Updated estimates of excess total mortality in Italy during the circulation of the BA.2 and BA.4-5 Omicron variants: April-July 2022

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Gianfranco Alicandro
Alberto Giovanni Gerli
Giuseppe Remuzzi
Stefano Centanni
Carlo La Vecchia


COVID-19, Omicron, excess deaths, mortality


Background: The impact of new lineages and sub-lineages of Omicron on total and excess mortality is largely unknown. This study aims to provide estimates of excess mortality during the circulation of the Omicron variant in Italy updated to July 2022. Methods: Over-dispersed Poisson regression models, fitted separately for men and women, on 2011-2019 mortality data were used to estimate the expected number of deaths during the Covid-19 pandemic. The excess deaths were then obtained by the difference between observed and expected deaths and computed at all ages and at working ages (25-64 years). Results: Between April and June 2022, we estimated 9,631 excess deaths (+6.3%) at all ages (4,400 in April, 3,369 in May, 1,862 in June) and 12,090 in July 2022 (+23.4%). At working ages, the excess was 763 (+4.9%) in April-June 2022 and 679 (+13.0%) in July 2022. Conclusions: Excess total mortality persisted during the circulation of different lineages and sub-lineages of the Omicron variant in Italy. This excess was not limited to the elderly population but involved also working age individuals, though the absolute number of deaths was small. The substantial excess found in July 2022 is, however, largely attributable to high temperatures. At the end of the year, this may translate into 30 to 35,000 excess deaths, i.e. over 5% excess mortality. This reversed the long-term trend toward increasing life expectancy, with the relative implications in social security and retirement schemes.

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1. Alicandro G, Remuzzi G, La Vecchia C. COVID-19 pandemic and total mortality in the first six months of 2020 in Italy. Med Lav. 2020;111(5):351-353. Doi:10.23749/MDL.V111I5.10786
2. Sorveglianza integrata COVID-19: i principali dati nazionali. Accessed October 11, 2022. https://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-dati
3. Alicandro G, Remuzzi G, Centanni S, Gerli A, La Vecchia C. Excess total mortality during the Covid-19 pandemic in Italy: updated estimates indicate persistent excess in recent months. Med Lav. 2022;113(2):e2022021-e2022021. Doi:10.23749/MDL.V113I2.13108
4. Monitoraggio delle varianti del virus SARS-CoV-2 di interesse in sanità pubblica in Italia. Accessed Oc-tober 10, 2022. https://www.epicentro.iss.it/coronavirus/sars-cov-2-monitoraggio-varianti-rapporti-periodici
5. Istituto Nazionale di Statistica. Decessi e cause di morte: cosa produce l’Istat. Published 2022. Accessed June 2, 2022. https://www.istat.it/it/archivio/240401
6. Istituto Nazionale di Statistica. Popolazione residente e ricostruzione intercensuaria della popolazione. Published 2022. Accessed June 2, 2022. https://demo.istat.it/
7. Alicandro G, Remuzzi G, Centanni S, Gerli A, La Vecchia C. No excess mortality among working-age Ital-ians during the Omicron wave of Covid-19. Med Lav. 2022;113(3). Doi:10.23749/MDL.V113I3.13092
8. Sigal A, Milo R, Jassat W. Estimating disease severity of Omicron and Delta SARS-CoV-2 infections. Nat Rev Immunol. 2022;22(5):267-269. Doi:10.1038/s41577-022-00720-5
9. Trunfio M, Portesani F, Vicinanza S, et al. Real-life Evidence of Lower Lung Virulence in COVID-19 Inpa-tients Infected with SARS-CoV-2 Omicron Variant Compared to Wild-Type and Delta SARS-CoV-2 Pneumonia. Lung. 2022;200:573-577. Doi:10.1007/s00408-022-00566-7
10. Governo Italiano - Report Vaccini Anti Covid-19. Accessed October 11, 2022. https://www.governo.it/it/cscovid19/report-vaccini/
11. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022;23(2):194-202. Doi:10.1038/s41590-021-01104-y
12. Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. Eur Heart J. 2022;43(11):1157-1172. Doi:10.1093/EURHEARTJ/EHAC031
13. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590. Doi:10.1038/S41591-022-01689-3
14. Katsoularis I, Fonseca-Rodríguez O, Farrington P, et al. Risks of deep vein thrombosis, pulmonary em-bolism, and bleeding after Covid-19: nationwide self-controlled cases series and matched cohort study. BMJ. 2022;377:e069590. Doi:10.1136/BMJ-2021-069590
15. Puntmann VO, Martin S, Shchendrygina A, et al. Long-term cardiac pathology in individuals with mild in-itial COVID-19 illness. Nat Med. Published online September 5, 2022:1-7. Doi:10.1038/s41591-022-02000-0
16. Spadea T, Di Girolamo C, Landriscina T, et al. Indirect impact of Covid-19 on hospital care pathways in Italy. Sci Reports. 2021;11(1):1-6. Doi:10.1038/s41598-021-00982-4
17. Woolf SH, Chapman DA, Sabo RT, Zimmerman EB. Excess Deaths from COVID-19 and Other Causes in the US, March 1, 2020, to January 2, 2021. JAMA - J Am Med Assoc. 2021;325(17):1786-1789. Doi:10.1001/jama.2021.5199
18. Excess deaths in England and Wales: March 2020 to June 2022 - Office for National Statistics. Accessed October 11, 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/excessdeathsinenglandandwalesmarch2020tojune2022/2022-09-20
19. Office of National Statistics. Coronavirus (COVID-19) latest insights - Office for National Statistics. Office of National Statistics. Published 2022. Accessed October 13, 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/deaths
20. Aburto JM, Schöley J, Kashnitsky I, et al. Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries. Int J Epidemiol. 2022;51(1):63-74. Doi:10.1093/IJE/DYAB207