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d'Andrea V, Trentini F, Marziano V, Zardini A, Manica M, Guzzetta G, Ajelli M, Petrone D, Del Manso M, Sacco C, Andrianou X, Bella A, Riccardo F, Pezzotti P, Poletti P, Merler S. Spatial spread of COVID-19 during the early pandemic phase in Italy. BMC Infect Dis 2024; 24:450. [PMID: 38684947 PMCID: PMC11057115 DOI: 10.1186/s12879-024-09343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
Quantifying the potential spatial spread of an infectious pathogen is key to defining effective containment and control strategies. The aim of this study is to estimate the risk of SARS-CoV-2 transmission at different distances in Italy before the first regional lockdown was imposed, identifying important sources of national spreading. To do this, we leverage on a probabilistic model applied to daily symptomatic cases retrospectively ascertained in each Italian municipality with symptom onset between January 28 and March 7, 2020. Results are validated using a multi-patch dynamic transmission model reproducing the spatiotemporal distribution of identified cases. Our results show that the contribution of short-distance ( ≤ 10 k m ) transmission increased from less than 40% in the last week of January to more than 80% in the first week of March 2020. On March 7, 2020, that is the day before the first regional lockdown was imposed, more than 200 local transmission foci were contributing to the spread of SARS-CoV-2 in Italy. At the time, isolation measures imposed only on municipalities with at least ten ascertained cases would have left uncontrolled more than 75% of spillover transmission from the already affected municipalities. In early March, national-wide restrictions were required to curb short-distance transmission of SARS-CoV-2 in Italy.
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Affiliation(s)
- Valeria d'Andrea
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Department of Physics and Astronomy "Galileo Galilei", University of Padua, Padua, Italy
| | - Filippo Trentini
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
- Dondena Centre for Research On Social Dynamics and Public Policy, Bocconi University, Milan, Italy
- Department of Decision Sciences, Bocconi University, Milan, Italy
| | | | - Agnese Zardini
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Mattia Manica
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Giorgio Guzzetta
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
- Department of Statistics, Sapienza University of Rome, Rome, Italy
| | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Xanthi Andrianou
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Piero Poletti
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Stefano Merler
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy.
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Previsdomini M, Perren A, Chiesa A, Kaufmann M, Pargger H, Ludwig R, Cerutti B. Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study. Swiss Med Wkly 2024; 154:3589. [PMID: 38579322 DOI: 10.57187/s.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND AND AIM The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. METHODS Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. RESULTS After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (-9.6%, corresponding to -8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (-14.9%), gastrointestinal (-13.9%) and cardiovascular (-9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). CONCLUSIONS Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.
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Affiliation(s)
- Marco Previsdomini
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Andreas Perren
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Biomedical Sciences, Università Svizzera Italiana, Lugano, Switzerland
| | - Alessandro Chiesa
- Intensive Care Unit, Department of Intensive Care Medicine - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Mark Kaufmann
- Intensive Care Unit, Department Acute Medicine, University Hospital and University Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, Department Acute Medicine, University Hospital and University Basel, Basel, Switzerland
| | - Roger Ludwig
- Department of Intensive Care Medicine, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Bernard Cerutti
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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3
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Ruzsa R, Benkő R, Hambalek H, Papfalvi E, Csupor D, Nacsa R, Csatordai M, Soós G, Hajdú E, Matuz M. Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary. Antibiotics (Basel) 2024; 13:102. [PMID: 38275331 PMCID: PMC10812576 DOI: 10.3390/antibiotics13010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010-2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010-2019) and a prediction interval was set up to assess whether the pandemic years' observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.
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Affiliation(s)
- Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Institute of Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Róbert Nacsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Márta Csatordai
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, 6725 Szeged, Hungary;
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
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Jacobs BKM, Keter AK, Henriquez-Trujillo AR, Trinchan P, de Rooij ML, Decroo T, Lynen L. Piloting a new method to estimate action thresholds in medicine through intuitive weighing. BMJ Evid Based Med 2023; 28:392-398. [PMID: 37648419 DOI: 10.1136/bmjebm-2023-112350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES In clinical decision-making, physicians take actions such as prescribing treatment only when the probability of disease is sufficiently high. The lowest probability at which the action will be considered, is the action threshold. Such thresholds play an important role whenever decisions have to be taken under uncertainty. However, while several methods to estimate action thresholds exist, few methods give satisfactory results or have been adopted in clinical practice. We piloted the adapted nominal group technique (aNGT), a new prescriptive method based on a formal consensus technique adapted for use in clinical decision-making. DESIGN, SETTING AND PARTICIPANTS We applied this method in groups of postgraduate students using three scenarios: treat for rifampicin-resistant tuberculosis (RR-TB), switch to second-line HIV treatment and isolate for SARS-CoV-2 infection. INTERVENTIONS The participants first summarise all harms of wrongly taking action when none is required and wrongly not taking action when it would have been useful. Then they rate the statements on these harms, discuss their importance in the decision-making process, and finally weigh the statements against each other. MAIN OUTCOME MEASURES The resulting consensus threshold is estimated as the relative weights of the harms of the false positives divided by the total harm, and averaged out over participants. In some applications, the thresholds are compared with an existing method based on clinical vignettes. RESULTS The resulting action thresholds were just over 50% for RR-TB treatment, between 20% and 50% for switching HIV treatment and 43% for COVID-19 isolation. These results were considered acceptable to all participants. Between sessions variation was low for RR-TB and moderate for HIV. Threshold estimates were moderately lower with the method based on clinical vignettes. CONCLUSIONS The aNGT gives sensible results in our pilot and has the potential to estimate action thresholds, in an efficient manner, while involving all relevant stakeholders. Further research is needed to study the value of the method in clinical decision-making and its ability to generate acceptable thresholds that stakeholders can agree on.
