Source
r/CoronavirusDownunder•
pooheygirl

Why we should not be drawing comparisons between Italy and Australia. Some factors that may influence how the disease plays out there, compared to here

Opinion/Speculation

- We know that the elderly are at significantly greater risk of death. Italy has a significantly higher portion of their population that is aged 65 or over (22.75% compared to Australia’s 15%). You could infer from this that serious cases and deaths would be higher in Italy based upon this.

- Italy has 3.18 hospital beds per 1000 people. Australia has 3.8 hospital beds per thousand people. We could infer that this would place Australia above Italy in terms of our capacity to treat infected patients (this effect is greater still, when you account for our lower rates of elderly population).

- Population density in Italy is 206 people per square kilometer. Australia’s density is 3.3 people per square kilometer. Even when comparing major cities, Australia's density is far lower. Rome city proper has population density of 2232 people per square kilometer, while Sydney built urban area has 1237 people per square kilometer. We could infer that between household transmissions might then be greater in Italy than in Australia by virtue of closer proximity to more people (however, we must note that between household transmissions are less risk than within household transmission in general).

- We know that within household transmission occurs at a greater rate than between household transmission. Italy and Australia have similar average household sizes, with Italy at 2.58 per household and Australia at 2.61. We could infer that household size will have similar impacts on R0 (rate of transmission).

- Hypertension has shown to be the comorbidity that has the highest death rates in coronavirus. Italy has a rate of hypertension in the 18+ age group of of 55-59% (even 11% of people age 18-35 are estimated to have hypertension there). Australia’s rate of hypertension is much lower, at 33.7% of people aged 18 and over. We can infer from this that Italy’s rates of serious cases/deaths would be greater than Australia.

- Diabetes is the comorbidity with the second highest risk of death in coronavirus. Italy has a prevalence of diabetes of 5.3%. In comparison, Australia has a diabetes prevalence of 4.9% in the general population. We may infer from this that the effect of diabetes impacting mortality would be similar in each country, if slightly lower in Australia.

- Heart disease is the comorbidity which shows the third highest risk of death in coronavirus. Italy has a coronary heart disease death rate of 64.95 per 100,000 people. Australia has a coronary heart disease death rate of 54.11 per 100,000 people. We could infer from this that heart disease would contribute to higher rates of serious illness and death from coronavirus in Italy, compared to Australia.

- Italy has a population of around 60 million, while Australia has a population of around 24 million. We need to keep this is mind, as we often only hear reports coming out of countries in terms of total numbers, which can be misleading. For example, if 50% of people hypothetically were infected in Italy, the numbers reported from Italy would be 30 million confirmed cases. This is more than the population of Australia, so it would appear scary. However, if the disease acted identically here and infected 50% of Australians, our total number of infections would be 12 million, not 30 million. Therefore, the size of total numbers is quite deceptive when it’s occurring in the context of a much larger population. What is meaningful when drawing comparisons is rates of infection and death, not total numbers (and even then we must be wary because, as demonstrated above, there are vary many factors at play in different countries that will influence how the disease plays out).

Note: Please take the above as my opinion/speculation, not as fact. Also keep in mind there are also very many other factors that will be at play. These are merely a few that I can lay out easily here to demonstrate the complexity of attempting to draw any conclusions about how the disease may behave in our country based on comparisons of what we see happening in other countries.

Posted Mar 10, 2020, 11:25 PM UTC · edited

9175
TrogdorBoardGame•

we should not be drawing comparisons between Italy and Australia

...

here are all my comparisons

41
eucalyptusmacrocarpa•

I think what OP means is that WHEN we draw comparisons, we should not draw conclusions that we are in the same position as Italy. The comparisons tell us that we are not. (But those margins of difference are pretty slight, apart from the population density)

19
pooheygirlOP•

The difference in ageing population demographics are arguably not slight. If Australia's 65+ age group was 22.75% of population like Italy, it could equate to Australia having 87,699 additional deaths.

Calculation is based upon 50% infection rate (Victorian Health Minister currently estimates this) and 9.2% death rate among over 65's (9.2% was used as it is the median of the 3.6%-14.8% death rates found in over 60's in the largest study to date. The death rate in that study increased with age).

Similarly, it would result in additional hospitalizations in the hundreds of thousands.

It's quite significant.

