Why does Italy have higher death rate if the US has more confirmed coronavirus cases?

The United States surpassed all countries in the number of confirmed coronavirus cases Thursday, but the death rate here is far lower than in Italy, which has a death rate of about 10%.

The U.S. has a death rate of 1.5%, according to the Johns Hopkins Coronavirus Resource Center. Germany by contrast has a death rate of .6%.

Why the drastic variations?

“Case fatality rates have been very confusing,” Dr. Steven Lawrence, an infectious disease expert and associate professor of medicine at Washington University School of Medicine in St. Louis, told NPR. “The numbers may look different even if the actual situation is the same.”

“Death rate” refers to the number of people who die from coronavirus compared to the number of confirmed cases. A lot of variables impact a country’s coronavirus death rate, including how many people are tested, the age of an infected population and whether the country’s healthcare system is overwhelmed, according to NPR.

Testing widely can significantly impact the death rate in a country, The Washington Post reported. Germany had over 49,300 confirmed cases as of Friday, while France has more than 29,500confirmed cases, but France’s death rate is more than five times higher than Germany’s, according to Johns Hopkins.

That implies there were more undiagnosed cases in France, according to The Washington Post.

In South Korea, for example, authorities tested significantly more people for coronavirus than other countries, so there are more reported cases among people who are less likely to have severe symptoms, the German news outlet Deutsche Welle reported.

Countries with a lower median age range, like those in Sub-Saharan Africa, will likely have a far lower death rate because the people infected with the virus are younger and have stronger immune systems, according to DW.

The World Health Organization calls the distribution of age and gender in a given country the “population pyramid,” according to DW. Older people have a higher risk of contracting coronavirus because they often have pre-existing health conditions, so if a country is only testing those with severe symptoms, that can make the death rate seem higher as those with reported cases are more likely to die because of it, the outlet said.

In the U.S., doctors and nurses working in several hospitals around the country told Buzzfeed that the official counts of coronavirus-related deaths may be skewed for three main reasons: a lack of tests and protective equipment results in fewer diagnoses, overwhelmed hospitals may be reporting the numbers to state and county authorities late, and some hospitals reporting totals on a daily basis say some state and county reports lag in reflecting the numbers.

The most significant factor, however, is how well prepared a country’s health care system is and whether it can “flatten the curve,” experts say. If a country doesn’t flatten the curve, it will see a sharp, concentrated uptick in cases that exceeds the capacity of the health care system, according to TIME magazine.

For example, it’s possible to reduce the number of deaths among severely ill coronavirus patients with help from respirators and ventilators, DW said. Therefore, it makes a big difference when hospitals have enough space and access to those machines.

Infectious disease experts attribute Germany’s lower death rate to its early action during the coronavirus outbreak, The Washington Post reported. It tracked infection clusters, resulting in a better understanding of the size of the outbreak compared to places that only tested the obviously symptomatic, most seriously ill or highest-risk patients.

This story was originally published March 27, 2020 at 12:29 PM with the headline "Why does Italy have higher death rate if the US has more confirmed coronavirus cases?."