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Affiliation(s)
- Bart K M Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Alfred Kipyegon Keter
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
- Human Sciences Research Council, Sweetwaters, Pietermaritzburg, South Africa
| | - Aquiles Rodrigo Henriquez-Trujillo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Facultad de Medicina, Universidad de Las Américas, Quito, Ecuador
| | - Paco Trinchan
- Health Services Department, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Madeleine L de Rooij
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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Bianco C, Guidet B, Flaatten H, Dechartres A, Vallet H. Mortality in older patients admitted to an ICU for COVID-19: A systematic review. Acta Anaesthesiol Scand 2023; 67:1140-1147. [PMID: 37323022 DOI: 10.1111/aas.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/06/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE The objective was to conduct a systematic review of mortality and factors independently associated with mortality of older patients admitted to an intensive care unit (ICU) for COVID-19. MATERIALS AND METHODS Data sources were MEDLINE, EMBASE, the Cochrane Library, and references of included studies. Two reviewers independently selected studies evaluating mortality of older patients (≥ 70 years) admitted to an ICU for COVID-19. They extracted general characteristics, mortality rate, and factors independently associated with mortality. The methodological quality of each study was evaluated by using the Critical Appraisal Skills Programme checklist. RESULTS We selected 36 studies (11,989 patients). Many of the studies were conducted in Europe (42%) and many were retrospective (61%) and multicenter (61%). ICU mortality ranged from 8% to 90%, 1-month mortality from 33% to 90% and 3-month mortality, reported in five studies, from 46% to 60%. Frailty, assessed by the Clinical Frailty Score (CFS), was significantly associated with 1-month and 3-month mortality respectively in two studies (hazard ratio [HR]: 3.2 [2.56-4.13] and HR: 2.83 [95% CI: 1.96-4.08]). CONCLUSION In this systematic review of older patients admitted to an ICU with COVID-19, we documented high heterogeneity of mortality rates.
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Affiliation(s)
- Céline Bianco
- Department of Geriatrics, Saint Antoine Hospital, APHP, Paris, France
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Réanimation Médicale, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Agnès Dechartres
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
| | - Hélène Vallet
- Sorbonne Université, INSERM, UMRS 1135, Centre d'immunologie et de Maladies Infectieuses (CIMI), Department of Geriatrics, Saint Antoine Hospital, APHP, Paris, France
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Marziano V, Guzzetta G, Menegale F, Sacco C, Petrone D, Mateo Urdiales A, Del Manso M, Bella A, Fabiani M, Vescio MF, Riccardo F, Poletti P, Manica M, Zardini A, d'Andrea V, Trentini F, Stefanelli P, Rezza G, Palamara AT, Brusaferro S, Ajelli M, Pezzotti P, Merler S. Estimating SARS-CoV-2 infections and associated changes in COVID-19 severity and fatality. Influenza Other Respir Viruses 2023; 17:e13181. [PMID: 37599801 PMCID: PMC10432583 DOI: 10.1111/irv.13181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background The difficulty in identifying SARS-CoV-2 infections has not only been the major obstacle to control the COVID-19 pandemic but also to quantify changes in the proportion of infections resulting in hospitalization, intensive care unit (ICU) admission, or death. Methods We developed a model of SARS-CoV-2 transmission and vaccination informed by official estimates of the time-varying reproduction number to estimate infections that occurred in Italy between February 2020 and 2022. Model outcomes were compared with the Italian National surveillance data to estimate changes in the SARS-CoV-2 infection ascertainment ratio (IAR), infection hospitalization ratio (IHR), infection ICU ratio (IIR), and infection fatality ratio (IFR) in five different sub-periods associated with the dominance of the ancestral lineages and Alpha, Delta, and Omicron BA.1 variants. Results We estimate that, over the first 2 years of pandemic, the IAR ranged between 15% and 40% (range of 95%CI: 11%-61%), with a peak value in the second half of 2020. The IHR, IIR, and IFR consistently decreased throughout the pandemic with 22-44-fold reductions between the initial phase and the Omicron period. At the end of the study period, we estimate an IHR of 0.24% (95%CI: 0.17-0.36), IIR of 0.015% (95%CI: 0.011-0.023), and IFR of 0.05% (95%CI: 0.04-0.08). Conclusions Since 2021, changes in the dominant SARS-CoV-2 variant, vaccination rollout, and the shift of infection to younger ages have reduced SARS-CoV-2 infection ascertainment. The same factors, combined with the improvement of patient management and care, contributed to a massive reduction in the severity and fatality of COVID-19.
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Affiliation(s)
| | - Giorgio Guzzetta
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Francesco Menegale
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
- Department of MathematicsUniversity of TrentoTrentoItaly
| | - Chiara Sacco
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Daniele Petrone
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | | | - Martina Del Manso
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Antonino Bella
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Massimo Fabiani
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | | | - Flavia Riccardo
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Piero Poletti
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Mattia Manica
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Agnese Zardini
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Valeria d'Andrea
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
| | - Filippo Trentini
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
- Dondena Centre for Research on Social Dynamics and Public PolicyBocconi UniversityMilanItaly
- COVID Crisis LabBocconi UniversityMilanItaly
| | - Paola Stefanelli
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Giovanni Rezza
- Health Prevention directorateMinistry of HealthRomeItaly
| | | | - Silvio Brusaferro
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Department of Epidemiology and BiostatisticsIndiana University School of Public HealthBloomingtonIndianaUSA
| | - Patrizio Pezzotti
- Department of Infectious DiseasesIstituto Superiore di SanitàRomeItaly
| | - Stefano Merler
- Center for Health EmergenciesBruno Kessler FoundationTrentoItaly
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7
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Beccia F, Lontano A, Rossi MF, Marziali E, Pascucci D, Raponi M, Santoro PE, Moscato U, Laurenti P. Three-year COVID-19 and flu vaccinations among medical residents in a tertiary hospital in Italy: The threat of acceptance decline in seasonal campaigns. Hum Vaccin Immunother 2023; 19:2252708. [PMID: 37706326 PMCID: PMC10503443 DOI: 10.1080/21645515.2023.2252708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/15/2023] Open
Abstract
The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant's emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022-2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25-2.17). The dropping in influenza vaccination coverage in 2022-2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.
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Affiliation(s)
- Flavia Beccia
- Section of Hygiene - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Lontano
- Section of Hygiene - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Francesca Rossi
- Section of Occupational Health - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Marziali
- Section of Hygiene - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Pascucci
- Section of Hygiene - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Health Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Raponi
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Emilio Santoro
- Section of Occupational Health - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Umberto Moscato
- Section of Occupational Health - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Laurenti
- Section of Hygiene - Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Mannucci PM, Galbussera AA, D'Avanzo B, Tettamanti M, Remuzzi G, Fortino I, Leoni O, Harari S, Nobili A. Two years of SARS-CoV-2 pandemic and COVID-19 in Lombardy, Italy. Intern Emerg Med 2023; 18:1445-1451. [PMID: 37314640 DOI: 10.1007/s11739-023-03315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/14/2023] [Indexed: 06/15/2023]
Abstract
Lombardy, the largest and most densely populated Italian region, was severely hit in February 2020 by the first pandemic wave of SARS-CoV-2 and associated COVID-19. Since then, additional infection waves spread in the region. The aim of this study was to compare the first with the subsequent waves using the administrative database of the Lombardy Welfare directorate. In the time frames of the four 2020-2022 waves, the absolute number of infected cases, sites of management and crude mortality rate associated with SARS-CoV-2 positivity were extracted from the database. Infected cases progressively increased in the region by approximately 5-fold in the second versus the first wave, 4-fold in the third and 20-fold during the most recent wave mainly associated with the omicron variant. The crude death decreased from 18.7% in the first to 2% in the second and third wave to reach a 0.3% nadir at the time of the fourth wave. This study confirms that in Lombardy outcomes of public health and health-care relevance such as deaths and number of hospitalizations declined dramatically across the four virus waves and reached very low values in 2022 when, at variance with the first three SARS-CoV-2 waves, the majority of infected cases had been previously vaccinated.