6
eucalyptusmacrocarpa•

Thanks for clarifying. I skim read the article: tbh I was more interested in the meaning of the sentence about comparison, rather than the maths. Maths is not my strong point, apart from "exponential growth is bad"

3
[deleted]•

[deleted]

0
ruptupable•

Exactly this, we can’t keep comparing apples to oranges. But we can see how other countries such as Italy have chosen to respond and we can either choose to learn from them or ignore what they’ve learned. At this point in time our government seems to be ignoring the consequences of treating this virus as the flu, rather than a more serious threat.

3
raspberryfriand•

And actually specifically writes

What is meaningful in drawing comparisons...

5
pooheygirlOP•

The context of my post is that I have noticed people extrapolating from Italy's trajectory and total numbers to predict where Australia will be at on any given number of days in terms of cases and deaths (I have also been asked to provide on our Australian case tracker, a comparison of Italy's total numbers several days out from when they had the same numbers as ours).

Hence my points are to illustrate why comparisons of total numbers is a flawed perspective from which to predict Australian trajectory or outcomes.

2
TemporaryConfidence8•

I think the difference between Australia and Italy will be when we decide to quarantine. This is the difference between Wuhan and say Guangzhouhttps://threadreaderapp.com/thread/1237347774951305216.html
Even if it is following Koreas self quarantine after massive testing.
I think it would be easier for people to comply with Korea's path

0
[deleted]•

[deleted]

0
TemporaryConfidence8•

better to say compare and contrast

3
Phenom_Mv3•

Good analysis, though the developing situation in Australia is quite concerning nonetheless.

I will also say, physical contact in Italy is culturally more significant than it is in Australia. It’s far more common people greet each other with a kiss on both cheeks, hugs, and other forms of contact. They are also very social so isolation in the beginning stages would have been far more of a challenge over there than here.

36
pooheygirlOP•

Really good points.

Sharing meals is also found to be a major factor in super spreading events. Culturally I know that food is important to Italians. I wonder if that would also be something to add.

13
pooheygirlOP•

And agreed, it's still incredibly concerning and should not be underestimated. Even a significantly better trajectory could still be overwhelming, particularly if enough were not done.

2
joel1232•

We don’t even know how bad things are going to get in Italy. It worsens every day.

35
marlybarrow•

Fact is that Italy right now is existing at the edge of its capabilities, something like 7 weeks after it was first detected.

2 points we can deduce from the above statement:

  1. We are likely to be in a similar position in a similar timeframe.

  2. It's going to get worse for Italy, and us, from here on out.

So it doesn't matter if we have more hospital beds or they're slightly older, Italy is going to fall off the edge of a cliff and we'll follow a few weeks later.

15
philstrom•

Why will that happen in Italy when it hasn’t in China or South Kore?

2
zxc223•

China and South Korea are doing much more testing and were more proactive in their approach. Plus, stricter measures and sooner. They were able to get ahead of the outbreak. Italy is playing catch-up.

7
captainmanlyhands•

But to what extent were Italy not able to get ahead because an ageing population means more cases that become severe or die, leading to faster overwhelm? Chicken or egg?

1
zxc223•

Ageing population matters for number of deaths but not rate of spread (perhaps it reduces the rate of spread even - it probably made the outbreak more visible in Italy so that should've helped slow it down). Rate of spread matters more for controlling an outbreak and that is what South Korea and China have succeeded in reducing, in comparison to Italy.

2
philstrom•

Italy’s actually had stricter measures than South Korea, we’ll see how it works out in the next couple of weeks

1
Eueyyy•

A big one is societal compliance. China being totalitarian and having a culture that has less of an issue in things like mask wearing , self isolation and quarantine due to the threat of virus outbreaks in the past is naturally more receptive to these measures (albeit if they enforced strongly). South Korea having a similar culture but with a democracy also places then better.

Australia and Italy don't really have these cultures at all and will struggle in these early stages to contain if and when they bring in strict quarantining.

1
[deleted]•

[deleted]

0
girlshirl•

The most surprising thing about this post is that Italy has greater rates of hypertension, diabetes and heart disease. The "Mediterranian Diet" is often described as the one of the healthiest.

