Previous bad flu epidemics in the UK and Italy as yardsticks for overall COVID-19 severity

Significant spike in excess mortality in England in winter 2014/15 – influenza the likely culprit

Significant spike in excess mortality in England in winter 2014/15 - influenza the likely culprit. Significant increases in excess all-cause mortality, particularly in the elderly,were observed during the winter of 2014/15 in England. With influenza A(H3N2) the dominant circulating influenza A subtype, this paper determines the contribution of influenza to this excess controlling for weather. A standardised multivariable Poisson regression model was employed with weekly all-cause deaths the dependent variable for the period 2008-2015.

Adjusting for extreme temperature, a total of 26 542 (95% CI 25 301-27 804) deaths in 65+ and 1942 (95% CI 1834-2052) in 15-64-year-olds were associated with influenza from week 40, 2014 to week 20,2015.
This is compatible with the circulation of influenza A(H3N2). It is the largest estimated number of influenza-related deaths in England since prior to 2008/09. The findings highlight the potential health impact of influenza and the important role of the annual influenza vaccination programme that is required to protect the population including the elderly, who are vulnerable to a severe outcome. 

Epidemiol Infect. 2018 Jul;146(9):1106-1113. doi: 10.1017/S0950268818001152. Epub 2018 May 10.  Pebody RG(1), Green HK(1), Warburton F(1), Sinnathamby M(1), Ellis J(1), Mølbak K(2), Nielsen J(2), de Lusignan S(3), Andrews N(1). 

 Author information: (1) Public Health England,London,UK. (2) Statens Serum Institut,Copenhagen,Denmark. (3)University of Surrey,Guildford,UK.

• Other UK Public health documents estimate usual influenza related deaths (excess mortality) are 8000 per year.
• At the time of posting (8 April),  COVID-19 deaths in the UK are 6159 , with new deaths a day 756.

Update about Italy


Investigating the impact of influenza on excess mortality in all ages in Italy during recent seasons (2013/14-2016/17 seasons). 

 OBJECTIVES: In recent years, Italy has been registering peaks in death rates, particularly among the elderly during the winter season. Influenza epidemics have been indicated as one of the potential determinants of such an excess. The objective of our study was to estimate the influenza-attributable contribution to excess mortality during the influenza seasons from 2013/14 to 2016/17 in Italy. 

METHODS: We used the EuroMomo and the FluMomo methods to estimate the annual trend of influenza-attributable excess death rate by age group. Population data were provided by the National Institute of Statistics, data on influenza like illness and confirmed influenza cases were provided by the National Institutes of Health. As an indicator of weekly influenza activity (IA) we adopted the Goldstein index, which is the product of the percentage of patients seen with influenza-like illness (ILI) and percentage of influenza-positive specimens, in a given week. RESULTS: We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16 and 2016/17, respectively, using the Goldstein index. The average annual mortality excess rate per 100,000 ranged from 11.6 to 41.2 with most of the influenza-associated deaths per year registered among the elderly. However children less than 5 years old also reported a relevant influenza attributable excess death rate in the 2014/15 and 2016/17 seasons (1.05/100,000 and 1.54/100,000 respectively). 

CONCLUSIONS: Over 68,000 deaths were attributable to influenza epidemics in the study period. The observed excess of deaths is not completely unexpected, given the high number of fragile very old subjects living in Italy. In conclusion, the unpredictability of the influenza virus continues to present a major challenge to health professionals and policy makers. Nonetheless, vaccination remains the most effective means for reducing the burden of influenza, and efforts to increase vaccine coverage and the introduction of new vaccine strategies (such as vaccinating healthy children) should be considered to reduce the influenza attributable excess mortality experienced in Italy and in Europe in the last seasons.  

Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved. DOI: 10.1016/j.ijid.2019.08.003 PMID: 31401203 [Indexed for MEDLINE]

Int J Infect Dis. 2019 Nov;88:127-134. doi: 10.1016/j.ijid.2019.08.003. Epub 2019 Aug 8. 

Rosano A(1), Bella A(2), Gesualdo F(3), Acampora A(4), Pezzotti P(2), Marchetti S(5), Ricciardi W(6), Rizzo C(7). 

Author information: (1)National Institutes of Health, Viale Regina Elena, 299, 00198 Rome, Italy; Italian National Agency for Regional Healthcare Services, Via Piemonte, 60, 00187 Rome, Italy. Electronic address: aldo.rosano@iss.it. (2)National Institutes of Health, Viale Regina Elena, 299, 00198 Rome, Italy. (3)Bambino Gesù Children's Hospital, Piazza Sant'Onofrio, 4, 00165 Rome, Italy. (4)Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy. (5)Italian National Institute of Statistics, Via Cesare Balbo, 16, 00184 Rome, Italy. (6)Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168 Rome, Italy. (7)National Institutes of Health, Viale Regina Elena, 299, 00198 Rome, Italy; Bambino Gesù Children's Hospital, Piazza Sant'Onofrio, 4, 00165 Rome, Italy. 

• Rosano 2019 findings correspond to 17000 excess influenza deaths in a typical bad influenza season in Italy.
• At the time of writing (7 April) confirmed Italian deaths from COVID-19 stood at 16525 with additional observations indicating that excess deaths from the epidemic are several-fold higher than confirmed deaths. So at the moment, the impact of Coronavirus in Italy, with heroic public efforts, exceeds the excess mortality of a bad influenza epidemic.