This study investigated the case fatality rate (CFR) among confirmed COVID-19 cases (N=22,512) in Italy, using Italian National Institute of Health surveillance data up to March 17, 2020.

• The overall fatality rate of persons with confirmed COVID-19 in the Italian population, based on data up to March 17, was 7.2% (1625 deaths/22,512 cases). This was substantially higher than the CFR in China, which was 2.3% (1,023/44,672; 2.3%).
• Compared with China, the largest case-fatality age rate differences were observed for those aged 70-79 (CFR 12.8% versus 8.0%) and ≥80 years (CFR 20.2% versus 14.8%). CFRs between the two countries were similar for all other age groups.
• The higher CFR in Italy is likely related to:
  • Age differences. The overall age distribution in Italy is higher than in most countries. Individuals ≥70 years represent 37.6% of cases in Italy versus 11.9% in China.
  • How COVID-19-related deaths are identified. Case-fatality statistics in Italy are based on defining COVID-19-related deaths as those occurring in patients who test positive for SARS-CoV-2 via RT-PCR, independently from preexisting diseases that may have caused death. This may have led to overestimation of the CFR.
  • Testing. Italy prioritized testing for patients with more severe clinical symptoms. This may have resulted in a high proportion of positive results and an apparent increase in the CFR.
• There is no standardized definition for COVID-19-related deaths, which may influence country-specific CFRs and cross-country comparisons.