Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy

Conti, Sara; Ferrara, Pietro; Mazzaglia, Giampiero; D’Orso, M; Ciampichini, Roberta; Fornari, Carla; Madotto, Fabiana; Magoni, Michele; Sampietro, Giuseppe; Silenzi, Andrea; Sileo, Claudio Vito; Zucchi, Alberto; Cesana, Giancarlo; Manzoli, Lamberto; Mantovani, Lorenzo Giovanni

doi:10.1183/23120541.00458-2020

Cited by 28 publications

(23 citation statements)

References 15 publications

(21 reference statements)

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“…Italy has rapidly become one among the countries most affected by the novel coronavirus disease 2019 (COVID-19) pandemic, after the detection of the first confirmed case in late February 2020 [ 1 , 2 ]. As for other countries, the rapid spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has posed an unprecedented challenge, with a high number of confirmed cases—reaching more than 2.8 million cases and almost 97,000 deaths by February 25, 2021, an enormous death toll and impactful consequences on the entire healthcare service system [ 1 , 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, with the goal to fill this gap, the presented study aimed to primarily estimate the prevalence and time-persistence of SARS-CoV-2 antibodies, and to suggest factors associated with positivity among different categories of workers from a densely populated vast geographical area of northern Italy, which was hit hardest in terms of cases and deaths during the first epidemic wave (March—May 2020) [ 5 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study

Valle

Fabbri

Madotto

et al. 2021

IJERPH

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Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with positivity, through the detection of virus-specific immunoglobulin G and M (IgG/IgM) in serum samples. Enrollees were divided in low exposure and medium-high groups on the basis of their work activity. Antibody responders were re-contacted after 3 months for the follow-up. Of 2255 sampled workers, 4.8% tested positive for SARS-CoV-2 IgG/IgM antibodies, with 81.7% to IgG only. Workers who continued to go to their place of work, were healthcare workers, or experienced at least one COVID-19-related symptom were more likely to test positive for SARS-CoV-2 antibodies. SARS-CoV-2 antibodies prevalence was significantly higher in the medium-high risk vs. low-risk group (7.2% vs. 3.0%, p < 0.0001). At 3-month follow-up, 81.3% of subjects still had antibody response. This study provided important information of SARS-CoV-2 infection prevalence among workers in northern Italy, where the impact of COVID-19 was particularly intense. The presented surveillance data give a contribution to refine current estimates of the disease burden expected from the SARS-CoV-2.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study

Valle

Fabbri

Madotto

et al. 2021

IJERPH

Self Cite

View full text Add to dashboard Cite

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“…There is no consensus on the sex difference in the excess mortality during the COVID-19 outbreak. Two studies reported higher excess deaths in male than in females [ 11 , 31 ], while inconclusive sex difference was reported in several locations [ 17 , 20 ]. Similarly, we did not identify a significant sex difference.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, examining the excess mortality by sociodemographic status could reveal the inequalities in the effects of COVID-19 outbreak and further illuminate targeted approaches to reducing the adverse effects of the outbreak. Age and gender disparities have been explored previously [ 6 – 9 , 11 – 13 , 17 – 20 ]. To our knowledge, there is no previous study estimating the excess deaths for subpopulations of other sociodemographic status, such as marital status and occupation class.…”

Section: Introductionmentioning

confidence: 99%

Temporal dynamic in the impact of COVID− 19 outbreak on cause-specific mortality in Guangzhou, China

Hua

Han

et al. 2021

BMC Public Health

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Background Studies related to the SARS-CoV-2 spikes in the past few months, while there are limited studies on the entire outbreak-suppressed cycle of COVID-19. We estimate the cause-specific excess mortality during the complete circle of COVID-19 outbreak in Guangzhou, China, stratified by sociodemographic status. Methods Guangzhou Center for Disease Control Prevention provided the individual data of deaths in Guangzhou from 1 January 2018 through 30 June 2020. We applied Poisson regression models to daily cause-specific mortality between 1 January 2018 and 20 January 2020, accounting for effects of population size, calendar time, holiday, ambient temperature and PM2.5. Expected mortality was estimated for the period from 21 January through 30 June 2020 assuming that the effects of factors aforementioned remained the same as described in the models. Excess mortality was defined as the difference between the observed mortality and the expected mortality. Subgroup analyses were performed by place of death, age group, sex, marital status and occupation class. Results From 21 January (the date on which the first COVID-19 case occurred in Guangzhou) through 30 June 2020, there were three stages of COVID-19: first wave, second wave, and recovery stage, starting on 21 January, 11 March, and 17 May 2020, respectively. Mortality deficits were seen from late February through early April and in most of the time in the recovery stage. Excesses in hypertension deaths occurred immediately after the starting weeks of the two waves. Overall, we estimated a deficit of 1051 (95% eCI: 580, 1558) in all-cause deaths. Particularly, comparing with the expected mortality in the absence of COVID-19 outbreak, the observed deaths from pneumonia and influenza substantially decreased by 49.2%, while deaths due to hypertension and myocardial infarction increased by 14.5 and 8.6%, respectively. In-hospital all-cause deaths dropped by 10.2%. There were discrepancies by age, marital status and occupation class in the excess mortality during the COVID-19 outbreak. Conclusions The excess deaths during the COVID-19 outbreak varied by cause of death and changed temporally. Overall, there was a deficit in deaths during the study period. Our findings can inform preparedness measures in different stages of the outbreak.

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“…The growing body of evidence on COVID-19 has led to a development of numerous management guidelines and new treatment options [ 9 – 11 ]; however, the impact of the pandemic inevitably extends beyond the patients infected with SARS-CoV‑2. Not only has an excess mortality been observed in several European countries during the first wave of the COVID-19 pandemic, but the number of excess deaths also surpassed the number of deaths attributed to COVID-19 in some countries [ 12 – 14 ]. Furthermore, the reduction of elective activity was accompanied by a decline in hospital admission rates for cardiovascular emergencies and an increase in intrahospital mortality [ 15 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

Bologheanu

Maleczek

Laxar

et al. 2021

Wien Klin Wochenschr

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Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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Magnitude and time-course of excess mortality during COVID-19 outbreak: population-based empirical evidence from highly impacted provinces in northern Italy

Cited by 28 publications

References 15 publications

Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study

Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study

Temporal dynamic in the impact of COVID− 19 outbreak on cause-specific mortality in Guangzhou, China

Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

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