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Affiliation(s)
- Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Antonella Galbussera
- Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Giuseppe Remuzzi
- Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - Ida Fortino
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Olivia Leoni
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Sergio Harari
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
- Division of Internal Medicine, Multimedica IRCSS, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
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9
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Trentini F, Ciani O, Vanni E, Ghislandi S, Torbica A, Azzolini E, Melegaro A. A repeated cross-sectional analysis on the economic impact of SARS-CoV-2 pandemic at the hospital level in Italy. Sci Rep 2023; 13:12386. [PMID: 37524912 PMCID: PMC10390582 DOI: 10.1038/s41598-023-39592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023] Open
Abstract
Italy was the first country in Europe to be hit by the Severe Acute Respiratory Syndrome Coronavirus 2. Little research has been conducted to understand the economic impact of providing care for SARS-CoV-2 patients during the pandemic. Our study aims to quantify the incremental healthcare costs for hospitalizations associated to being discharged before or after the first SARS-CoV-2 case was notified in Italy, and to a positive or negative SARS-CoV-2 notified infection. We used data on hospitalizations for 9 different diagnosis related groups at a large Italian Research Hospital with discharge date between 1st January, 2018 and 31st December 2021. The median overall costs for a hospitalization increased from 2410EUR (IQR: 1588-3828) before the start of the pandemic, to 2645EUR (IQR: 1885-4028) and 3834EUR (IQR: 2463-6413) during the pandemic, respectively for patients SARS-CoV-2 negative and positive patients. Interestingly, according to results of a generalized linear model, the highest increases in the average costs sustained for SARS-CoV-2 positive patients with respect to patients discharged before the pandemic was found among those with diagnoses unrelated to COVID-19, i.e. kidney and urinary tract infections with CC (59.71%), intracranial hemorrhage or cerebral infarction (53.33), and pulmonary edema and respiratory failure (47.47%). Our study highlights the economic burden during the COVID-19 pandemic on the hospital system in Italy based on individual patient data. These results contribute to the to the debate around the efficiency of the healthcare services provision during a pandemic.
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Affiliation(s)
- Filippo Trentini
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, 1 Roentgen St., Milan, Italy.
- Covid Crisis Lab, Bocconi University, Milan, Italy.
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy.
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Elena Vanni
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Simone Ghislandi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, 1 Roentgen St., Milan, Italy
- Covid Crisis Lab, Bocconi University, Milan, Italy
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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10
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Barchielli C, Vainieri M, Seghieri C, Salutini E, Zoppi P. The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6179. [PMID: 37372765 DOI: 10.3390/ijerph20126179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.
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Affiliation(s)
- Chiara Barchielli
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Chiara Seghieri
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Eleonora Salutini
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
| | - Paolo Zoppi
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
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11
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Zajic P, Hiesmayr M, Bauer P, Baron DM, Gruber A, Joannidis M, Posch M, Metnitz PGH. Nationwide analysis of hospital admissions and outcomes of patients with SARS-CoV-2 infection in Austria in 2020 and 2021. Sci Rep 2023; 13:8548. [PMID: 37236991 DOI: 10.1038/s41598-023-35349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
This retrospective study evaluated temporal and regional trends of patient admissions to hospitals, intensive care units (ICU), and intermediate care units (IMCU) as well as outcomes during the COVID-19 pandemic in Austria. We analysed anonymous data from patients admitted to Austrian hospitals with COVID-19 between January 1st, 2020 and December 31st, 2021. We performed descriptive analyses and logistic regression analyses for in-hospital mortality, IMCU or ICU admission, and in-hospital mortality following ICU admission. 68,193 patients were included, 8304 (12.3%) were primarily admitted to ICU, 3592 (5.3%) to IMCU. Hospital mortality was 17.3%; risk factors were male sex (OR 1.67, 95% CI 1.60-1.75, p < 0.001) and high age (OR 7.86, 95% CI 7.07-8.74, p < 0.001 for 90+ vs. 60-64 years). Mortality was higher in the first half of 2020 (OR 1.15, 95% CI 1.04-1.27, p = 0.01) and the second half of 2021 (OR 1.11, 95% CI 1.05-1.17, p < 0.001) compared to the second half of 2020 and differed regionally. ICU or IMCU admission was most likely between 55 and 74 years, and less likely in younger and older age groups. We find mortality in Austrian COVID-19-patients to be almost linearly associated with age, ICU admission to be less likely in older individuals, and outcomes to differ between regions and over time.
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Affiliation(s)
- Paul Zajic
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michael Hiesmayr
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Peter Bauer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - David M Baron
- Department of Anaesthesiology, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Anastasiia Gruber
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Posch
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Philipp G H Metnitz
- Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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12
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Ruggeri L, Fumagalli F, Bernasconi F, Semeraro F, Meessen JM, Blanda A, Migliari M, Magliocca A, Gordini G, Fumagalli R, Sechi G, Pesenti A, Skrifvars MB, Li Y, Latini R, Wik L, Ristagno G. Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial. EBioMedicine 2023; 90:104544. [PMID: 36977371 PMCID: PMC10060104 DOI: 10.1016/j.ebiom.2023.104544] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation. METHODS The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ≥ 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ≥ 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA < 6.5 mV-Hz deferred defibrillation in favor of an additional 2-min CPR cycle. AMSA was measured and displayed in real-time during CC pauses for ventilation with a modified defibrillator. FINDINGS The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18-4.90]). No adverse events were reported. INTERPRETATION AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF. TRIAL REGISTRATION NCT03237910. FUNDING European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.
