News and Commentary

Here’s Why COVID-19 Ravaged Italy While South Korea Remained Relatively Stable
ROME, ITALY - MARCH 16: A tobacconist keeps working during the Coronavirus (COVID-19) emergency on March 16, 2020 in Rome, Italy. It's a week after the Italian Government has taken the unprecedented measure of a nationwide lockdown by closing all businesses except essential services such as pharmacies, grocery stores, hardware stores, gas stations and tobacco stores. During the Coronavirus (COVID-19) emergency.
Ernesto Ruscio/Getty Images

This article has been updated since its original publication. 

As Surgeon General Jerome Adams put it on Monday: the next two weeks will be America’s time window to see whether or not the COVID-19 pandemic will unfold like the panic-stricken Italy or the relatively stable South Korea, depending on how diligent people are about following guidelines.

In South Korea, as of this writing, the current death toll for COVID-19 stands at 66, which equals about 0.6% of those infected. Conversely, the death toll in Italy now tops 2,000 as the country’s healthcare system quickly becomes overwhelmed, with nurses and doctors having to make difficult decisions regarding which patients to whom they will administer care. Here’s why the pandemic unfolded so differently in the two countries, according to CNN:

Though testing is known to effectively reduce the risk of transmission, many experts are beginning to also associate more widespread testing with the statistic of greatest concern — survival from the disease.

The connection seems straightforward. Consider two countries with large outbreaks.

In South Korea, the rate of testing has been quite high (3,692 tests per million people as of March 8), and its mortality among those infected quite low (about 0.6%, or 66 deaths, at last count).

By contrast, Italy tests about 826 people per million and its mortality among those with diagnosed infection is about 10 times higher, with more than 1,000 people dead from the disease.

Though COVID-19 testing works to help prevent the spread of infection (as opposed to treating the infection), it cannot necessarily be correlated with fewer deaths and a relatively stable healthcare apparatus. In fact, much of South Korea’s success in fighting this pandemic stems from several factors, including Italy’s high senior population and high smoking rate for women.

“According to a UN report in 2015, 28.6% of the Italian population was 60 years old or older (second in the world after Japan at 33%),” continued CNN. “This compares to South Korea, where 18.5% of the population is at least 60 years of age, ranking 53rd globally. The impact of this disparity is quickly shown in the analysis of coronavirus deaths in each county. In Italy, 90% of the more than 1,000 deaths occur in those 70 or older.”

In South Korea, 30% of COVID-19 patients were in their 20s versus just 20% 60 years or older. The survival rate breaks strongly along gender lines as well in South Korea, where at least 62% of cases were reported among women. If China provides a window, the death rate among men currently stands at 4.7% versus just 2.8% among women. None of this even accounts for the smoking rates in Italy among women.

“Smoking is another factor clearly associated with poor survival. Smoking rates are about the same between the two countries: 24% for Italians and 27% for South Koreans,” reported CNN. “But gender differences among smokers are widely different: In Italy, 28% of men versus 20% of women smoke, while in Korea, it is about 50% of men and less than 5% (!) of women. In other words, South Korea has an outbreak among youngish, non-smoking women, whereas Italy’s disease is occurring among the old and the very old, many of whom are smokers. (We do not know the male-female breakdown of Italy’s cases).”

Given that the United States has entered the early stages of the COVID-19 pandemic, we will not know exactly how it will spread among particular demographics for several weeks. Until then, follow the safety guidelines as outlined by the surgeon general and practice social distancing.

The original article mistakenly said that the South Korean death rate stood at 0.06%. The article has been adjusted to say 0.6%.

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