#Age-specific #SARS-CoV-2 infection #fatality #ratio and associated #risk factors, #Italy, February to April 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Age-specific SARS-CoV-2 infection fatality ratio and associated risk factors, Italy, February to April 2020

Piero Poletti1  , Marcello Tirani2,3 , Danilo Cereda2 , Filippo Trentini1 , Giorgio Guzzetta1 , Valentina Marziano1 , Sabrina Buoro2,4 , Simona Riboli5 , Lucia Crottogini2 , Raffaella Piccarreta6,7 , Alessandra Piatti2 , Giacomo Grasselli8,9 , Alessia Melegaro6,10 , Maria Gramegna2 , Marco Ajelli11 , Stefano Merler1

Affiliations: 1 Bruno Kessler Foundation, Trento, Italy; 2 Directorate General for Health, Lombardy Region, Milan, Italy; 3 Health Protection Agency of Pavia, Pavia, Italy; 4 Quality Management Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy; 5 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; 6 Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy; 7 Department of Decision Sciences, Bocconi University, Milan, Italy; 8 Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 9 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy; 10 Department of Social and Political Sciences, Bocconi University, Milan, Italy; 11 Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, United States

Correspondence:  Piero Poletti ; Marcello Tirani

Citation style for this article: Poletti Piero  , Tirani Marcello , Cereda Danilo , Trentini Filippo , Guzzetta Giorgio , Marziano Valentina , Buoro Sabrina , Riboli Simona , Crottogini Lucia , Piccarreta Raffaella , Piatti Alessandra , Grasselli Giacomo , Melegaro Alessia , Gramegna Maria , Ajelli Marco , Merler Stefano . Age-specific SARS-CoV-2 infection fatality ratio and associated risk factors, Italy, February to April 2020. Euro Surveill. 2020;25(31):pii=2001383. https://doi.org/10.2807/1560-7917.ES.2020.25.31.2001383

Received: 14 Jul 2020;   Accepted: 04 Aug 2020

 

Abstract

We analysed 5,484 close contacts of coronavirus disease (COVID-19) cases in Italy, all tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection fatality ratio was 0.43% (95% confidence interval (CI): 0.21–0.79) for individuals younger than 70 years and 10.5% (95% CI: 8.0–13.6) for older individuals. Risk of death after infection was 62% lower (95% CI: 31–80) in clusters identified after 16 March 2020 and 1.8-fold higher for males (95% CI: 1.03–3.16).

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; Italy; Epidemiology.

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#Inpatient #Care during the #COVID19 Pandemic: A Survey of #Italian #Physicians (Respiration, abstract)

[Source: Respiration, full page: (LINK). Abstract, edited.]

Inpatient Care during the COVID-19 Pandemic: A Survey of Italian Physicians

Attanasi M.a · Pasini S.b · Caronni A.c · Pellegrino G.M.d,e · Faverio P.f,g · Di Pillo S.a · Cimino M.M.h · Cipolla G.i · Chiarelli F.a · Centanni S.d · Sferrazza Papa G.F.d,e · Collaborators for the RECOVER Investigators Study Group

Author affiliations: a Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, Research Center of Excellence on Aging, University of Chieti, Chieti, Italy; b Internal Medicine Unit, Ospedale Maggiore di Lodi, ASST Lodi, UOC Medicina, Lodi, Italy; c U.O. di Recupero e Rieducazione Funzionale, I.R.C.C.S. Fondazione Don Carlo Gnocchi Onlus, Milan, Italy; d Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy; e Casa Cura Policlinico, Department of Neurorehabilitation Sciences, Milan, Italy; f School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; g Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy; h Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Hospital Center – IRCCS, Humanitas University, Rozzano, Italy; i ASST Lodi, UOC Pneumologia, Lodi, Italy

Respiration | DOI: https://doi.org/10.1159/000509007

 

Abstract

Background:

Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern.

Objective:

We explored the clinical management of inpatients with COVID-19 in Italy.

Methods:

A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed.

Results:

A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%.

Conclusions:

In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.

© 2020 S. Karger AG, Basel

Keywords: SARS-CoV-2; COVID-19; Italy.