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13
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Kintossou AK, Villar S, Kozlakidis Z. Immunological considerations for laboratory staff and COVID-19 biosafety. BIOSAFETY AND HEALTH 2023; 5:108-111. [PMID: 37123452 PMCID: PMC9984229 DOI: 10.1016/j.bsheal.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
The vulnerability of healthcare and laboratory to potential infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has thus far been analyzed through the lens of the acute phase of the pandemic, including remote-based work, as well as emergency settings that are different from routine healthcare operations. However, as lockdowns ease and activities return to an identifiable pre-pandemic routine, the safety considerations also require to shift accordingly. As laboratory workers are likely to continue being exposed to unidentified SARS-CoV-2 positive samples through routine blood collection and processing operations, coronavirus disease 2019 (COVID-19) might have to be re-considered as an occupational disease within this context. Additionally, as per many such occupational diseases, a surveillance system is implemented for the medium- and long-term. This manuscript presents the views on the possible surveillance scenarios for laboratory staff, viewed from an immunological and biosafety perspective.
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Affiliation(s)
| | - Stephanie Villar
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
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14
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Anesi GL, Dress E, Chowdhury M, Wang W, Small DS, Delgado MK, Bayes B, Szymczak JE, Glassman LW, Barreda FX, Weiner JZ, Escobar GJ, Halpern SD, Liu VX. Among-Hospital Variation in Intensive Care Unit Admission Practices and Associated Outcomes for Patients with Acute Respiratory Failure. Ann Am Thorac Soc 2023; 20:406-413. [PMID: 35895629 PMCID: PMC9993147 DOI: 10.1513/annalsats.202205-429oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: We have previously shown that hospital strain is associated with intensive care unit (ICU) admission and that ICU admission, compared with ward admission, may benefit certain patients with acute respiratory failure (ARF). Objectives: To understand how strain-process-outcomes relationships in patients with ARF may vary among hospitals and what hospital practice differences may account for such variation. Methods: We examined high-acuity patients with ARF who did not require mechanical ventilation or vasopressors in the emergency department (ED) and were admitted to 27 U.S. hospitals from 2013 to 2018. Stratifying by hospital, we compared hospital strain-ICU admission relationships and hospital length of stay (LOS) and mortality among patients initially admitted to the ICU versus the ward using hospital strain as a previously validated instrumental variable. We also surveyed hospital practices and, in exploratory analyses, evaluated their associations with the above processes and outcomes. Results: There was significant among-hospital variation in ICU admission rates, in hospital strain-ICU admission relationships, and in the association of ICU admission with hospital LOS and hospital mortality. Overall, ED patients with ARF (n = 45,339) experienced a 0.82-day shorter median hospital LOS if admitted initially to the ICU compared with the ward, but among the 27 hospitals (n = 224-3,324), this effect varied from 5.85 days shorter (95% confidence interval [CI], -8.84 to -2.86; P < 0.001) to 4.38 days longer (95% CI, 1.86-6.90; P = 0.001). Corresponding ranges for in-hospital mortality with ICU compared with ward admission revealed odds ratios from 0.08 (95% CI, 0.01-0.56; P < 0.007) to 8.89 (95% CI, 1.60-79.85; P = 0.016) among patients with ARF (pooled odds ratio, 0.75). In exploratory analyses, only a small number of measured hospital practices-the presence of a sepsis ED disposition guideline and maximum ED patient capacity-were potentially associated with hospital strain-ICU admission relationships. Conclusions: Hospitals vary considerably in ICU admission rates, the sensitivity of those rates to hospital capacity strain, and the benefits of ICU admission for patients with ARF not requiring life support therapies in the ED. Future work is needed to more fully identify hospital-level factors contributing to these relationships.
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Affiliation(s)
- George L. Anesi
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine
- Leonard Davis Institute of Health Economics
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
| | - Erich Dress
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
| | - Marzana Chowdhury
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
| | - Wei Wang
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
| | | | - M. Kit Delgado
- Leonard Davis Institute of Health Economics
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, and
| | - Brian Bayes
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
| | - Julia E. Szymczak
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Lindsay W. Glassman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | | | | | | | - Scott D. Halpern
- Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine
- Leonard Davis Institute of Health Economics
- Palliative and Advanced Illness Research Center, Perelman School of Medicine
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente, Oakland, California
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15
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Albertsen A. Covid-19 and age discrimination: benefit maximization, fairness, and justified age-based rationing. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:3-11. [PMID: 36242727 PMCID: PMC9568913 DOI: 10.1007/s11019-022-10118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Age-based rationing remains highly controversial. This question has been paramount during the Covid-19 pandemic. Analyzing the practices, proposals, and guidelines applied or put forward during the current pandemic, three kinds of age-based rationing are identified: an age-based cut-off, age as a tiebreaker, and indirect age rationing, where age matters to the extent that it affects prognosis. Where age is allowed to play a role in terms of who gets treated, it is justified either because this is believed to maximize benefits from scarce resources or because it is believed to be in accordance with the value of fairness understood as (a) fair innings, where less priority is given to those who have lived a full life or (b) an egalitarian concern for the worse off. By critically assessing prominent frameworks and practices for pandemic rationing, this article considers the balance the three kinds of age-based rationing strike between maximizing benefits and fairness. It evaluates whether elements in the proposals are, in fact, contrary to the justifications of these measures. Such shortcomings are highlighted, and it is proposed to adjust prominent proposals to care for the worse off more appropriately and better consider whether the acquired benefits befalls the young or the old.
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Affiliation(s)
- Andreas Albertsen
- Department of Political Science, Aarhus University and the Centre for the Experimental-Philosophical Study of Discrimination, CEPDISC, Aarhus University, Aarhus, Denmark.
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16
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Teran-Tinedo JR, Gonzalez-Rubio J, Najera A, Lorente-Gonzalez M, Cano-Sanz E, De La Calle-Gil I, Ortega-Fraile MÁ, Carballo-López D, Hernández-Nuñez J, Churruca-Arróspide M, Zevallos-Villegas A, López-Padilla D, Puente-Maestú L, Navarro-Lopez JD, Jimenez-Diaz L, Landete P. Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study. Arch Bronconeumol 2023; 59:288-294. [PMID: 36797139 PMCID: PMC9892311 DOI: 10.1016/j.arbres.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild-moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC+CPAP initiates early lower mortality and endotracheal intubation (ETI) rates. METHODS Subjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC+CPAP (first 24h, EHC group) and Delayed HFNC+CPAP (after 24h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables. RESULTS The median age of the 760 included patients was 57 (IQR 47-66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1-3) and 46.8% were obese. The median PaO2/FiO2 upon IRCU admission was 95 (IQR 76-126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p=0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p=0.002). CONCLUSIONS Particularly in the first 24h after IRCU admission, the HFNC+CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.
