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).

Background Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. Methods Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. Results 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134–273] vs 238 mmHg [150–281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan–Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). Conclusion Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.

Platelet transfusion is conventionally used to prevent or treat bleeding in patients with low platelet counts or impaired platelet function. The identification of accurate thresholds of platelet count for guiding platelet transfusion practices is a crucial aspect in health care to prevent adverse events, side effects, unwarranted costs for the health care service, and deprivation of supplies. This article is therefore aimed at providing a narrative overview on current guidelines and recommendations for platelet transfusion across many clinical settings, including platelet function disorders, and critically analyzing the available platelet transfusion thresholds according to the current analytical performance of platelet counting with automated hematological analyzers. Overall, universal agreement on the definition of platelet transfusion thresholds has not been reached. The degree of accuracy and imprecision of many fully automated hematological analyzers appears also unsatisfactory, especially at the lower thrombocytopenic range, and this may thus jeopardize the managed care of patients who are candidates for platelet transfusions. Potential solutions to overcome the current shortcomings of automated platelet counting are also discussed, encompassing the use of alternative tests for guiding platelet transfusion (e.g., thrombin generation assays or thromboelastography) along with innovative approaches for platelet enumeration (e.g., fluorescent labeling and flow cytometry).

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