12
Phenom_Mv3•

There are a lot of poor socioeconomic areas in Italy. Calabria for example. They can’t enjoy the much healthier diverse diet the sicilians eat (like seafood, lean meats etc), and often eat a lot of carbohydrate dense cheap foods like pasta

11
[deleted]•

The “Mediterranean diet” is a myth cherry picked from countries that suited the hypothesis.

8
thatreddittherapist•

Thank you so much for this. A lot of things with regards to the numbers do seem to be different. The government could still be doing more, but I do have faith that our situation will not be as bad as other places.

10
Littlearthquakes•

Human have a heap of cognitive biases that are helpful in some situations but not so much in others. Two spring to mind here:

Normalcy bias:

“Normalcy bias, or normality bias, is a tendency for people to believe that things will always function the way they normally have functioned and therefore to underestimate both the likelihood of a disaster and its possible effects.”

Optimism bias:

“Optimism bias is a cognitive bias that causes someone to believe that they themselves are less likely to experience a negative event. It is also known as unrealistic optimism or comparative optimism. Optimism bias is common and transcends gender, ethnicity, nationality and age.”

As humans our decisions and thoughts are influenced by these type of cognitive biases. Even when we know about them we still get influenced by them.

13
pooheygirlOP•

You're correct that people should not automatically underestimate a risk based on cognitive bias, and no one has suggested we should do this.

It's a fact that different countries are experiencing different trajectories.

It's equally flawed to assume your country will resemble the worse trajectory as it is to assume it will resemble the best one.

There are infinite number of factors that influence the trajectory in any given country, from demographics, to government response etc etc. And this is the only point being made here.

8
thatreddittherapist•

That's why it's good to look at some numbers and comparisons.

3
AnxiouslyPerplexed•

Thank you, I've been feeling like this is the case, but no one really wants to say it (or isn't being heard) I've been re-evaluating my perspective and trying to pinpoint cognitive biases for a while now, and had this am I the only one seeing this, or is that another bias moment

3
pooheygirlOP•

Oh for sure, I strongly believe we could be doing much more. And each countries response will go on to influence disease outcomes and behaviour, too. I've just noticed a tendency for many to extrapolate from Italy's data to estimate what it will happen in Australia cases/deaths within a given period of time based on our current numbers, whereas in reality this is not really a very effective way of looking at it.

6
SJDidge•

This is an excellent analysis, I really like that you taken the time to do this, people go straight to doom and gloom / pretend it’s not happening without thinking about the facts first . You have done the opposite, thinking about it objectively and logically. Great job.

6
Kre8ivity•

I agree. Well done OP, really appreciate your efforts.

2
[deleted]•

One correction. The population density of 1237 is Sydneys built urban area (greater sydney area minus national parks area). Not Sydney CBD.

5
pooheygirlOP•

Thank you, I'll update the terminology I've used.

1
msszenzy•

Other things that I have noticed, comparing Italy to Australia is the use of credit/debit card vs banknotes. In Italy I would rarely go out without cash and I would never use debit cards, while in Australia I have zero cash and debit/credit cards are very easy to clean.

But yes, the density factor is very big. Not only that, but Australia is organized in cities, while Italy is spread out in very small cities without any big breaks, so everywhere is in contact with everywhere.

Melbourne and Sydney, from what I've seen, a part from the center/cbd, also seem to have shops and centers all grouped together, and then areas for houses, no shops mixed out there, so a quarantine here would be pretty easy. You could easily take a walk in the resident area where you live and you wouldn't meet other people busy shopping (this would always happen to me in Italy).

Other factor, people here in Australia seem not worried, versus people in Italy were very alarmed when the first patient from Codogno was found to have not returned from China.

Another thing is that Italy has a lot more military per 1000 people: 7.59 per 1,000 people, which would make it easier than Australia to enforce lockdowns, in my opinion.

5
Shaunzki•

With your research, how will asthma impact people/impacts the corona virus. As a relatively healthy 26 year old who has asthma, will taking regular medications (preventer, puffer) be enough?

4
TheNextLiamNeeson•

If I were you I'd be doing a deep dive into some stats from Italy and China on co-morbidities and basing my actions on that.

3
dzm29•

Smoking too. Not sure if more Italians smoke.

1
sydneysider3001•

Same boat here - 22 with bad asthma. I haven’t seen much around if it increases risk of fatality but I’m sure it would to some degree.