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Affiliation(s)
- Jose Rafael Teran-Tinedo
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, National Hospital for Paraplegics, Toledo, Spain; Complutense University of Madrid, Spain
| | - Jesus Gonzalez-Rubio
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Alberto Najera
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Miguel Lorente-Gonzalez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Eduardo Cano-Sanz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Isabel De La Calle-Gil
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Octubre University Hospital, Madrid, Spain
| | - Maria Ángeles Ortega-Fraile
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Daniel Carballo-López
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Joaquín Hernández-Nuñez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Maria Churruca-Arróspide
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Annette Zevallos-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Daniel López-Padilla
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Luis Puente-Maestú
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Juan D Navarro-Lopez
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Lydia Jimenez-Diaz
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Pedro Landete
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Department of Pneumology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Pneumology department. Hospital Universitario La Princesa, Madrid, Spain.
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17
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Alderotti G, Corvo MF, Buscemi P, Stacchini L, Giorgetti D, Lorini C, Bonaccorsi G, Pinilla MJC, Lastrucci V. Communicating with Patients about COVID-19 Vaccination: A Qualitative Study on Vaccinators in Tuscany Region, Italy. Vaccines (Basel) 2023; 11:vaccines11020223. [PMID: 36851101 PMCID: PMC9968224 DOI: 10.3390/vaccines11020223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The rapid development of the vaccine and the infodemia have challenged communication about COVID-19 vaccines. This study aims to characterize-through the experience of vaccinators-the challenges faced during COVID-19 vaccination consultations and the communication strategies adopted. A qualitative study was conducted on COVID-19 vaccinators in Tuscany, Italy. Face-to-face interviews were conducted and examined by thematic analysis. In total, 30 vaccinators were interviewed. Four main themes emerged. The first highlighted distinct profiles of users' attitudes toward COVID-19 vaccination. Barriers and promoters of vaccine uptake emerged in the second theme: concerns over the vaccine, excessive exposure to information, and a lack of clear guidance from institutions were the main factors behind hesitancy. The third theme highlighted users' information-seeking behaviors; vaccinators observed that users ideologically opposed to the vaccine (IOV) unconsciously seek information that confirms their theories. The last theme comprised communication strategies for dealing with hesitancy. Empathy, first-hand examples, transparency, and tailored communication style appear to be effective in building vaccine trust. Lastly, the impossibility of developing a decision-making partnership with IOVs was noticed. These findings may help to better characterize public attitudes toward COVID-19 vaccination and highlight key communication principles and strategies to foster vaccine confidence.
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Affiliation(s)
- Giorgia Alderotti
- Epidemiology Unit, Meyer Children’s Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
| | - Martina Felicia Corvo
- Global Health Center, Meyer Children’s University Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
| | - Primo Buscemi
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
| | - Lorenzo Stacchini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
| | - Duccio Giorgetti
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | | | - Maria José Caldés Pinilla
- Global Health Center, Meyer Children’s University Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
| | - Vieri Lastrucci
- Epidemiology Unit, Meyer Children’s Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
- Department of Health Sciences, University of Florence, 50134 Florence, Italy
- Correspondence:
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18
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Sauer CM, Chen LC, Hyland SL, Girbes A, Elbers P, Celi LA. Leveraging electronic health records for data science: common pitfalls and how to avoid them. Lancet Digit Health 2022; 4:e893-e898. [PMID: 36154811 DOI: 10.1016/s2589-7500(22)00154-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 12/29/2022]
Abstract
Analysis of electronic health records (EHRs) is an increasingly common approach for studying real-world patient data. Use of routinely collected data offers several advantages compared with other study designs, including reduced administrative costs, the ability to update analysis as practice patterns evolve, and larger sample sizes. Methodologically, EHR analysis is subject to distinct challenges because data are not collected for research purposes. In this Viewpoint, we elaborate on the importance of in-depth knowledge of clinical workflows and describe six potential pitfalls to be avoided when working with EHR data, drawing on examples from the literature and our experience. We propose solutions for prevention or mitigation of factors associated with each of these six pitfalls-sample selection bias, imprecise variable definitions, limitations to deployment, variable measurement frequency, subjective treatment allocation, and model overfitting. Ultimately, we hope that this Viewpoint will guide researchers to further improve the methodological robustness of EHR analysis.
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Affiliation(s)
- Christopher M Sauer
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands; Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Li-Ching Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | | | - Armand Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Paul Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Leo A Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ryu S, Kim D, Jung LY, Kim B, Lee CS. Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study. Medicine (Baltimore) 2022; 101:e29596. [PMID: 35905280 PMCID: PMC9333082 DOI: 10.1097/md.0000000000029596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) resulted in a marked decrease in the number of patient visits for acute myocardial infarction and delayed patient response and intervention in several countries. This study evaluated the effect of the COVID-19 pandemic on the number of patients, patient response time (pain-to-door), and intervention time (door-to-balloon) for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI visiting a hospital in South Korea who underwent primary coronary intervention during the COVID-19 pandemic (January 29, 2020, to December 31, 2020) were compared with those in the equivalent period from 2018 to 2019. Patient response and intervention times were compared for the COVID-19 pandemic window (2020) and the equivalent period from 2018 to 2019. We observed no decrease in the number of patients with STEMI (P = .88) and NSTEMI (P = 1.00) during the COVID-19 pandemic compared to that in the previous years. Patient response times (STEMI: P = .39; NSTEMI: P = .59) during the overall COVID-19 pandemic period did not differ significantly. However, we identified a significant decrease in door-to-balloon time among patients with STEMI (14%; P < .01) during the early COVID-19 pandemic. We found that the number of patients with STEMI and NSTEMI was consistent during the COVID-19 pandemic and that no time delays in patient response and intervention occurred. However, the door-to-balloon time among patients with STEMI significantly reduced during the early COVID-19 pandemic, which could be attributed to decreased emergency care utilization during the early pandemic.
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Affiliation(s)
- Sukhyun Ryu
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Dasom Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Lae Young Jung
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Baekjin Kim
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, South Korea
| | - Chang-Seop Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- *Correspondence: Chang-Seop Lee, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea (e-mail: )
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A model-based opinion dynamics approach to tackle vaccine hesitancy. Sci Rep 2022; 12:11835. [PMID: 35821508 PMCID: PMC9276809 DOI: 10.1038/s41598-022-15082-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/17/2022] [Indexed: 01/07/2023] Open
Abstract
Uncovering the mechanisms underlying the diffusion of vaccine hesitancy is crucial in fighting epidemic spreading. Toward this ambitious goal, we treat vaccine hesitancy as an opinion, whose diffusion in a social group can be shaped over time by the influence of personal beliefs, social pressure, and other exogenous actions, such as pro-vaccine campaigns. We propose a simple mathematical model that, calibrated on survey data, can predict the modification of the pre-existing individual willingness to be vaccinated and estimate the fraction of a population that is expected to adhere to an immunization program. This work paves the way for enabling tools from network control towards the simulation of different intervention plans and the design of more effective targeted pro-vaccine campaigns. Compared to traditional mass media alternatives, these model-based campaigns can exploit the structural properties of social networks to provide a potentially pivotal advantage in epidemic mitigation.
