Italy has the largest number of deaths in proportion to the number of diagnosed Coronavirus, leaving virologists perplexed about this particularly high mortality rate. A Greek researcher believes that, unknowingly, Italy is moving toward the direction of herd immunity — and Greece is doing the same.
Constantinos Farsalinos is a physician and a researcher at King Abdulaziz University, Patras University and the Western Attica School of Public Health. He was considered one of the world’s “highly cited researchers” for 2019, according to the list of the most influential scientists in global scientific research during the last decade.
The scientist believes that the number of Greeks who have been infected by COVID-19 is significantly larger than the number of those detected; therefore Greeks are most likely to reach the state of herd immunity. However, he also advises that mass testing should be carried out and that Greek citizens should be more careful in their behavior.
As Dr. Farsalinos explains, Italy is not only facing a dramatic spread of the coronavirus epidemic, but at the same time it is experiencing enormous mortality rates. It must therefore be asked why is it that other countries are showing significantly lower mortality figures.
According to figures from March 15, South Korea has seven times fewer coronavirus fatalities, and Germany 35 times fewer deaths, than does Italy. These enormous differences cannot be explained by the aging of the population, as many have hastened to conclude.
Indeed, Italy actually has an older population than South Korea, but does not have an older population than Germany. Age cannot, therefore, fully explain the dramatic differences in coronavirus death rates.
The answer can be found, perhaps, if one looks at the age distribution of coronavirus cases in each country, where there are striking differences. While 59.7 percent of cases of coronavirus fatalities in Italy were over 60 years of age (the majority), only 21 percent of cases in South Korea and 15.5 percent of cases in Germany were from the same age group.
Indeed, it is striking that the age distribution of the population in South Korea is almost entirely in line with the age distribution of the cases of coronary heart disease. In Italy, on the other hand, the incidence rate is more than three times higher than that of the population who are over 80 years of age.
It is well known that mortality increases significantly at older ages, and this largely explains the difference in mortality between countries.
But why is it only in Italy that the coronavirus seems to affect the elderly, while not in Germany and South Korea? The explanation is simple: because Italy has failed to detect the largest percentage of cases, and the number of cases announced is not real.
Soon after the pandemic began, Italy’s policy was selective in examining suspected cases of coronavirus, unlike Germany and South Korea, where there were mass collections of samples and mass analyses were conducted.
Until recently, South Korea had performed more than 250,000 analyses of samples (with over 100,000 analyses just between February 12 and 19), while the country has the capacity to conduct a total of 250,000 analyses per week.
Germany is also carrying out a huge number of analyses regularly. From March 2 to March 9, 35,000 analyses of coronavirus cases were performed in the private health sector alone. Undoubtedly thousands of additional analyses in public hospitals, universities and other organizations are also being conducted.
Germany currently has the capacity to carry out 12,000 analyses per day, or 84,000 per week.
According to official data published on March 15, about 14,800 of the total 24,747 confirmed cases in Italy were in people over the age of 60. This figure actually represents 15-20 percent of all cases, compared to other countries, not the 59.70 percent as Italy officially states.
So Italy is probably approaching or exceeding 100,000 real cases, most of which have not been diagnosed. And seeing the increase in the rate of cases, the difference between actual and confirmed cases is probably increasing daily.
In short, Dr. Farsalinos believes that the deficient testing for COVID-19 in Italy was the reason much of the younger population has not been diagnosed, and it is certain that a large number of younger Itaiians are infected but are unaware that they carry the virus.
This has a huge impact not only on the actual number of cases (which is far from the official tally) but also on the speed at which the disease is spreading. Young people are obviously more active, associate with more people, move around much more frequently and have significantly more social and professional contacts in their daily lives.
Many of them had and have been infected with coronavirus but were never examined, simply because they never exhibited any symptoms.
Most likely, some have had a mild form of the illness, which either did not affect their activities at all or they fell ill for a couple of days and then returned to their daily routine. These were the so-called “moving bombs” (also called super spreaders) who were for the most part responsible for transmitting the coronavirus to the community.
So what does all this mean for Greece? Greece is currently conducting extremely selective testing for coronavirus, perhaps even more selective than Italy had performed. This means that today we must have a large number of cases that have not been identified and are circulating among us.
Unfortunately, most of them are younger, have mild symptoms (or are still asymptomatic) and of course do not need hospital care. But these are the ones who eventually transmit the coronavirus to the community in a big way. In effect, they become super spreaders all over the country.
This has happened the previous days and is happening now, as those of younger ages continue to go to work, shop, care for elderly parents, and so on. And even with a universal lockdown, basic needs (e.g. grocery shopping, serving the elderly) the same age group will continue to offer these services to older people in society.
Finally, there will be many who will not be forced to go into strict isolation for the necessary length of time needed if they are infected but never had a formal diagnosis.
Preliminary data already show that the average age of confirmed cases in Greece is much older than the average population age. That is to say that the phenomenon in Greece is the same as in Italy. We have already failed to detect and isolate many cases, and this number is multiplying every day.
We continue to announce the number of new cases every day, but that is a number that is far from the real one.
We truly have no idea of the real extent of the pandemic in Greece. Every day we lose a lot more cases than the ones we detect, just as in Italy, and this happens because we carry very selective testing for coronavirus.
It is therefore critical, Dr. Farsalinos asserts, to perform mass coronavirus testing on all patients who show symptoms of the disease. Even to those who show mild symptoms and to all their contacts, regardless of symptoms.
It is even more important for young people (who will have fewer and milder symptoms) to be screened than for those who have severe symptoms (who will be hospitalized but will not transmit the disease after being forced to be hospitalized).
To control an epidemic there are two basic requirements: the detection and accurate recording of cases and the isolation of all cases from healthy individuals.
In Greece we are at the beginning of the epidemic and are already losing the ability to detect and record cases, especially of those at a young age. We automatically lose the ability to isolate them from the healthy. We are making the most critical mistake, and this may prove to be decisive in the evolution of the epidemic.
Without the diagnosis and detection of cases, you cannot isolate coronavirus victims from healthy people. Geographical isolation and lockdown are not enough to tackle the problem — they will actually only prolong it.
A change of attitude is needed now, according to this veteran researcher. Requisition of labs and equipment is needed, and labs need to be properly staffed 24 hours a day. Community intervention is needed to find and control cases, to prepare screening centers for coordinated turnover and sample collection.
All cases must be found and diagnosed at all costs. And all this has to be done immediately.
Without the diagnosis and detection of outbreaks it is impossible to stop any epidemic of communicable diseases. Let’s learn from the mistakes Italy made as soon as possible.
Italy is very close to a herd immunity scenario, that is to say, a much larger part of the population is affected. This is also England’s conscious decision and strategy, based on its Prime Minister’s recent announcements.
Some have described his decision as “paranoid crazy,” expressing fears that England “is heading towards the macabre primacy of the highest number of deaths in Europe, perhaps in the world, by the coronavirus.”
Dr. Farsalinos says that Greece does not seem to be consciously employing this strategy, but we must immediately realize that we are still heading for a herd immunity scenario regardless. We need to change tactics now. Otherwise, let’s make a decision and let the government officially inform us that we are implementing such a strategy.
And one last note: Public health organizations in all countries must provide free access to all data they collect (patient demographics, risk factors, complications, outcome, etc.) to the scientific community. Their analysis will provide valuable data on the pandemic. These data are not the intellectual property of any one person or entity.