At the outset of Italy’s COVID-19 outbreak, they launched a surveillance system to collect information on all people with COVID-19 in-country. There are concerns as to why the fatality rate (what percent of people who are infected die) is so high there.

• The fatality rate in Italy was 7.2% (1625 deaths/22 512 cases) as of March 17.
• This rate is higher than that observed in other countries and may be related to 3 factors:
  1. Population age – Italy has more elderly people than other countries (23% are 65 years or more)
  2. Case-related death definition – Italy defined any death in a patient positive for SARS-CoV-2 as a case-related death, regardless of pre-existing conditions.
  3. Testing bias – Because of limited tests, more severe cases are likely to be tested. More than 19% of those tested were positive, and less severe cases are likely missing from the denominator.
• Further surveillance is needed to determine what other characteristics might be related to death in COVID cases.