1
Shaunzki•

How severe is yours? Preventer day and night + puffer during the day? I'm curious too as my preventer more or less allows me to live a normal life - no issue with exercise, day to day activities what so ever - you wouldn't know I had asthma due to the preventer. However I am curious to know what this might mean with the virus if we were to get hit with a severe strain.

2
stormy786•

I am 29 and also have asthma - I take preventer twice daily (I’m on a strong dose). I don’t need to take reliever but lately have been needing it before exercise. I actually find that stress and anxiety triggers my asthma and inflammation so I’m trying to remain calm.

I’d like to know some statistics for us as well. Are we still at low risk due to our age, or high risk because of our condition?

It’s worth mentioning that Australia and other first world western countries have higher rates of asthma in the population (1 in 10 here). Wonder if this could skew our results...

1
Shaunzki•

I'd say we will be fine, maybe if we were hit with a severe strain we'd need respiratory assistance but I don't see it as something which should put us in that fatal 0.2% category.

1
CapableExplorer•

Thanks for this. I guess the Italy situation really brought it all home for me, compared to what we saw in China, because China is China...

There are still a lot of dissimilarities between Australia and Italy though - a lot of reasons it may hit harder there than here.

4
polaris343•

good analysis

3
RottonGrub•

i rarely hear much account on how we are catching the bugs. via saliva, kissing faces, sharing food or microscopic saliva droplets floating around from coughing. also, bugs in poop. flushing toilets, sewage vents, splashing from treatment plants? again, microscopic particles wafting around. not to mention scratching itchy bottoms and noses then handling everything. it helps to understand and learn protocols of how not to catch bugs.

3
alexur•

Doesn’t mean shit when we are on those disease riddled death traps (Sydney Trains) every morning.

3
capndumdum•

Good post

2
umexquseme•

Would be good to also compare to other countries like SK, Iran, Japan, etc, to get a better idea of how much effect these things have.

2
PMmeblandHaikus•

I predict mass death in regional Australia. We have a significant population of people who live hours away from hospitals. Italy doesn't have this problem. Canada would be a better comparison for us.

Regional communities need to isolate hard. Inner city people should be ok but if this hits regional areas, I think our fatality numbers could sky rocket. There is serious inequality in relation to health surfaces for people that live in the country.

2
pooheygirlOP•

I grew up in rural Australia and most of my extended family are still about 2-3 hours drive from a hospital. Have been thinking about it a lot.

There are potentially ways to mitigate this, as some studies have showed that there is a delay between experiencing symptoms/getting confirmed and then requiring hospitalisation. I wonder whether one measure the government might put in pace is for suspected/confirmed regional cases to be housed closer to medical facilities (and what the logistics of that would look like?).

One thing I’ve also wondered is whether smaller communities will attempt to sequestrate themselves. Arguably farming communities have a greater capacity for self sufficiency than average communities.

I do agree there is a greater risk but not that it necessarily must result in hugely divergent death rates, if enough is done.

2
stormy786•

I actually agree with this sentiment. I’ve lived in country towns outside of Sydney and access to doctors and medical services is tough. I’ve lived in towns with population of 2000 all the way to 30,000 and access to medicine is comparable. It can take weeks to get a doctors appointment and the hospital cannot cater for even a small percentage of the population.

I’m not sure how likely it is that the virus would reach these communities, but big country towns like Orange, Bathurst, Wagga, Dubbo are not immune. There are direct flights from Sydney to these towns, and lots of people who drive back to Sydney on weekends. It has the potential to spread in our rural communities who would not be as equipped as the cities to deal with this.

1
dangoist•

Another difference is regional Australia, there only a few hospitals spaced out every few hundred KM (whether if they got ICU / prepared for infective disease outbreak is another question.), if COVID somehow, although somewhat unlikely, starts clusters in regional areas - those hospitals may very quickly become overwhelmed / and probably high death rates merely due distance from appropriate care. The indigenous, will sure cop it hard due to the naturally significantly higher rates of diabetes and High BP...

Also of note, is our multicultural "clusters" (or ghettos) in certain cities, I'm pretty sure they will react to COVID different than each other- not to mention collective cultural behaviours.

In terms of city comparisons for pop density, it probably be better to use the epicenter as as reference. Country based density, is rather - pointless... we out size nearly ALL countries....

