Excess Deaths and Hospital Admissions for COVID-19 Due to a Late Implementation of the Lockdown in Italy.

In Italy, the COVID-19 epidemic curve started to flatten when the health system had already exceeded its capacity, raising concerns that the lockdown was indeed delayed. The aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy. Using national data on the daily number of COVID-19 cases, we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared results under the actual and counterfactual scenarios. An early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths, corresponding to 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%) reduction, respectively. We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic.

Prone Positioning in Non-Intubated Patients With COVID-19 Outside of the Intensive Care Unit: More Evidence Needed.

The coronavirus disease (COVID-19) pandemic has brought the Italian National Health System to its knees. The abnormally high influx of patients, together with the limited resources available, has forced clinicians to make unprecedented decisions and provide compassionate treatments for which little or no evidence is yet available. This is the case for the use of noninvasive positive pressure ventilation and continuous airway pressure ventilation, combined with prone position in patients with COVID-19 and acute respiratory distress syndrome treated outside of intensive care units. In our article, we comment on the evidence available, so far, and provide a brief summary of data collected at our health institution in Piedmont, Italy.

Predicted Effects of Stopping COVID-19 Lockdown on Italian Hospital Demand

Objective:Italy has been one of the first countries to implement mitigation measures to curb the COVID-19 pandemic. There is currently a debate on when and how such measures should be loosened.To forecast the demand for hospital ICU and non-ICU beds for COVID-19 patients from May-September, we developed two models, assuming a gradual easing of restrictions or an intermittent lockdown.Methods:We used a compartmental model to evaluate two scenarios: A) an intermittent lockdown;B) a gradual relaxation of the lockdown. Predicted intensive care unit (ICU) and non-ICU demand was compared with the peak in hospital bed utilization observed in April 2020.Results:Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%;95%CI: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95%CI: 71-121) and 237% (95%CI: 191-282) of the April peak.Conclusions:Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in healthcare resources to maintain surge capacity across the country.