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#Public #perspectives on #protective #measures during the #COVID19 pandemic in the #Netherlands, #Germany and #Italy: A survey study (PLOS One, abstract)

[Source: PLOS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS |  PEER-REVIEWED | RESEARCH ARTICLE

Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: A survey study

Karien Meier, Toivo Glatz, Mathijs C. Guijt, Marco Piccininni, Merel van der Meulen, Khaled Atmar, Anne-Tess C. Jolink, Tobias Kurth, Jessica L. Rohmann , Amir H. Zamanipoor Najafabadi , on behalf of the COVID-19 Survey Study group

Published: August 5, 2020 | DOI: https://doi.org/10.1371/journal.pone.0236917

 

Abstract

Background

The extent to which people implement government-issued protective measures is critical in preventing further spread of coronavirus disease 2019 (COVID-19) caused by coronavirus SARS-CoV-2. Our study aimed to describe the public belief in the effectiveness of protective measures, the reported implementation of these measures, and to identify communication channels used to acquire information on COVID-19 in European countries during the early stage of the pandemic.

Methods and findings

An online survey available in multiple languages was disseminated starting on March 19th, 2020. After five days, we computed descriptive statistics for countries with more than 500 respondents. Each day, we assessed enacted community containment measures by stage of stringency (I-IV). In total, 9,796 adults responded, of whom 8,611 resided in the Netherlands (stage III), 604 in Germany (stage III), and 581 in Italy (stage IV). To explore possible dynamics as containment strategies intensified, we also included 1,365 responses submitted during the following week. Participants indicated support for governmental measures related to avoiding social gatherings, selective closure of public places, and hand hygiene and respiratory measures (range for all measures: 95.0%-99.7%). Respondents from the Netherlands less frequently considered a complete social lockdown effective (59.2%), compared to respondents in Germany (76.6%) or Italy (87.2%). Italian residents applied enforced social distancing measures more frequently (range: 90.2%-99.3%, German and Dutch residents: 67.5%-97.0%) and self-initiated hygienic and social distancing behaviors (range: 36.3%-96.6%, German and Dutch residents: 28.3%-95.7%). Respondents reported being sufficiently informed about the outbreak and behaviors to avoid infection (range: 90.2%-91.1%). Information channels most commonly reported included television newspapers, official health websites, and social media. One week later, we observed no major differences in submitted responses.

Conclusions

During the early stage of the COVID-19 pandemic, belief in the effectiveness of protective measures among survey respondents from three European countries was high and participants reported feeling sufficiently informed. In March 2020, implementation of measures differed between countries and were highest among respondents from Italy, who were subjected to the most stringent lockdown measures and greatest COVID-19 burden in Europe during this period.

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Citation: Meier K, Glatz T, Guijt MC, Piccininni M, van der Meulen M, Atmar K, et al. (2020) Public perspectives on protective measures during the COVID-19 pandemic in the Netherlands, Germany and Italy: A survey study. PLoS ONE 15(8): e0236917. https://doi.org/10.1371/journal.pone.0236917

Editor: Abdallah M. Samy, Faculty of Science, Ain Shams University (ASU), EGYPT

Received: April 13, 2020; Accepted: July 1, 2020; Published: August 5, 2020

Copyright: © 2020 Meier et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript. Data cannot be shared publicly because of we have no permission from the respondents of our survey to share the de-identified dataset with the general public (Ethics committee: METC-LDD). Data requests can be directed to our data access committee of our COVID-19 Survey Study group (contact via covid19studie@gmail.com).

Funding: The authors received no specific funding for this work.

Competing interests: Outside of the submitted work, TK reports to having contributed to an advisory board of CoLucid and a research project funded by Amgen, for which the Charité – Universitätsmedizin Berlin received an unrestricted compensation. He further reports having received honoraria from Lilly, Newsenselab, and Total for providing methodological advice, from Novartis and from Daiichi Sankyo for providing a lecture on neuroepidemiology and research methods. He is further a consulting clinical epidemiology editor at The BMJ and has received compensation for editorial services. This does not alter our adherence to PLOS ONE policies on sharing data and materials. All other authors have nothing to disclose.