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Impact of the COVID-19 Pandemic on Inpatient Antibiotic Consumption in Switzerland. Antibiotics (Basel) 2022; 11:antibiotics11060792. [PMID: 35740198 PMCID: PMC9219927 DOI: 10.3390/antibiotics11060792] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to analyze inpatient antibiotic consumption during the first 16 months of the COVID-19 pandemic in Switzerland. The entire period (January 2018−June 2021) was divided into the prepandemic period, the first and second waves, and the intermediate period. In the first year of the pandemic, total overall inpatient antibiotic consumption measured in defined daily doses (DDD) per 100 bed-days remained stable (+1.7%), with a slight increase in ICUs of +4.2%. The increase in consumption of broad-spectrum antibiotics was +12.3% overall and 17.3% in ICUs. The segmented regression model of monthly data revealed an increase in overall antibiotic consumption during the first wave but not during the second wave. In the correlation analysis performed in a subset of the data, a significant positive association was found between broad-spectrum antibiotic consumption and an increasing number of hospitalized COVID-19 patients (p = 0.018). Restricting this dataset to ICUs, we found significant positive correlations between the number of hospitalized COVID-19 patients and total antibiotic consumption (p = 0.007) and broad-spectrum antibiotic consumption (p < 0.001). In conclusion, inpatient antibiotic use during the different periods of the COVID-19 pandemic varied greatly and was predominantly notable for broad-spectrum antibiotics.
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22
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Stafseth SK, Skogstad L, Ræder J, Hovland IS, Hovde H, Ekeberg Ø, Lie I. Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7010. [PMID: 35742259 PMCID: PMC9222786 DOI: 10.3390/ijerph19127010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022]
Abstract
Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.
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Affiliation(s)
- Siv Karlsson Stafseth
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway
- MEVU, Lovisenberg Diaconal University College, 0456 Oslo, Norway
| | - Laila Skogstad
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway;
| | - Johan Ræder
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Ingvild Strand Hovland
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, 0424 Oslo, Norway;
| | - Haakon Hovde
- The Norwegian Association for Critical Care Nurses, 0152 Oslo, Norway;
| | - Øivind Ekeberg
- Psychosomatic and Consultation-Liaison Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway;
| | - Irene Lie
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, 0424 Oslo, Norway;
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 2815 Gjøvik, Norway
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23
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Teran-Tinedo JR, Gonzalez-Rubio J, Najera A, Castany-Faro A, Contreras MDLN, Garcia IM, Lopez-Mellado L, Lorente-Gonzalez M, Perez-Garvin P, Sacristan-Crespo G, Suarez-Ortiz M, Navarro-Lopez JD, Jimenez-Diaz L, Landete P. Clinical characteristics and respiratory care in hospitalized vaccinated SARS-CoV-2 patients. EClinicalMedicine 2022; 48:101453. [PMID: 35611064 PMCID: PMC9121909 DOI: 10.1016/j.eclinm.2022.101453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The main objective of the present study was to analyze both clinical characteristics and evolution during hospitalization of a cohort of patients admitted for COVID-19 pneumonia who were not vaccinated, or with a complete or incomplete vaccination schedule. METHODS This COVID-19 specialized single-center cohort study of 1888 COVID-19 patients hospitalized at the "Enfermera Isabel Zendal" Emergencies Hospital (HEEIZ), Madrid (Spain) was performed between July 1 and September 30, 2021. It compared the results of 1327 hospitalized unvaccinated patients to 209 hospitalized fully vaccinated and 352 hospitalized partially vaccinated patients. The four different COVID-19 vaccines authorized in Spain during the time-period studied were: BNT162b2 (Pfizer); ChAdOx1 nCoV-19 (AstraZeneca), mRNA-1273 (Moderna); Ad26.COV2.S (Janssen). FINDINGS Hospitalized patients' median age was 41 years (IQR 33-50) for the unvaccinated and 61 years (IQR 53-67) for the fully vaccinated ones. The main comorbidities were obesity, hypertension and diabetes mellitus. 20% of unvaccinated patients (266) required noninvasive respiratory care, as did 14% (51) of partially and 14% (30) of fully vaccinated; 6% (78) of the unvaccinated patients also needed invasive respiratory care, as did 5% (16) of partially and 11 (5%) fully vaccinated. INTERPRETATION Fully vaccinated patients were 84% (95% CI: 82-86%) less likely to be admitted to hospital, and protection rose for those aged <50 years. Once hospitalized, vaccinated patients displayed more protection against requiring respiratory care than unvaccinated ones, despite being older and having more comorbidities. No differences appeared for the four studied COVID-19 vaccines and complying with vaccination recommendations proved relevant. FUNDING The research was funded by the "Plan Propio de Investigación" Program of the Castilla-La Mancha University /European Regional Development Fund (2021-GRIN-31,039).
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Affiliation(s)
- Jose Rafael Teran-Tinedo
- Respiratory intermediate Care Unit, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
- Pneumology Service, General Universitary Hospital “Gregorio Marañón”, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Jesus Gonzalez-Rubio
- University of Castilla-La Mancha, NeuroPhysiology & Behavior Lab, Centre for Regional Biomedical Reserch (CRIB), Faculty of Medicine of Albacete, Spain
| | - Alberto Najera
- University of Castilla-La Mancha, NeuroPhysiology & Behavior Lab, Centre for Regional Biomedical Reserch (CRIB), Faculty of Medicine of Albacete, Spain
- Corresponding author at: Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain.
| | - Andrea Castany-Faro
- Admission Service, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
| | | | - Isabel Maria Garcia
- Nursering Management, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
- Pneumology Service. Hospital Universitario "La Paz", Madrid, Spain
| | | | - Miguel Lorente-Gonzalez
- Respiratory intermediate Care Unit, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
| | | | | | - Miguel Suarez-Ortiz
- Respiratory intermediate Care Unit, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
| | - Juan D Navarro-Lopez
- University of Castilla-La Mancha, NeuroPhysiology & Behavior Lab, Centre for Regional Biomedical Reserch (CRIB), Faculty of Medicine of Ciudad Real, Spain
- Corresponding author at: Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Lydia Jimenez-Diaz
- University of Castilla-La Mancha, NeuroPhysiology & Behavior Lab, Centre for Regional Biomedical Reserch (CRIB), Faculty of Medicine of Ciudad Real, Spain
- Corresponding author at: Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Pedro Landete
- Respiratory intermediate Care Unit, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain
- Department of Pneumology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Corresponding author at: Respiratory intermediate Care Unit, “Enfermera Isabel Zendal” Emergency Hospital, Madrid, Spain.
