A few years from now, long after the global pandemic with COVID-19 has passed and the world is a semblance of “normal,” health experts and scientists will still be discussing the case of 102-year-old Italica Grondona. The centenarian has apparently recovered from the coronavirus after spending more than 20 days in the hospital, according to CNN who talked to the woman’s doctors and a relative.

One of her doctors, Vera Sicbaldi, said, 'We nicknamed her Highlander, the immortal. Italica represents a hope for all the elderly facing this pandemic."

The question, however, remains: Why does Italy have such a high fatality rate with the coronavirus? Of the several possible answers, the correct one may be “all of the above."

The “raw” statistics as of March 31 at 10:44 GMT, according to Worldometer, a Shanghai, China-based coronavirus tracker, show 101,739 confirmed cases and 11,591 deaths --  an 11.39% death rate. Worldwide the numbers are 38,721 deaths out of nearly 800,000 cases, a 4.84% rate of fatalities.

Here are the likely factors that explain the situation in Italy:

  • Age – Italica Grondona is undoubtedly the rare exception as the elderly are among the most vulnerable to the virus. The average age of people who have died after testing positive is 78, according to the country’s Health Institute. Blaming age alone is not the complete answer because there is a wider variability in the heath of people over 60 than with younger people. A robust 70-year-old should be able to withstand the infection better than a frail younger person with underlying conditions.
  • Variability in testing between countries is another factor that has worked against Italy. The country was the first one to be hit hard after China before the importance of early testing on even mild cases was found to contribute to effective containment. Dr. Massimo Galli, head of the infectious disease unit at the Sacco Hospital in Milan, said that Italy's number of confirmed cases is "not representative of the entire infected population," adding that the real figure was "much much more." If only the most severe cases are tested the death rate will be skewed upward, said Dr. Galli.
  • Lack of protective gear is a third factor that could be affecting the ability and willingness of health care workers to enter a zone of infection.
  • Cultural norms are another aspect than can partially explain why China and South Korea have fared better so far than Italy. China imposed an authoritarian crackdown, quieted anyone raising alarms about the disease and probably is not reporting the entire scale of the crisis to frame a positive picture of how the Communist regime handled the pandemic. South Korea aggressively tested and identified infected people and the population seemed to unite under their government by obeying guidelines.

The day of mourning marks a month in which Italy saw more deaths from a single disaster than at any time since World War II The day of mourning marks a month in which Italy saw more deaths from a single disaster than at any time since World War II Photo: Quirinale Press Office / Handout

Neither China nor South Korea’s techniques will work very well in western cultures like Italy and Spain. Spain seems to be following the Italian path with a higher than average 8.67% death rate, according to Worldometer.

Dr. Giorgio Palu, former president of the European and Italian Society for Virology and a professor of virology and microbiology of the University of Padova, told CNN that the Italian measures are "not so forceful or strict like the Chinese ones."

He added, "But this is the best you can do in a democracy," comparing Italy’s response to the draconian restrictions implemented by China.