Italy’s large elderly population poses a challenge in slowing the number of coronavirus deaths in the worst-affected country in Europe, a health specialist has said.
The virus has killed 79 people in Italy, overwhelmingly aged between 63 and 95 with underlying serious illnesses.
The youngest patient to die was 55 and suffering from chronic disease. A 61-year-old doctor who was not known to have underlying health problems has also died.
What is Covid-19 - the illness that started in Wuhan?
It is caused by a member of the coronavirus family that has never been encountered before. Like other coronaviruses, it has come from animals. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city.
Have there been other coronaviruses?
Severe acute respiratory syndrome (Sars) and Middle Eastern respiratory syndrome (Mers) are both caused by coronaviruses that came from animals. In 2002, Sars spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. Mers appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected.
What are the symptoms caused by the new coronavirus?
The virus can cause pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure. As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. Recovery depends on the strength of the immune system. Many of those who have died were already in poor health.
Should I go to the doctor if I have a cough?
UK Chief Medical Officers are advising anyone who has travelled to the UK from mainland China, Thailand, Japan, Republic of Korea, Hong Kong, Taiwan, Singapore, Malaysia or Macau in the last 14 days and who is experiencing a cough or fever or shortness of breath to stay indoors and call NHS 111, even if symptoms are mild.
Is the virus being transmitted from one person to another?
China’s national health commission has confirmed human-to-human transmission, and there have been such transmissions elsewhere.
How many people have been affected?
As of 4 March, the global death toll was 3,190, while more than 93,000 people have been infected in more than 80 countries.
The death toll has passed 3,000 in China, where there have been over 80,000 cases. South Korea, the nation worst hit by the outbreak outside China, has had 5,328 cases. More than 44,000 people in China have recovered from Covid-19.
There have been 87 recorded cases and no fatalities to date in the UK. There are 53 confirmed cases in Australia, with two deaths.
Why is this worse than normal influenza, and how worried are the experts?
We don’t yet know how dangerous the new coronavirus is, and we won’t know until more data comes in. The mortality rate is around 2% at the centre of the outbreak, Hubei province, and less than that elsewhere. For comparison, seasonal flu typically has a mortality rate below 1% and is thought to cause about 400,000 deaths each year globally. Sars had a death rate of more than 10%.
Another key unknown is how contagious the coronavirus is. A crucial difference is that unlike flu, there is no vaccine for the new coronavirus, which means it is more difficult for vulnerable members of the population – elderly people or those with existing respiratory or immune problems – to protect themselves. Hand-washing and avoiding other people if you feel unwell are important. One sensible step is to get the flu vaccine, which will reduce the burden on health services if the outbreak turns into a wider epidemic.
Is the outbreak a pandemic?
A pandemic, in WHO terms, is “the worldwide spread of a disease”. Coronavirus cases have been confirmed outside China, but by no means in all 195 countries on the WHO’s list. It is also not spreading within those countries at the moment, except in a very few cases. By far the majority of cases are travellers who picked up the virus in China.
Should we panic?
No. The spread of the virus outside China is worrying but not an unexpected development. The WHO has declared the outbreak to be a public health emergency of international concern. The key issues are how transmissible this new coronavirus is between people, and what proportion become severely ill and end up in hospital. Often viruses that spread easily tend to have a milder impact. Generally, the coronavirus appears to be hitting older people hardest, with few cases in children.
The death toll, provided by officials on Tuesday night, marked an increase of 27 in 24 hours. Twenty-three per cent of the Italian population is over 65, making it the oldest in the world after Japan.
“Italy is a country of old people,” said Prof Massimo Galli, the director of infectious diseases at Sacco hospital in Milan. “The elderly with previous pathologies are notoriously numerous here. I think this could explain why we are seeing more serious cases of coronavirus here, which I repeat, in the vast majority of cases start mildly and cause few problems, especially in young people and certainly in children.
“Our life expectancy is among the highest in the world. But unfortunately, in a situation like this, old people are more at risk of a serious outcome.”
The are more than 2,500 people infected in Italy. Health workers have carried out 25,856 swab tests, significantly dwarfing the number undertaken in other European countries.
Those tested include Pope Francis, 83, after he was forced to cancel engagements this week because of a cold. He returned a negative result, Il Messaggero newspaper reported on Tuesday.
The majority of cases – 1,520 – are in the northern Lombardy region, where 10 towns have been under lockdown for more than a week. The virus has spread to more than half of Italy’s 20 regions, including Tuscany, Puglia, Sicily and recently Sardinia.
Authorities say the majority of people who tested positive in other regions were travelling from Lombardy or had been in the north for a few weeks before the outbreak.
Of those infected, 1034 are in hospital – 229 in intensive care – and 1,229 are recovering at home. The number of people who have recovered from the illness has more than doubled to 160.
Researchers at Sacco hospital last week isolated a strain of the virus from an Italian patient, which suggests Covid-19 may have circulated in northern Italy for weeks before it was detected.
Galli said: “It has been claimed that the so-called Italian virus is very different from the Chinese one. These are simply rumours. We are currently mapping out the sequences and only afterwards can we know.
“Obviously, since it is an RNA virus, it is expected to be at least a little different from the Chinese one. RNA viruses typically change: between each viral copy and its template there will be a few differences, like a single nucleic acid mutation. But only once we have the sequences can we begin to make comparisons.”
Italy had experienced the coronavirus outbreak despite being one of the first countries that not only closed contact with Wuhan but also all air contact with China, he said.
“Some countries have accused us of taking too drastic measures. Yet even taking drastic measures, proactively, does not seem to have been enough,” Galli said. “What is certain is that we had no way of predicting the outbreak in the so-called red zone or identifying it before sick people appeared.”
Many people could reach Italy from other countries that had not closed direct flights from China, Galli said, adding that “outbreaks that will eventually appear elsewhere in Europe” may not necessarily come from Italy.
“Let us remember the case of a person who had travelled from Singapore, of British nationality, who then went to visit friends in France and infected them,” he said. “If such a thing happened in other parts of Europe, it means we might end up with other red zones.”
A doctor in Italy who is recovering from the virus at home told the Guardian she had only mild symptoms. She lives with her parents and brother, all of whom tested negative. She will be tested again on Friday, after two weeks in quarantine.
“In the majority of cases, people heal,” said the doctor, who asked not to be named. “The problem is we don’t have the mechanisms to protect those who are most vulnerable: the elderly or those with serious health problems. But we need to be objective – an increase in new cases doesn’t mean an increase in serious cases.”
