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A study compares mortality from COVID-19 in six western metropolitan areas

17 April 2020
Research

Lombardy and Milan with lower rates than New York, Madrid and Brussels

 

The preliminary data of a study conducted by researchers of hygiene and public health of the Vita-Salute San Raffaele University, as part of a European Horizon 2020 project on COVID-19, analyze the spread of the COVID-19 epidemic in 6 metropolitan areas surrounding large agglomerations and which, in addition to sharing consolidated exchanges with China, have similar characteristics for demography, commercial activities and large movements of people: this is the metropolitan area of ​​New York (8.6 million inhabitants), the Paris region, Île-de-France (12.3 million), Greater London (9.3 million), the Brussels-Capital area (1.2 million), the Autonomous Comunidad of Madrid (6.6 million) and Lombardy (10 million).

The highest cumulative mortality rates 30 days after the beginning of the epidemic were recorded in the areas of New York (81.2 x 100,000) and Madrid (77.1 x 100,000) while Lombardy (with its 41.4 per 100,000) is below average and is the only case in which the capital city (Milan) has not been heavily hit by the epidemic wave. The study analyzes the reasons for these data by comparing the containment measures adopted and the role played by the hospital network.

"Our work highlights how a "false myth" has been imposed that attributes an excess of Covid-19 mortality to Lombardy" - explains Professor Carlo Signorelli, full professor of Hygiene and Public Health at the Vita-Salute San Raffaele University and first author of the study.

"The two metropolitan areas where the epidemic has spread most so far have been New York and Madrid, while the Lombardy Region - the first western area to be affected by the epidemic and therefore potentially less prepared - has shown so high overall mortality data in terms of cases (over 10,000), but lower, in proportion to the resident population, to three of the six other areas considered, and with a cumulative mortality rate on the 30th day lower than the metropolitan city of New York and the Comunidad Autonoma of Madrid and the metropolitan province of Brussels".

The fact that the epidemic did not affect the metropolitan capital of Milan but only some neighboring cities may have contributed to this positive result. There may have been two factors that have positively contributed to "defend" the metropolitan area with the highest concentration of population and with the greatest commercial exchanges: on the one hand, the effectiveness and timeliness of the containment and mitigation measures of public authorities that reduced the gatherings and therefore the risk of contagion; on the other, the efficacy and safety of the treatments provided by the hospital structures that admitted the COVID-19 patients. All over the world, the health fields have been the main drivers of this epidemic, but in the Milan area, hospitals have fortunately so far not performed the function of multiplier of cases, as instead happened in small and low-density hospitals care. 

"In reality, the lowering and extension of the epidemic curve have been more favorable in Lombardy and Greater London and in part also in Paris - reality with publicly based health systems - and where the health authorities quickly signed formal agreements with private hospitals to meet the increased request for assistance. Emergency care was provided free of charge in all six realities considered by our study but Lombardy and Greater London could have combined the effectiveness of hospital systems with the fact of having public health systems. These data say that there is no "Lombardy case" regarding excess mortality and that the rapid adjustment of the hospital network, combined with the precautions observed by citizens and the lock downs imposed by the institutions, has been able to limit the spread of the epidemic in the area. with higher population density

- concludes Professor Signorelli.

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