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Roasio A, Costanzo E, Bergesio G, Bosso S, Longu S, Zapparoli F, Bertocchini S, Forno G, Fogliati A, Novelli MT. Impact of the Proactive Rounding Team on Rapid Response System During COVID-19 Pandemic: A Retrospective Study From an Italian Medical Center. Cureus 2022; 14:e24432. [PMID: 35637817 PMCID: PMC9128792 DOI: 10.7759/cureus.24432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/05/2022] Open
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Pediatric Emergencies and Hospital Admissions in the First Six Months of the COVID-19 Pandemic in a Tertiary Children's Hospital in Romania. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040513. [PMID: 35455557 PMCID: PMC9028540 DOI: 10.3390/children9040513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has had a significant impact on the pediatric population, particularly on their access to health services. We conducted a retrospective study to assess the influence that the pandemic, and its related containment and mitigation public health measures, had on pediatric emergencies and hospitalizations in a major tertiary pediatric hospital in Bucharest, Romania, during the first six months of the pandemic, March−August 2020, compared to the same period in 2019. In these first 6 months of the COVID-19 pandemic, the number of pediatric emergencies decreased 2.8-fold compared to the same period in 2019, but the proportion of major emergencies increased significantly (p < 0.001). The number of admissions also decreased 3.3-fold in 2020, compared to 2019, but the risk of admission for lower respiratory tract infections and respiratory failure increased 1.3- and 2.3-fold, respectively. In conclusion, the restrictions imposed by the pandemic containment and mitigation plan not only had a significant impact on reducing emergency department presentations, but also on pediatric admissions in Romania. These data highlight the importance of maintaining optimal access to child health services when confronted with a public health threat, such as the COVID-19 pandemic. Active communication with parents, involving general practitioners, pediatricians, and authorities, is essential for managing children with acute signs of illness in the case of future restrictions or lockdown measures.
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26
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Zuglian G, Ripamonti D, Tebaldi A, Cuntrò M, Riva I, Farina C, Rizzi M. The changing pattern of bacterial and fungal respiratory isolates in patients with and without COVID-19 admitted to intensive care unit. BMC Infect Dis 2022; 22:185. [PMID: 35196993 PMCID: PMC8865172 DOI: 10.1186/s12879-022-07176-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic has had a heavy impact on national health system, especially in the first wave. That impact hit principally the intensive care units (ICUs). The large number of patients requiring hospitalization in ICUs lead to a complete upheaval of intensive wards. The increase in bed, the fewer number of nurses per patient, the constant use of personal protective equipment, the new antimicrobial surveillance protocols could have had deeply effects on microbiological flora of these wards. Moreover, the overconsumption of antimicrobial therapy in COVID-19 patients, like several studies report, could have impact of this aspect. Aim of this study is to evaluate the changing pattern of microbiological respiratory isolates during and before COVID-19 pandemic in a tertiary hospital ICUs. Methods A retrospective, observational study was conducted in ICUs of “ASST Papa Giovanni XXIII”, a large tertiary referral hospital in Northern Italy. We have retrospectively collected the microbiological data from bronchoalveolar lavage (BAL) and tracheal aspirate (TA) of patients with COVID-19, hospitalized in ICUs from 22nd February 2020 to 31st May 2020 (Period 1), and without COVID-19, from 22nd February 2019 to 31st May 2019 (Period 2). We compared the prevalence and the antibiotic profile of bacterial and fungal species in the two time periods. Results The prevalence of Pseudomonas spp. shows a statistically significant increase from patients without COVID-19 compared to COVID-19 positive as well as the prevalence of Enterococcus spp. On the contrary, the prevalence of Gram negative non fermenting bacteria (GN-NFB), Haemophilus influenzae and Streptococcus pneumoniae showed a significant reduction between two periods. There was a statistically significant increase in resistance of Pseudomonas spp. to carbapenems and piperacillin/tazobactam and Enterobacterales spp. for piperacillin/tazobactam, in COVID-19 positive patients compared to patients without COVID-19. We did not observe significant changing in fungal respiratory isolates. Conclusions A changing pattern in prevalence and resistance profiles of bacterial and fungal species was observed during COVID-19 pandemic.
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Affiliation(s)
- Gianluca Zuglian
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy.
| | - Diego Ripamonti
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
| | - Alessandra Tebaldi
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
| | - Marina Cuntrò
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Ivano Riva
- Intensive Care Unit, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Claudio Farina
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy
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Prevalence of COVID-19 Infection among Patients with Diabetes and Their Vaccination Coverage Status in Saudi Arabia: A Cross-Sectional Analysis from a Hospital-Based Diabetes Registry. Vaccines (Basel) 2022; 10:vaccines10020310. [PMID: 35214769 PMCID: PMC8878518 DOI: 10.3390/vaccines10020310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with diabetes have a higher risk of severe infection and mortality due to COVID-19. Considering the current limited effective pharmacological treatments, vaccination remains one of the most effective means to control the pandemic. The current study aimed to determine the prevalence of COVID-19 infection and the rate of COVID-19 vaccination coverage among patients with type 2 diabetes mellitus. The patients were identified from a diabetes hospital registry at Prince Sultan Military Medical City, Riyadh, Saudi Arabia in July 2021. The history of COVID-19 infection and the vaccination status were retrieved from the National Health Electronic Surveillance Network (HESN) program and the Seha platform, respectively. A total of 11,573 patients were included in this study (representing 99.5% of all patients in the registry). A total of 1981 patients (17.1%) had a history of confirmed COVID-19 infection. The rate of vaccination with a 1st dose was 84.8% (n = 9811), while the rate of full vaccination with the 2nd dose was 55.5% (n = 6422). The analysis showed that a higher proportion of male patients were fully vaccinated than female patients (61.0% versus 51.2%, p < 0.001). There were statistically significant differences among the age groups, with the full vaccination rate ranging from 59.0% for the 61–70-year-old age group to 49.0% for the > 80-year-old age group (p < 0.001). The patients with no previous history of COVID-19 infection were more likely to get fully vaccinated than those with a previous history of the infection (63.9% versus 14.6%, respectively, p < 0.001). The factors associated with a higher likelihood of unvaccinated status included the female gender (adjusted odds ratio (aOR) = 1.705 (95% confidence interval (CI): 1.528–1.902)), elderly patients in the age group of 61–70 (aOR (95% CI) = 1.390 (1.102–1.753)), the age group of 71–80 (aOR (95% CI) = 1.924 (1.499–2.470)) and the age group of >80 (aOR (95% CI) = 3.081 (2.252–4.214), and prior history of COVID-19 infection (aOR (95% CI) = 2.501 (2.223–2.813)). In conclusion, a considerable proportion of patients with type 2 diabetes had confirmed COVID-19 infection. Continued targeted efforts are needed to accelerate vaccination coverage rates among patients with diabetes in general and the particular subgroups identified in this study.
