillance reports have attributed a limited number of deaths to novel coronavirus disease 2019 (COVID-19) during the outbreak. The aim of this study was to assess the excess mortality during the COVID-19 outbreak in highly impacted areas of northern Italy.
Methods: We analysed data on deaths that occurred in the first 4 months of 2020 provided by the health protection agencies (HPAs) of Bergamo and Brescia (Lombardy), building a time-series of daily number of deaths and predicting the daily standardised mortality ratio (SMR) and cumulative number of excess deaths through a Poisson generalised additive model of the observed counts in 2020, using 2019 data as a reference.
Results: We estimated that there were 5740 (95% credible set (CS) 5552-5936) excess deaths in the HPA of Bergamo and 3703 (95% CS 3535-3877) in Brescia, corresponding to a 2.55-fold (95% CS 2.50-2.61) and 1.93 (95% CS 1.89-1.98) increase in the number of deaths. The excess death wave started a few days later in Brescia, but the daily estimated SMR peaked at the end of March in both HPAs, roughly 2 weeks after the introduction of lockdown measures, with significantly higher estimates in Bergamo (9.4, 95% CI 9.1-9.7).
Conclusion: Excess mortality was significantly higher than that officially attributed to COVID-19, disclosing its hidden burden likely due to indirect effects on the health system. Time-series analyses highlighted the impact of lockdown restrictions, with a lower excess mortality in the HPA where there was a smaller delay between the epidemic outbreak and their enforcement.