Keywords: SARS-CoV-2; COVID-19; Society; Germany; Italy; Netherlands.

——

Tension #pneumomediastinum in patients with #COVID19 (Thorax, summary)

[Source: Thorax, full page: (LINK). Summary, edited.]

Tension pneumomediastinum in patients with COVID-19

Alessio Campisi 1, Venerino Poletti 2,3, Angelo Paolo Ciarrocchi 1, Maurizio Salvi 4, Franco Stella 1

Author affiliations: 1 Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, Forlì, Italy; 2 Pulmonary Operative Unit, Department of Thoracic Diseases, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forli’, Italy; 3 Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; 4 Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, AUSL della Romagna Rimini, Forlì, Italy;

Correspondence to Dr Alessio Campisi, Thoracic Surgery Unit, Department of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, University of Bologna, Forlì, Emilia-Romagna, Italy; alessio.campisi@studio.unibo.it

DOI: http://dx.doi.org/10.1136/thoraxjnl-2020-215012

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A 65-year-old obese male, with no other comorbidities, was admitted to our intensive care unit for acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was mechanically ventilated (intermittent positive pressure ventilation autoflow mode with tidal volume of 6 mL/kg, positive end expiratory pressure (PEEP) 12 cmH2O, respiratory rate 20 breaths/min and fractional inspired oxygen (FiO2) to the lowest level to maintain arterial pO2 in a range of 55–60 mm Hg) for 7 days before his condition abruptly worsened. He became haemodynamically unstable with changes in the cardiac electrical activity and hypotension unresponsive to catecholamines. An initial plain chest X-ray revealed widespread subcutaneous emphysema.

(…)

Keywords: SARS-CoV-2; COVID-19; ARDS; Intensive Care.

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#Legionella #pneumonia: increased #risk after #COVID19 #lockdown? #Italy, May to June 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Legionella pneumonia: increased risk after COVID-19 lockdown? Italy, May to June 2020

Claudia Palazzolo1 , Gaetano Maffongelli1 , Alessandra D’Abramo1 , Luciana Lepore1 , Andrea Mariano1 , Antonella Vulcano1 , Tommaso Ascoli Bartoli1 , Nazario Bevilacqua1 , Maria Letizia Giancola1 , Enrico Di Rosa2 , Emanuele Nicastri1

Affiliations: 1 National Institute for Infectious Diseases ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy; 2 Local Health Office, ASL Roma 1, Rome, Italy

Correspondence:  Gaetano Maffongelli

Citation style for this article: Palazzolo Claudia , Maffongelli Gaetano , D’Abramo Alessandra , Lepore Luciana , Mariano Andrea , Vulcano Antonella , Bartoli Tommaso Ascoli , Bevilacqua Nazario , Giancola Maria Letizia , Di Rosa Enrico , Nicastri Emanuele . Legionella pneumonia: increased risk after COVID-19 lockdown? Italy, May to June 2020. Euro Surveill. 2020;25(30):pii=2001372. https://doi.org/10.2807/1560-7917.ES.2020.25.30.2001372

Received: 13 Jul 2020;   Accepted: 27 Jul 2020

 

Abstract

We report a case of Legionella pneumonia in a dishwasher of a restaurant in Rome, Italy, just after the end of the lockdown that was in place to control the SARS-CoV-2 epidemic. The case highlights the importance of strict monitoring of water and air systems immediately before reopening business or public sector buildings, and the need to consider Legionella infections among the differential diagnosis of respiratory infections after lockdown due to the ongoing COVID-19 pandemic.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; Legionellosis; Italy.

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A Structural Equation #Model to Examine the #Clinical #Features of Mild‐to‐Moderate #Covid19: A Multicenter #Italian Study (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

A Structural Equation Model to Examine the Clinical Features of Mild‐to‐Moderate Covid‐19: A Multicenter Italian Study

Maria Rosaria Barillari MD, PhD,  Luca Bastiani PhD,  Jerome R Lechien MD, PhD, Giuditta Mannelli MD, PhD,  Gabriele Molteni MD, PhD,  Giovanna Cantarella MD,  Nicola Coppola MD,  Giuseppe Costa MD,  Eleonora M C Trecca MD,  Calogero Grillo MD,  Ignazio La Mantia MD, PhD,  Carlos M Chiesa‐Estomba MD,  Claudio Vicini MD,  Sven Saussez MD, PhD,  Andrea Nacci MD,  Giovanni Cammaroto MD, PhD

First published: 25 July 2020 | DOI:  https://doi.org/10.1002/jmv.26354

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26354

 

Abstract

Purpose

To evaluate the clinical features of mild‐to‐moderate COVID‐19 in a sample of Italian patients and to investigate the occurrence of smell and taste disorders.

