Most of Those Dying in Lombardy due to Coronavirus are Elderly Men

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Italy is one of the hardest hit areas in the whole world when it comes to coronavirus pandemic. The Lombardy region in Italy has had worst health outcomes with 55% share in total reported deaths from the entire country. The region also has 39% of all coronavirus cases in the country.

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A new study published in the Journal of American Medical Association (JAMA) has found that of the 1,591 people tested positive for COVID-19 and admitted to the ICUs of Lombardy, 26% died. What is more worrisome is that the majority of those who died of coronavirus were older men.

The Oldest Population

Italy right now has a reported death rate of 10% from COVID-19. It is much higher than the average reported by World Health Organization at 3.4%.

One factor for this high rate of death can be its old population. According to data, Italy has the oldest population in Europe. Nearly 23% of its population is 65 years old or older. The median age is just 47.3 years old.

Source: BBC

Other reports show that older adults make the greater proportion of cases in Italy. 37% of the cases are aged 70 years or older in Italy as compared to China where 12% cases were older people.

The Data

The new retrospective study was conducted by collecting the data from ICUs all over Lombardy through phone calls at the coordinator center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, in Milan, Italy. The 72 ICUs were all part of the COVID-19 Lombardy ICU Network.

The data was collected in the first 6 to 24 hours following the admission, and different variable were checked and entered into a worksheet by the researchers at the coordinator center.

The researchers found that between March 18 and February 20, a total of 1,694 patients were referred to their center. Only 1,591 had confirmed diagnosed cases of coronavirus.

The Subjects

Of the total patients, 68% had at least one comorbidity. Of these 68% patients, 49% of had hypertension, 21% had cardiovascular disease, 18% had hypercholesterolemia, and 4% had a history of chronic obstructive pulmonary disease.

The researchers noted that people all the people over the age of 80 had a comorbidity. Comorbidities increase he risk of death and complications in patients diagnosed with COVID-19. Old age is also a risk factor.

Of all the people admitted to the ICUs, majority (82%) were men. The median age of infection was 63 years.

Treatment and Results

Of the patients with available respiratory support data, 99% needed invasive or noninvasive respiratory support. Nearly 1,100 patients required endotracheal intubation and mechanical ventilation and 11% needed noninvasive ventilation.

Distribution of Age and Respiratory Measures on Admission to a COVID-19 Intensive Care Unit. –JAMA

The rate of noninvasive ventilation in other areas was much higher than this. Different sources reported the rates of noninvasive ventilation at 19% (Washington State, US), and 42%, 56% and 62% (Wuhan, China).

89% of older patients required invasive mechanical ventilation whereas 88% younger patients required the same. The median positive end-expiratory pressure (PEEP) was 14 cm H2O, and Fio2 was greater than 50% in 89% of patients.

The need of invasive mechanical ventilation in these patients was higher compared to 71% (Washington State, US), 47% (Wuhan, China), 42% (Wuhan, China).

PEEP is pressure in the lungs above the outside pressure of the body that exists after one breathes out. Normal levels of PEEP are between 4-6 cm H2O. The more the levels increase, the more deteriorated is the condition of the patient. Median PEEP levels were almost similar in older and young patients.

Previously, the reported mortality rate of patients admitted to ICUs were 16% to 38%, 62%, 67%, and 78%. In Lombardy, Italy, the fatality rate was 26% and discharge rate was 16%. However, the rate could even be higher as most patients when studied were still in ICUs. Most of the people who died were old and were men.

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