Is a more aggressive COVID-19 case detection approach mitigating the burden on ICUs? Some reflections from Italy

Lorenzoni, Giulia; Lanera, Corrado; Azzolina, Danila; Berchialla, Paola; Gregori, Darío

doi:10.1186/s13054-020-02881-y

Cited by 17 publications

(21 citation statements)

References 3 publications

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“…However, the number of ICU admissions is also related to the preventive actions implemented by the health care decision-makers. For example, a broad testing strategy, as adopted by the Veneto region, was associated with a reduction in the ICU admission rate [33]. An eventual mitigation of the mortality increase is therefore expected.…”

Section: Discussionmentioning

confidence: 99%

How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

Magnani

Azzolina

Gallo

et al. 2020

IJERPH

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Objective: Overall mortality is a relevant indicator of the population burden during an epidemic. It informs on both undiagnosed cases and on the effects of health system disruption. Methods: We aimed at evaluating the extent of the total death excess during the COVID-19 epidemic in Italy. Data from 4433 municipalities providing mortality reports until April 15th, 2020 were included for a total of 34.5 million residents from all Italian regions. Data were analyzed by region, sex and age, and compared to expected from 2015–2019. Results: In both genders, overall mortality was stable until February 2020 and abruptly increased from March 1st onwards. Within the municipalities studied, 77,339 deaths were observed in the period between March 1st to April 15th, 2020, in contrast to the 50,822.6 expected. The rate ratio was 1.11 before age 60 and 1.55 afterwards. Both sexes were affected. The excess was greater in the regions most affected by COVID-19 but always exceeded the deaths attributed to COVID-19. The extrapolation to the total Italian population suggests an excess of 45,033 deaths in the study period, while the number of COVID–19 deaths was 21,046. Conclusion: Our paper shows a large death excess during the COVID-19 epidemic in Italy; greater than the number attributed to it. Possible causes included both the undetected cases and the disruption of the Health Service organization. Timely monitoring of overall mortality based on unbiased nationwide data is an essential tool for epidemic control.

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Section: Discussionmentioning

confidence: 99%

How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

Magnani

Azzolina

Gallo

et al. 2020

IJERPH

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“…More importantly for the management of the healthcare system, such slowdown allowed to ‘gain’ about 3.11 days before reaching the same levels of hospitalisation as predicted by the model, giving the opportunity, in particular to the ICUs working in the regional area, to get better organised. 13…”

Section: Discussionmentioning

confidence: 99%

A first estimation of the impact of public health actions against COVID-19 in Veneto (Italy)

Gregori

Azzolina

Lanera

et al. 2020

J Epidemiol Community Health

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Background Veneto is one of the first Italian regions where the COVID-19 outbreak started spreading. Containment measures were approved soon thereafter. The present study aims at providing a first look at the impact of the containment measures on the outbreak progression in the Veneto region, Italy. Methods A Bayesian changepoint analysis was used to identify the changing speed of the epidemic curve. Then, a piecewise polynomial model was considered to fit the data in the first period before the detected changepoint. In this time interval, that is, the weeks from 27 February to 12 March, a quadratic growth was identified by a generalised additive model (GAM). Finally, the model was used to generate the projection of the expected number of hospitalisations at 2 weeks based on the epidemic speed before the changepoint. Such estimates were then compared with the actual outbreak behaviour. Results The comparison between the observed and predicted hospitalisation curves highlights a slowdown on the total COVID-19 hospitalisations after the onset of containment measures. The estimated daily slowdown effect of the epidemic growth is estimated as 78 hospitalisations per day as of 27 March (95% CI 75 to 81). Conclusions The containment strategies seem to have positively impacted the progression of the COVID-19 epidemic outbreak in Veneto.Gregori D, et al.

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“…A first solution to this problem is proposed by Bassi, Arbia, and Falorsi (2020), who found that positive cases are underestimated at the nation level. However, after the start of the outbreak, the Italian Ministry of Health introduced guidelines in testing symptomatic subjects (Lorenzoni, Lanera, Azzolina, Berchialla, & Gregori, 2020). In Appendix Figure A1, a plot for the ratio of positive cases on the number of tests is provided.…”

Section: Methodsmentioning

confidence: 99%

A Spatio‐temporal analysis of COVID‐19 outbreak in Italy

Ghosh

Cartone

2020

Regional Science Policy & Practice

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Within two weeks from the first detection of the SARS-CoV-2 positive patient on 21st February, from Lombardy the disease has spread over every region in Italy. The main objective of this study is to identify spatial effects and spatiotemporal patterns of the outbreak of COVID-19 in different regions of Italy. Spatial indicators for different periods, as Moran's I, local Moran, LISA clusters, Getis and Ord G, and scatterplots are used for this purpose. Results confirm the great presence of spatial effects as well as changes in spatial regimes between the quarantine and the easing phase. The evidence could be of help for policymakers to a proper assessments of health strategies aware of local characteristics.

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Is a more aggressive COVID-19 case detection approach mitigating the burden on ICUs? Some reflections from Italy

Cited by 17 publications

References 3 publications

How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19 Epidemic? An Analysis on All-Causes Mortality Data in Italy

A first estimation of the impact of public health actions against COVID-19 in Veneto (Italy)

A Spatio‐temporal analysis of COVID‐19 outbreak in Italy

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