Methods

Infected individuals with suspected (clinical diagnosis) or laboratory‐confirmed COVID‐19 infection were recruited. Patients completed a survey‐based questionnaire with the aim of assessing their epidemiological and clinical characteristics, general otorhinolaryngological symptoms and smell and taste disorders.

Results

A total of 294 mild‐to‐moderate COVID19 patients completed the survey (147 females). The most prevalent general symptoms included fever, myalgia, cough and headache. A total of 70.4% and 59.2% of patients reported smell and taste disorders, respectively. A significant association between the two above‐mentioned disorders was found (rs : 0.412; p< 0.001). Smell disorders occurred prior to the other symptoms in 11.6% of patients and was not significantly associated with nasal obstruction or rhinorrhea. Interestingly, our statistical analysis did not show any significant difference, either for general symptoms or otorhinolaryngological features, between the clinical diagnosis group and the laboratory confirmed diagnosis (PCR) group. The structural equation model confirmed significant standardized paths (p <0.05) between general symptoms, comorbidities and general otorhinolaryngological complaints in the absence of a significant correlation between these elements and smell and taste alterations.

Conclusion

The prevalence of smell and taste disorders in mild‐to‐moderate Italian COVID‐19 patients is significant both in suspected and laboratory confirmed cases and reveals a strong correlation between these clinical signs regardless of the presence of general or otorhinolaryngological symptoms, such as nasal obstruction or rhinorrhea.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Anosmia; Italy.

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#Knowledge, #Concerns, and #Behaviors of Individuals During the First Week of the #Coronavirus Disease 2019 Pandemic in #Italy (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Knowledge, Concerns, and Behaviors of Individuals During the First Week of the Coronavirus Disease 2019 Pandemic in Italy

Francesco Pagnini, PsyD, PhD1,2; Andrea Bonanomi, PhD3; Semira Tagliabue, PhD1;  Michela Balconi, PhD1; Mauro Bertolotti, PhD1; Emanuela Confalonieri, PhD1; Cinzia Di Dio, PhD1; Gabriella Gilli, PhD1; Guendalina Graffigna, PhD1,4; Camillo Regalia, PhD1; Emanuela Saita, PhD1; Daniela Villani, PhD1

Author Affiliations: 1 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy; 2 Department of Psychology, Harvard University, Cambridge, Massachusetts; 3 Department of Statistical Sciences, Università Cattolica del Sacro Cuore, Milan, Italy”; 4 EngageMinds HUB, Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy

JAMA Netw Open. 2020;3(7):e2015821. doi:10.1001/jamanetworkopen.2020.15821

 

Key Points

  • Question  – What were the worries and perceptions experienced by residents of different exposure areas during the first week of outbreak of the coronavirus disease 2019 (COVID-19) in Italy?
  • Findings  – This survey study including 2886 participants found that people were well informed about COVID-19 and its implications. Higher scores for cognitive rigidity and emotional instability were associated with more worries and concerns regarding the COVID-19 outbreak regardless of exposure region.
  • Meaning  – These findings suggest that at the beginning of the COVID-19 outbreak, people who were cognitively flexible and emotionally stable were more likely to be more resilient to worries and concerns relating to COVID-19.

 

Abstract

Importance  

At the beginning of a public health crisis, such as the coronavirus disease 2019 (COVID-19) pandemic, it is important to collect information about people’s knowledge, worries, and behaviors to examine their influence on quality of life and to understand individual characteristics associated with these reactions. Such information could help to guide health authorities in providing informed interventions and clear communications.

