Doubled Deaths’ Count in Italy in COVID-19 Times: Quantifying What Is Not Captured by Surveillance

Abstract

Background: It important to quantify the true burden of COVID-19 in different countries, so as to inform decisions about imposing and relaxing control measures. COVID-19 surveillance data fails in this as influenced by different control policies and capacities. We aimed at quantifying excess mortality and estimate its distribution between COVID-19 and Non-COVID-19 causes. Methods: We carried out an in-depth analysis of deaths for all causes between 2015 and 2020 in Italy at the national, regional, and local level. We first explored excess mortality over time and space, then we assessed how it related with COVID-19 surveillance, and ultimately, assuming fix male÷female range ratios we developed and applied a model to estimate the shares of, respectively, COVID-19 and Non-COVID-19 2020-excess mortality. Findings: We report doubled deaths’ count in Italy in March-April 2020, as compared to 2015-2019 (+109%), with excess mortality greater 600% in large municipalities in the north of Italy. Notified COVID-19 deaths accounts for only 43·5% (regional range: 43%-62%)· We estimate that more than two thirds of excess deaths not captured by surveillance are Non-COVID-19 deaths, likely associated with health systems’ suffering and lower demand and supply of health services in time of crisis. Interpretation: COVID-19 burden is larger than what reported in official figures. Excess deaths monitoring helped capturing the full effect of the COVID-19 pandemic which played out in different ways in different Italian Regions and which we estimate to have caused a large indirect effect on population wellbeing. Funding Statement: This research received no external funding. Declaration of Interests: None to declare. Ethics Approval Statement: Ethics approval was not required for this study as all considered data was publicly available aggregated data