Abstract The spread of coronavirus disease 2019 (COVID 19) reached pandemic world-wide especially in Italy from early March 2020. Many factors were under discussion among public health experts for the exorbitant mortality rate in Italy than other countries. A coordinated global response was desperately needed to prepare health systems to meet this unprecedented challenge in Italy. This review illustrates predictions, chronic comorbidities, effects of COVID 19 on Italian health system. Covid disease affecting the elderly population with co-morbidities, the same was associated in the mortality rate among elder population in Italy in a greater rate. The mortality rate in Italy was also higher due to the asymptomatic cases not being tested and isolated with initial screening. The most serious outcome of COVID 19 pneumonia was recorded among the population in Italy. Exhausted number of ICU’s beds, ventilators and respirators revealed their un-preparedness for the covid-19 pandemic. This review thus focuses on the various factors to be considered in future pandemics by analyzing the covid - 19 pandemic in Italy.