Objectives  

To document the initial knowledge about COVID-19 and recommended health behaviors; to assess worries (ie, one’s perception of the influence of the worries of others on oneself), social appraisal, and preventive behaviors, comparing respondents from areas under different movement restrictions during the first week after the outbreak; and to understand how worries, perceived risk, and preventive behaviors were associated with quality of life and individual characteristics among Italian adults.

Design, Setting, and Participants  

This convenience sample, nonprobablistic survey study recruited adult participants with a snowballing sampling method in any Italian region during the first week of the COVID-19 outbreak in Italy from February 26, 2020, to March 4, 2020. Data were analyzed from March 5 to 12, 2020.

Exposures  

Information was collected from citizens living in the quarantine zone (ie, red zone), area with restricted movements (ie, yellow zone), and COVID-19–free regions (ie, green zone).

Main Outcomes and Measures  

Levels of knowledge on the virus, contagion-related worries, social appraisal, and preventive behaviors were assessed with ratings of quality of life (measured using the Short Form Health Survey). Additionally, some individual characteristics that may be associated with worries and behaviors were assessed, including demographic characteristics, personality traits (measured using Big Five Inventory-10), perceived health control (measured using the internal control measure in the Health Locus of Control scale), optimism (measured using the Revised Life Orientation Test), and the need for cognitive closure (measured using the Need for Closure Scale).

Results  

A total of 3109 individuals accessed the online questionnaire, and 2886 individuals responded to the questionnaire at least partially (mean [SD] age, 30.7 [13.2] years; 2203 [76.3%] women). Most participants were well informed about the virus characteristics and suggested behaviors, with a mean (SD) score of 77.4% (17.3%) correct answers. Quality of life was similar across the 3 zones (effect size = 0.02), but mental health was negatively associated with contagion-related worries (β = –0.066), social appraisal (β = –0.221), and preventive behaviors (β = –0.066) in the yellow zone (R2 = 0.108). Social appraisal was also associated with reduced psychological well-being in the green zone (β = –0.205; R2 = 0.121). In the yellow zone, higher worries were negatively correlated with emotional stability (β = –0.165; R2 = 0.047). Emotional stability was also negatively associated with perceived susceptibility in the yellow (β = –0.108; R2 = 0.040) and green (β = –0.170; R2 = 0.087) zones. Preventative behaviors and social appraisal were also associated with the need for cognitive closure in both yellow (preventive behavior: β = 0.110; R2 = 0.023; social appraisal β = 0.115; R2 = 0.104) and green (preventive behavior: β = 0.174; R2 = 0.022; social appraisal: 0.261; R2 = 0.137) zones.

Conclusions and Relevance  

These findings suggest that during the first week of the COVID-19 outbreak in Italy, people were well informed and had a relatively stable level of worries. Quality of life did not vary across the areas, although mental well-being was challenged by the social appraisal and worries related to the contagion. Increased scores for worries and concerns were associated with more cognitive rigidity and emotional instability.

Keywords: SARS-CoV-2; COVID-19; Society; Psychology; Psychiatry; Italy.

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#Transmission #route and #introduction of Pandemic #SARS‐CoV‐2 between #China, #Italy and #Spain (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Transmission route and introduction of Pandemic SARS‐CoV‐2 between China, Italy and Spain

Benazi Nabil,  Bounab Sabrina,  Bounab Abdelhakim

First published: 22 July 2020 | DOI:  https://doi.org/10.1002/jmv.26333

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26333

 

Abstract

We present a phylodynamic and phylogeographic analysis of this new SARS‐CoV‐2 virus in this report. A tree of maximum credibility was constructed using the 72 entire genome sequences of this virus, from the three countries (China, Italy and Spain) available as of 03/26/2020 on the GISAID reference frame. To schematize the current SARS‐CoV‐2 migration scenario between and within the three countries chosen, using the multitype bearth‐death model implemented in BEAST2. Bayesian phylogeographic reconstruction shows that SARS‐COV‐2 has a rate of evolution of 2.11×10 ‐3 / sites / year (95% HPD:1.56×10‐3−3.89×10‐3), and a geographic origin in Shanghai, where tMRCA emerged, according to the analysis of the molecular clock, around November 13, 2019. While for Italy and Spain, there are two tMRCA for each country, which agree with the assumption of several introductions for these countries. That explains also this very short period of subepidermal circulation before the recent events. A total of 8 (median) migration events occurred during this short period, the largest proportion of which (6 events (75 %) occurred from Shanghai(China) to Spain and from Italy to Spain. Such events are marked by speeds of migration that are comparatively lower as compared to that from Shanghai to Italy. Shanghai’s R0 and Italy’s are closer to each other, though Spain’s is slightly higher. All these results allow us to conclude the need for an automatic system of mixed, molecular and classical epidemiological surveillance, which could play a role in this global surveillance of public health and decision‐making.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; China; Italy; Spain.

