Wild guess here but fatality rate is based on the number of dead and the number of reported cases. High fatality rate means either high number of dead, or low number of reported cases. Knowing the real number of infected is really hard, especially in population less at risk (the young and healthy).

For example, there was this anecdote this week about a woman in the US. She believes she's infected, but none of the responsible authorities will let her pass a test unless she's physically been to one of the high-risk countries. So she either self-quarantine or ignore all of it and go to work. The twist is that she's a health practitioner...

I would guess that the anecdote about the woman who can't get tested is because of a severe under supply of test kits. The CDC developed a test kit last month, but it is only being sent to approved laboratories, and the tests will only be given to people "who meet CDC criteria for COVID-19 testing." [1]

Test suppliers who develop test for hospitals and doctors offices are ramping up production as fast as they can, but it will take time.

[1] https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

A population that skews old is part of it.

This site is good for up to date, and fairly detailed numbers about Italy: https://lab24.ilsole24ore.com/coronavirus/

They are doing a pretty good job of testing: 4000 yesterday. Oregon, by comparison, has the capacity to test about 40 a day.

Edit: also, they are not being "drastic" enough in Italy.

Scenes from a ski area: https://ladige.it/news/cronaca/2020/03/07/come-previsto-oggi...

Stay home, or if you want to go out, go for a walk in the woods or something, but don't go where it's crowded.

Note that the population of Italy is 15x that of Oregon, so the proportional rate of testing is much closer.

It isn't, though, it's an still an order of magnitude less in Oregon.

4.2 million, 40 tests per day 60 million, 5700 tests yesterday

Here's my wild-ass guess: The percentage of lethal cases is actually close to 0.1% when the serious cases get the best care possible (my claim). If this is true, then Italy had 200*1000 = 20.000 early-stage cases 8 days ago. This yields on the order of 80.000 cases today, hopefully less as the quarantines should have an effect by now.

This assumes a median of 8 days from onset to death in the lethal cases, and a doubling time of # infections of 4 days, which seems to be around the current level for the world outside of China. The number is very sensitive to average lethality rate, and hence also to the age & health distribution of the population.

It's completely implausible that Italy has only 5000 cases, as people who have visited Italy for their winter holidays have very frequently tested positive after returning home. They haven't all randomly met the same 5000 Italians.

Uh... data from this Chinese study suggests that death & recovery take longer than that... I read it as about 30 - 40 days from exposure.

Also suggests you've got a critical / potentially terminal patient occupying an ICU bed for 2 - 3 weeks in the process, which becomes a significant load on your available hospital capacity...

https://www.medrxiv.org/content/10.1101/2020.03.03.20028423v...

Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people? If its really common then you'd find 100-1000 infected people and then you can calculate the real mortality rate simply by monitoring them and recording how many of them have died. Of course it is possible that proper medical care results in a much lower than usual mortality rate compared to untreated people but that sounds more like good news than bad news.

> Can't you just send out test kits to 10000 random Italians and then use that to calculate the number of infected people?

I think at this point, it's still very early in the spread of infection and the distribution of infection might not be random and might be clustered around certain locations, social circles etc.

I would LOVE to see a full population test sample... Would be expensive (probably need 5 K - 10 K tests for a significant read, most of which will likely be wasted on "likely healthy" members of the community... but would decisively settle this outstanding question of asymptomatic infection frequency.

The closest data point we have is likely that South Korean church, where I think they hunted down more or less every member and tested them... Doesn't give you a true view of asymptomatic presence in the general population but does provide a cue about relative size vs. known infected...

The scary part is the WHO mission were adamant that they failed to find a large number of asymptomatic/mild cases in the population at large, and they tested 300.000 people. I can't get this to match up with my other hunches, so I might be very wrong on this.

My wild guess is that the virus is quite spread there but healthcare caught up very late. South Korea has 7.041 cases with 36 persons in ICU; while Italy has 5.883 cases with 567 in ICU. If we correct by ICU numbers, then Italy should have diagnosed 109k persons with Coronavirus.

That assumes that South Korea did diagnose anyone who got the virus which is unlikely. So the real number might be in hundreds of thousands.

The virus is yet to hit the rest of Europe very hard, though. Italy should be a warning to the other countries of how bad the coronavirus is.

You've arrived at the same order as my estimate of the real number of cases in Italy (I arrived at ~80k, see sibling comment), using a different technique. Yours seems more reasonable.

But note that South Korea must inevitably have missed some cases, so assuming the same ratio of diagnosed to serious cases between Italy and SK. So the real number of diseased people in Italy must actually be a little higher.

Probably because everyone who dies of something resembling pneumonia is tested. In the first few days when they were hoping to track every infected case, they were testing everyone who was in contact with sick people, but at this point asymptomatic cases aren't tested anymore, there just isn't enough capacity. As tests are reserved to sicker and sicker people, fatality rate increases.

Anyway other countries such as Switzerland, Sweden or France aren't that behind in terms of cases per million people (Iceland was even ahead of Italy as of yesterday), perhaps 10 days or so. I don't feel like my region is particularly unlucky.

In Italy the average age of patients who have died is 81

I’ve read that the average age in those Italian areas is very old.

I have a friend living in southern Italy, and she surmised that there are a few hotspots that had a combination of lifelong smokers and a much older average aged population, and those areas seem to be skewing the mortality rates.

No need for theories, the disease is more fatal to those over 80 y.o. That's why the mortality is higher: demographics

>No need for theories

Germany has 700 cases and 0 deaths. Austria has 80 cases and 0 deaths...both of these countries are adjacent to Northern Italy region, in which 233+ have died.

Saying "no theory needed" frankly raises more questions than provides answers.

Death rate being 0.5% in Italy, for 80 Austrian cases we might have one fatality soon.

When was the 1st case in Germany and when was the 1st case in Italy?

233 out of 5883 is not 0.5%

Yes, you're right, bad mental math

it's ~ 4%

https://www.worldometers.info/coronavirus/#countries