{"id":49299,"date":"2020-05-07T08:18:35","date_gmt":"2020-05-07T08:18:35","guid":{"rendered":"http:\/\/taubcenter.secure2.anova-host.com\/why-is-israels-coronavirus-mortality-rate-so-low-in-part-age-structure\/"},"modified":"2020-12-29T08:48:48","modified_gmt":"2020-12-29T08:48:48","slug":"why-is-israels-coronavirus-mortality-rate-so-low-in-part-age-structure","status":"publish","type":"post","link":"https:\/\/www.taubcenter.org.il\/en\/why-is-israels-coronavirus-mortality-rate-so-low-in-part-age-structure\/","title":{"rendered":"Why is Israel\u2019s coronavirus mortality rate so low? In part, age structure"},"content":{"rendered":"

One of the unadulterated bright spots in Israel\u2019s experience of coronavirus is its relatively low mortality. Our daily analyses of CSSE data<\/a><\/span> show that even though rates of infection per capita in Israel are not great\u2014they\u2019re very similar to those in the US, marginally higher than those in the UK and most Scandinavian countries, and three times higher than those in Australia and New Zealand\u2014deaths per capita from coronavirus in Israel are low.[1]<\/p>\n

We can see this clearly using data up to April 5. Israel\u2019s per capita deaths from coronavirus are less than 10% of the level in the Belgium, France and Netherlands, less than 20% of the level in the US, UK, Sweden and Switzerland. They are also less than half of the level in Germany, and almost perfectly track those of Finland\u2014these two countries have both emerged as the medical stars of the coronavirus pandemic.
\n\"1\"<\/p>\n

What\u2019s going on? How has Israel been so successful in keeping deaths from coronavirus to these low levels even as its levels of infection are relatively average? \u00a0Certainly some of the credit belongs to skilled health professionals, to excellent critical care facilities\u2014in spite of being underfunded and overstretched<\/a><\/span>\u2014and to Israel\u2019s particular disease profile (e.g., like low rates of heart disease).<\/p>\n

Perhaps the most important factor, however, is demographic good fortune. <\/strong>There are two<\/em> separate issues here.\u00a0 First, Israel is confronting a virus that threatens the elderly much more than the young. This has been widely covered in scientific studies since January, and its implications for Israel, whose population is unusually young for a developed country, are explored in our own study<\/a><\/span>. Second, the age profile of infection<\/strong> is quite different in Israel.
\n\"2\"<\/p>\n

We can see both these factors at play in this second figure.\u00a0 The green bars in each panel point to the proportion of the total national population of Israel and Italy (2020 estimates) in each age group. Israel has a standard pyramid shape. This reflects continued exceptional high fertility in Israel<\/a><\/span>, and it means that Israel\u2019s population is relatively young. Only 25% of Israel\u2019s population is at least 50 years of age, and 35% are under age 20.<\/p>\n

Italy\u2019s bars are more pear-shaped. This reflects Italy\u2019s longstanding low fertility, pointing to a relatively high mean age in the population. In sharp contrast to Israel, 44% of the Italian population is at least 50 years of age, and only 18% is below age 20.<\/p>\n

If coronavirus infection rates were to follow the age structure proportionately, the red bars would parallel the green bars, at least from age 20 and up.[<\/a>2]<\/a> That would give them the same pyramid shape in Israel, and the same pear shape in Italy. Given what we know about age profile of coronavirus mortality, that proportionality would itself give Israel an advantage over all other OECD countries<\/em> in terms of lower expected mortality.<\/p>\n

Yet the red bars clearly don\u2019t parallel the green. Herein lies the second factor. The age profile of confirmed infections disproportionately targets the young in Israel and the elderly in Italy. \u00a0In Israel, for example, 36% of infections are to people aged less than 30, as opposed to a mere 5% of infections in Italy.[3]\u00a0 Likewise, whereas 21% of coronavirus infections in Israel are to people aged at least 60, that is the case for 56% of infections in Italy\u2014almost double the share of the 60+ age group in the Italian population.<\/p>\n

So why is Israel\u2019s coronavirus mortality rate so low? <\/strong>One important part of the explanation is a double helping of demographic good fortune: \u00a0Israel\u2019s population is young, and coronavirus is much more damaging to the elderly. That really is lucky for us. 100 years ago, Spanish influenza disproportionately killed 15-34 year olds. Until the development of antiretrovirals, HIV disproportionately killed people in their 20s-40s. Many new viruses (e.g., Ebola) have no age-gradient whatsoever. And other types of influenza (e.g., MERS) have a much less distinct age gradient. So Israel has lucked out here.<\/p>\n

Not so the Italians. Our good fortune\u2014in this sense of benefiting from an unintended consequence of our high fertility, and from the whimsical proclivity of a new virus\u2014is Italy\u2019s misfortune. Their ongoing tragedy is at least partly rooted in the same factors, just their flipside. Italy has one of the oldest populations in Europe, and<\/em> coronavirus in Italy has disproportionately affected the elderly. That is a catastrophic combination.[4]<\/p>\n

——————————————————————————————————————————————<\/p>\n

[<\/a>1]<\/a> This difference between Israel\u2019s \u201cranking\u201d on infections and deaths per capita also shows that the Israel\u2019s low mortality is not primarily caused by being at an earlier stage of the pandemic.<\/p>\n

[2] The low percentage of confirmed cases among children appears to reflect the higher prevalence in these ages of subclinical cases, that is, asymptomatic infection. Only once we field serological surveys in population-based samples will we be able ascertain the real distribution of infection across ages.<\/p>\n

[3] Of course, having high infection rates in people\u2019s 20s may also not be great, and certainly has implications for multigenerational family get-togethers as restrictions are eased. But if our focus is narrowly on mortality, it is certainly advantageous.<\/p>\n

[4] Italy also has a relatively low number of ICU bed per capita. But in that sense it is like Israel and unlike, say, Germany.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"One of the unadulterated bright spots in Israel\u2019s experience of coronavirus is its relatively low mortality. Our daily analyses of CSSE data show that even though rates of infection per capita in Israel are not great\u2014they\u2019re very similar…","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[493],"tags":[],"yoast_head":"\nWhy is Israel\u2019s coronavirus mortality rate so low? 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