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#Clinical #course of #COVID19 in 41 patients with immune-mediated #inflammatory #diseases: Experience from Humanitas center, #Milan (Pharmacol Res., summary)

[Source: Pharmacological Research, full page: (LINK). Summary, edited.]

Pharmacological Research | Volume 160, October 2020, 105061

Clinical course of COVID-19 in 41 patients with immune-mediated inflammatory diseases: Experience from humanitas center, Milan

Mariangela Allocca a,b

a IBD Center, Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy; b Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

Giacomo Maria Guidelli, Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy;

Riccardo G. Borroni a,b

a Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; b Dermatology, Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy

Carlo Selmi a,b

a Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; b Rheumatology and Clinical Immunology,Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy;

Alessandra Narcisi, Dermatology, Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy;

Silvio Danese a,b, Gionata Fiorino a,b

a IBD Center, Humanitas Clinical and Research Center -IRCCS, Rozzano, Milan, Italy; b Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

Received 7 June 2020, Available online 3 July 2020.

DOI: https://doi.org/10.1016/j.phrs.2020.105061

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Dear Sir The risk of infection from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the outcomes of the COronaVIrus Disease 19 (COVID-19) in patients with immune mediated inflammatory diseases (IMIDs) remains challenging. Whether treatments with immunosuppressive and biologic therapies may increase the risk of infection, its severity and outcome is poorly investigated and, as a result, the discontinuation of these treatments has been suggested [1]. Earlier studies did not find a correlation between immunomodulating treatments and the prognosis of COVID-19 [2,3], while drugs used in IMIDs are being tested to block the cytokine release syndrome associated with COVID-19 [4].

(…)

Keywords: SARS-CoV-2; COVID-19; Immunopathology; Italy.

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#Risk #Factors Associated With #Mortality Among Patients With #COVID19 in #ICU in #Lombardy, #Italy (JAMA Intern Med., abstract)

[Source: JAMA Internal Medicine, full page: (LINK). Abstract, edited.]

Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy

Giacomo Grasselli, MD1,2; Massimiliano Greco, MD3,4; Alberto Zanella, MD1,2; Giovanni Albano, MD5; Massimo Antonelli, MD6,7; Giacomo Bellani, MD, PhD8,9; Ezio Bonanomi, MD10; Luca Cabrini, MD11; Eleonora Carlesso, MS2; Gianpaolo Castelli, MD12; Sergio Cattaneo, MD13; Danilo Cereda, MD14; Sergio Colombo, MD15; Antonio Coluccello, MD16; Giuseppe Crescini, MD16; Andrea Forastieri Molinari, MD17; Giuseppe Foti, MD8,9; Roberto Fumagalli, MD8,18; Giorgio Antonio Iotti, MD19,20; Thomas Langer, MD8,18; Nicola Latronico, MD13,21; Ferdinando Luca Lorini, MD10; Francesco Mojoli, MD19,20; Giuseppe Natalini, MD22; Carla Maria Pessina, MD23; Vito Marco Ranieri, MD24; Roberto Rech, MD25; Luigia Scudeller, MD26; Antonio Rosano, MD22; Enrico Storti, MD27; B. Taylor Thompson, MD28; Marcello Tirani, MD14,29; Pier Giorgio Villani, MD27; Antonio Pesenti, MD1,2; Maurizio Cecconi, MD3,4; for the COVID-19 Lombardy ICU Network