Good analysis overall. It would be concerning though if this replicated in our italian communities.The biggest determining factors, is mostly - when, how and where isolation policies will be implemented.

2
pooheygirlOP•

Yeah, regional Australia is definitely a concerning one. I mentioned above that I thought one potential mitigating action would be to house suspected/confirmed regional cases closer to medical facilities (some studies indicate a delay between symptoms/diagnosis and requirement for hospitalisation that would more than allow for travel in between). I don't know if that's what the government will do or if it's logistically feasible, but higher risk does not automatically have to end in much higher deaths

I did see NT are limiting any unnecessary travel to indigenous communities, which is good to see. I'm not familiar enough with Italy to know if they have specific groups which may be equivalent in vulnerability? What does tend to link most vulnerable groups, though, is ow socioeconomic status, and this in term is something that is linked to a higher burden of conditions such as diabetes, hypertension etc. The GINI index (income inequality) for Italy is 36 and for Australia it is 34, which puts Australia only very slightly more equal than Italy.

Yes, I agree about country density, hence why I provided some comparisons per major city which demonstrate that the density different is still very large. Given they have a much larger population in a much smaller area overall, whether you compare via country, state or city, you invariably tend to end up with significant population density differences.

The timing of isolation will definitely make a difference. However, in countries whose trajectories escalate slower due to demographic factors, they will potentially have more time before a overwhelming spiral occurred, whereas as countries whose demographics lean toward a fast spiral in infection and/or deaths, they arguably may have less leeway.

(None of this is to say we shouldn't do more than we're doing, only to say we can't predict our total numbers based on italy's total number trajectory, as many have been doing. And that Italy is not necessarily the country that is most comparable to Australia in general, in terms of this outbreak)

2
zxc223•

The only thing here that I agree might be a significant factor is the difference in urban population density. The other things, e.g. hospital beds, I don't think will be very relevant as the rate of spread is a much more important factor than the capacity of the healthcare system, which will get overwhelmed no matter how prepared it is.

The high proportion of deaths in Italy is probably indicative of a much larger outbreak than the confirmed infected numbers suggest, in contrast to South Korea.

In Australia I think we have the advantage of having a slower / later outbreak than most other western countries. The rest of Europe has this advantage from seeing Italy as well (though is squandering it for the most part). Our not being in the middle of the flu season is also a major advantage. We have a lot going for us, but complacency is a killer.

2
pooheygirlOP•

Not at all, see my other comment re: percentage of ageing populating. If Australia had the same proportion of over 65’s as Italy we would experience almost 90,000 additional deaths. Additional hospital admissions would be in the hundreds of thousands. (This is based on an assumed infection rate of 50%).

The ageing demographics of a country are exceptionally important in this disease, as the number of hospitalisations and deaths increases so dramatically based upon how old a patient is.

1
wuhan_rat_99•

https://twitter.com/DrDenaGrayson/status/1236994353542901762

Oh? And are we sure? I think it best to not make a habit of talking so factually about things we do not have clarity on yet. Dangerous infact.

0
pooheygirlOP•

All large scale studies to date show that severe disease and deaths in coronavirus all increase dramatically with age (particularly in the over 60's).

1
wuhan_rat_99•

What 'large scale studies'? It has been no more than a month since we have had anything close to 'large scale' numbers to work with outside of China, and on top of that there is at max, 2 months of time in which countries (again outside of China) have had to conduct said studies, making them far from complete, and finally, nothing is pair reviewed! It has been about 4 months aprox. since we even discovered a totally novel virus which has mystified researchers in many aspects on many accounts.
Okay so we aren't sure. Thanks for clarifying!

No but in all seriousness, you prove exactly my point. There are no large scale studies to date on covid-19 PERIOD. Why do you speak with such certainty?

0
SkyRymBryn•

Hi, I don't know if this twitter link has been posted before, and maybe that's why we are now comparing various Italian figures with Australian figures.

My source is twitter, so take it with a grain of salt. It is quite terrifying, so read his comments at own risk.

https://twitter.com/jasonvanschoor/status/1237142891077697538

NIV : Non-intrusive ventilation

ITU : Intensive treatment unit (same as ICU)

OR : operating room

pts : patients

CPAP : Continuous Positive Airway Pressure

1