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Minerva Medica 2020 Jun 02

DOI: 10.23736/S0026-4806.20.06702-6


language: English

COVID-19 mortality rates in the European Union, Switzerland, and the UK: effect of timeliness, lockdown rigidity, and population density

Alberto G. GERLI 1, Stefano CENTANNI 2, Monica R. MIOZZO 3, J. Christian VIRCHOW 4, Giovanni SOTGIU 5, G. Walter CANONICA 6, Joan B. SORIANO 7, 8

1 Management Engineering Tourbillon Tech srl, Padova, Italy; 2 Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milano, Italy; 3 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; 4 Departments of Pneumology, Intensive Care Medicine, Center for Internal Medicine, Universitätsmedizin Rostock, Rostock, Germany; 5 Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical, Experimental Sciences, University of Sassari, Sassari, Italy; 6 Allergy & Asthma Clinic, Humanitas University & Research Hospital IRCCS, Milano, Italy; 7 Hospital Universitario de la Princesa, Madrid, Spain; 8 Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain


BACKGROUND: To date the European experience with COVID-19 mortality has been different to the observed in China and Asia. We aimed to forecast mortality trends in the 27 countries of the European Union (EU), plus Switzerland and the United Kingdom (UK), where lockdown dates and confinement interventions have been heterogeneous, and to explore its determinants.
METHODS: We have adapted our predictive model of COVID-19-related mortality, which rested on the observed mortality within the first weeks of the outbreak and the date of the respective lockdown in each country. It was applied in a training set of three countries (Italy, Germany and Spain), and then applied to the EU plus the UK and Switzerland. In addition, we explored the effects of timeliness and rigidity of the lockdown (on a five-step scale) and population density in our forecasts. We report r2, and percent variation of expected versus observed deaths, all following TRIPOD guidance.
RESULTS: We identified a homogeneous distribution of deaths, and found a median of 24 days after lockdown adoption to reach the maximum daily deaths. Strikingly, cumulative deaths up to April 25th, 2020 observed in Europe separated countries in three waves, according to the time lockdown measures were adopted following the onset of the outbreak: after a week, within a week, or even prior to the outbreak (r2=0.876). In contrast, no correlation neither with lockdown rigidity nor population density were observed.
CONCLUSIONS: The European experience confirms that early, effective interventions of 86 lockdown are fundamental to minimizing the COVID-19 death toll.

KEY WORDS: COVID-19; Europe; Lockdown; Mortality

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