Author Affiliations: 1 Dipartimento di Anestesia, Rianimazione e Emergenza-Urgenza, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2 Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3 Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center–IRCCS, Rozzano, Italy; 4 Department of Biomedical Sciences, Humanitas University, Milan, Italy; 5 Humanitas Gavazzeni, Bergamo, Italy; 6 Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 7 Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; 8 Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; 9 Department of Anesthesia and Intensive Care Medicine, Azienda Socio Sanitaria Territoriale (ASST) Monza–Ospedale San Gerardo, Monza, Italy; 10 Department of Anaesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy; 11 Università degli Studi dell’Insubria, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy; 12 Department of Anesthesiology and Intensive Care, ASST Mantova–Ospedale Carlo Poma, Mantova, Italy; 13 Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Spedali Civili University Hospital, Brescia, Italy; 14 Direzione Generale (DG) Welfare, Lombardy Region, Milan, Italy; 15 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 16 Department of Anesthesiology and Intensive Care, ASST Cremona–Ospedale di Cremona, Cremona, Italy; 17 Department of Anesthesiology and Intensive Care, ASST Lecco–Ospedale di Lecco, Lecco, Italy; 18 Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milan, Italy; 19 Department of Intensive Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 20 Department of Clinical-Diagnostic, Surgical and Pediatric Sciences, University of Pavia, Pavia, Italy; 21 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 22 Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy; 23 Department of Anesthesia and Intensive Care, ASST Rhodense–Presidio di Rho, Milano, Italy; 24 Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy; 25 Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy; 26 Direzione Scientifica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 27 Dipartimento Emergenza Urgenza, Unità Operativa Complessa (UOC) Anestesia e Rianimazione, ASST, Lodi, Italy; 28 Division of Pulmonary and Critical Medicine, Massachusetts General Hospital, Boston; 29 Health Protection Agency of Pavia, Pavia, Italy

JAMA Intern Med. Published online July 15, 2020. doi:10.1001/jamainternmed.2020.3539

 

Key Points

  • Question  – What are the risk factors associated with mortality among critically ill patients with laboratory-confirmed coronavirus disease 2019 admitted to intensive care units in Lombardy, Italy?
  • Findings   – In this cohort study that involved 3988 critically ill patients admitted from February 20 to April 22, 2020, the hospital mortality rate as of May 30 was 12 per 1000 patient-days after a median observation time of 70 days. In the subgroup of the first 1715 patients, 865 (50.4%) had been discharged from the intensive care unit, 836 (48.7%) had died in the intensive care unit, and 14 (0.8%) were still in the intensive care unit; 915 patients died in the hospital for overall hospital mortality of (53.4%).
  • Meaning   – This study found that most critically ill patients with coronavirus disease 2019 in the intensive care unit required invasive mechanical ventilation, and mortality rate and absolute mortality rate were high.

 

Abstract

Importance  

Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU).

Objective  

To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy.

Design, Setting, and Participants  

This retrospective, observational cohort study included 3988 consecutive critically ill patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di Ricovero e Cura a Carattere Scientifico] Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20 to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase–polymerase chain reaction assay of nasopharyngeal swabs. Follow-up was completed on May 30, 2020.

Exposures  

Baseline characteristics, comorbidities, long-term medications, and ventilatory support at ICU admission.

Main Outcomes and Measures  

Time to death in days from ICU admission to hospital discharge. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression.

Results  

Of the 3988 patients included in this cohort study, the median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI, 78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least 1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%) required invasive mechanical ventilation (IMV). The median follow-up was 44 (95% CI, 40-47; IQR, 11-69; range, 0-100) days; median time from symptoms onset to ICU admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12 (95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11; IQR, 6-17) days. Cumulative observation time was 164 305 patient-days. Hospital and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000 patients-days, respectively. In the subgroup of the first 1715 patients, as of May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%) died in the hospital. Independent risk factors associated with mortality included older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95% CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI, 1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06) or low Pao2:Fio2 ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19), hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR, 1.18; 95% CI, 1.01-1.39). No medication was independently associated with mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42; angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29).

Conclusions and Relevance  

In this retrospective cohort study of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients required IMV. The mortality rate and absolute mortality were high.

Keywords: SARS-CoV-2; COVID-19; Intensive Care; Italy.

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