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Marziano V, Guzzetta G, Mammone A, Riccardo F, Poletti P, Trentini F, Manica M, Siddu A, Bella A, Stefanelli P, Pezzotti P, Ajelli M, Brusaferro S, Rezza G, Merler S. The effect of COVID-19 vaccination in Italy and perspectives for living with the virus. Nat Commun 2021; 12:7272. [PMID: 34907206 PMCID: PMC8671442 DOI: 10.1038/s41467-021-27532-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 vaccination is allowing a progressive release of restrictions worldwide. Using a mathematical model, we assess the impact of vaccination in Italy since December 27, 2020 and evaluate prospects for societal reopening after emergence of the Delta variant. We estimate that by June 30, 2021, COVID-19 vaccination allowed the resumption of about half of pre-pandemic social contacts. In absence of vaccination, the same number of cases is obtained by resuming only about one third of pre-pandemic contacts, with about 12,100 (95% CI: 6,600-21,000) extra deaths (+27%; 95% CI: 15-47%). Vaccination offset the effect of the Delta variant in summer 2021. The future epidemic trend is surrounded by substantial uncertainty. Should a pediatric vaccine (for ages 5 and older) be licensed and a coverage >90% be achieved in all age classes, a return to pre-pandemic society could be envisioned. Increasing vaccination coverage will allow further reopening even in absence of a pediatric vaccine.
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Affiliation(s)
- Valentina Marziano
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Giorgio Guzzetta
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Alessia Mammone
- Health Prevention Directorate, Ministry of Health, Rome, Italy
| | | | - Piero Poletti
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Filippo Trentini
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Mattia Manica
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy
| | - Andrea Siddu
- Health Prevention Directorate, Ministry of Health, Rome, Italy
| | | | | | | | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Indiana University School of Public Health, Bloomington, United States
| | | | - Giovanni Rezza
- Health Prevention Directorate, Ministry of Health, Rome, Italy
| | - Stefano Merler
- Center for Health Emergencies, Bruno Kessler Foundation, Trento, Italy.
- Epilab-JRU, FEM-FBK Joint Research Unit, Trento, Italy.
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Zardini A, Galli M, Tirani M, Cereda D, Manica M, Trentini F, Guzzetta G, Marziano V, Piccarreta R, Melegaro A, Ajelli M, Poletti P, Merler S. A quantitative assessment of epidemiological parameters required to investigate COVID-19 burden. Epidemics 2021; 37:100530. [PMID: 34826786 PMCID: PMC8595250 DOI: 10.1016/j.epidem.2021.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 01/08/2023] Open
Abstract
Solid estimates describing the clinical course of SARS-CoV-2 infections are still lacking due to under-ascertainment of asymptomatic and mild-disease cases. In this work, we quantify age-specific probabilities of transitions between stages defining the natural history of SARS-CoV-2 infection from 1965 SARS-CoV-2 positive individuals identified in Italy between March and April 2020 among contacts of confirmed cases. Infected contacts of cases were confirmed via RT-PCR tests as part of contact tracing activities or retrospectively via IgG serological tests and followed-up for symptoms and clinical outcomes. In addition, we provide estimates of time intervals between key events defining the clinical progression of cases as obtained from a larger sample, consisting of 95,371 infections ascertained between February and July 2020. We found that being older than 60 years of age was associated with a 39.9% (95%CI: 36.2–43.6%) likelihood of developing respiratory symptoms or fever ≥ 37.5 °C after SARS-CoV-2 infection; the 22.3% (95%CI: 19.3–25.6%) of the infections in this age group required hospital care and the 1% (95%CI: 0.4–2.1%) were admitted to an intensive care unit (ICU). The corresponding proportions in individuals younger than 60 years were estimated at 27.9% (95%CI: 25.4–30.4%), 8.8% (95%CI: 7.3–10.5%) and 0.4% (95%CI: 0.1–0.9%), respectively. The infection fatality ratio (IFR) ranged from 0.2% (95%CI: 0.0–0.6%) in individuals younger than 60 years to 12.3% (95%CI: 6.9–19.7%) for those aged 80 years or more; the case fatality ratio (CFR) in these two age classes was 0.6% (95%CI: 0.1–2%) and 19.2% (95%CI: 10.9–30.1%), respectively. The median length of stay in hospital was 10 (IQR: 3–21) days; the length of stay in ICU was 11 (IQR: 6–19) days. The obtained estimates provide insights into the epidemiology of COVID-19 and could be instrumental to refine mathematical modeling work supporting public health decisions.
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Affiliation(s)
| | - Margherita Galli
- Bruno Kessler Foundation, Trento, Italy; Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Marcello Tirani
- Directorate General for Health, Lombardy Region, Milan, Italy; Health Protection Agency of the Metropolitan Area of Milan, Milano, Italy
| | - Danilo Cereda
- Directorate General for Health, Lombardy Region, Milan, Italy
| | | | - Filippo Trentini
- Bruno Kessler Foundation, Trento, Italy; Dondena Centre for Research on Social Dynamics and Public Policy, and CovidCrisisLab, Bocconi University, Milan, Italy
| | | | | | - Raffaella Piccarreta
- Dondena Centre for Research on Social Dynamics and Public Policy, and CovidCrisisLab, Bocconi University, Milan, Italy; Department of Decision Sciences, Bocconi University, Milan, Italy
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policy, and CovidCrisisLab, Bocconi University, Milan, Italy; Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Marco Ajelli
- Laboratory for Computational Epidemiology and Public Health, Indiana University School of Public Health, Bloomington, United States
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