Italy's coronavirus death toll is probably considerably higher than reported, statistics bureau ISTAT said on Wednesday in an analysis pointing to thousands of fatalities that have not been officially attributed to COVID-19.
In its second report on the epidemic's impact on Italy's mortality rate, ISTAT said that from February to the end of November there were almost 84,000 more deaths compared with the average of the previous five years.
Of these "excess deaths", 57,647 - or 69% - were officially registered by the health ministry and civil protection unit as being attributed to the new coronavirus.
Italy has continued to register hundreds of COVID-19 deaths per day since the study was concluded, with the updated official tally reaching 73,604 on Wednesday, the highest toll in Europe and the fifth highest in the world.
ISTAT's report, drawn up with the National Health Institute, said it was not possible to conclude that the excess mortality was all the result of COVID-19, because of methodological issues and difficulties in determining precise cause of death.
However, the report said the time-trend of excess deaths closely followed the path of the pandemic.
This saw a surge in northern regions during the spring, followed by a summer lull when overall death rates returned to normal, and a new, accelerating increase from October in the so-called "second-wave" of coronavirus infections.
During this second wave, both official COVID-19 fatalities and overall excess deaths were more evenly spread over the country, but they were still most pronounced in the north.
In northern regions in November alone, deaths were up by 61.4% compared with the average of the previous five years. They rose by 39.3% in central Italy, and were up 34.7% in the south.
In Lombardy, Italy's wealthiest and most populous region, deaths in November were up 66.4% from the average of the previous five years. That compared with an increase of 38% in the central Lazio region which includes Rome.