COVID-19 and Health Outcomes in People with Multiple Sclerosis: A Population-Based Study in Italy.

People with multiple sclerosis (PWMS) are at high risk of being affected by the disruption of health services that occurred during the COVID-19 pandemic months. The aim of this study was to evaluate the effect of the pandemic on the health outcomes of PWMS. PWMS and MS-free residing in Piedmont (north-west of Italy) were identified from electronic health records and linked with the regional COVID-19 database, the hospital-discharge database, and the population registry. Both cohorts (9333 PWMS and 4,145,856 MS-free persons) were followed-up for access to swab testing, hospitalisation, access to the Intensive Care Unit (ICU), and death from 22 February 2020 to 30 April 2021. The relationship between the outcomes and MS was evaluated using a logistic model, which was adjusted for potential confounders. The rate of swab testing was higher in PWMS, but the positivity to infection was similar to that of MS-free subjects. PWMS had a higher risk of hospitalisation (OR = 1.74; 95% IC, 1.41-2.14), admission to ICU (OR = 1.79; 95% IC, 1.17-2.72), and a slight, albeit not statistically significant, increase in mortality (OR = 1.28; 95% IC, 0.79-2.06). Compared to the general population PWMS with COVID-19 had an increased risk of hospitalization and admission to the ICU; the mortality rate did not differ.

Addressing health inequalities in Europe: key messages from the Joint Action Health Equity Europe (JAHEE).

Health inequalities within and between Member States of the European Union are widely recognized as a public health problem as they determine a significant share of potentially avoidable mortality and morbidity. After years of growing awareness and increasing action taken, a large gap still exists across Europe in terms of policy responses and governance. With the aim to contribute to achieve greater equity in health outcomes, in 2018 a new Joint Action, JAHEE, (Joint Action Health Equity Europe) was funded by the third EU Health Programme, with the main goal of strengthening cooperation between participating countries and of implementing concrete actions to reduce health inequalities. The partnership led by Italy counted 24 countries, conducting actions in five policy domains: monitoring, governance, healthy living environments, health systems and migration, following a three-step implementation approach. Firstly, specific Policy Frameworks for Action (PFA) collecting the available evidence on what practice should be done in each domain were developed. Second, different Country Assessments (CAs) were completed to check the country's adherence to the recommended practice in each domain. The gap between the expected policy response (PFA) and the present policy response (CA) guided the choice of concrete actions to be implemented in JAHEE, many of which are continuing even after the end of JA. Final recommendations based on the best results achieved during JAHEE were elaborated and agreed jointly with the representatives of the involved Ministries of Health. The JAHEE initiative represented an important opportunity for the participating countries to work jointly, and the results show that almost all have increased their level of action and strengthened their capacities to address health inequalities.

Self-Rated Health and Psychological Distress among Emerging Adults in Italy: A Comparison between Data on University Students, Young Workers and Working Students Collected through the 2005 and 2013 National Health Surveys.

BACKGROUND: The present study aimed at comparing self-reported physical health and mental health among university students, workers, and working students aged between 19 years and 29 years. METHOD: Using data from National Health Surveys held in 2005 and 2013, a cross-sectional study was conducted on 18,612 Italian emerging adults grouped into three groups: university students, workers, and working students. The odds ratios of self-reported anxiety or depression, poor general health, and poor mental health and physical health (as assessed through SF-12) were estimated through logistic regression models adjusted for potential confounders. RESULTS: Compared with workers, students showed an increased risk of anxiety or depression and a lower risk of poor general health. Students and working students showed an increased risk of reporting weak mental health compared with that in workers, while students displayed a lower risk of poor physical health. Significant differences were not found between the 2005 and 2013 surveys. CONCLUSIONS: These results are of considerable importance for psychologists as well as educational and occupation-based institutions for planning prevention programs and clinical interventions.

Multimorbidity and SARS-CoV-2-Related Outcomes: Analysis of a Cohort of Italian Patients.

BACKGROUND: Since the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples. OBJECTIVE: The objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab. METHODS: Data were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years). RESULTS: Of 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes. CONCLUSIONS: Our study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions.

Inequalities in the Health Impact of the First Wave of the COVID-19 Pandemic in Piedmont Region, Italy.

(1) Introduction: Several studies observe a social gradient in the incidence and health consequences of SARS-CoV-2 infection, but they rely mainly on spatial associations because individual-level data are lacking. (2) Objectives: To assess the impact of social inequalities in the health outcomes of COVID-19 during the first epidemic wave in Piedmont Region, Italy, evaluating the role of the unequal social distribution of comorbidities and the capacity of the healthcare system to promote equity. (3) Methods: Subjects aged over 35, resident in Piedmont on 22 February 2020, were followed up until 30 May 2020 for access to swabs, infection, hospitalization, admission to intensive care unit, in-hospital death, COVID-19, and all-cause death. Inequalities were assessed through an Index of Socioeconomic Disadvantage composed of information on education, overcrowding, housing conditions, and neighborhood deprivation. Relative incidence measures and Relative Index of Inequality were estimated through Poisson regression models, stratifying by gender and age groups (35-64 years; ≥65 years), adjusting for comorbidity. (4) Results: Social inequalities were found in the various outcomes, in the female population, and among elderly males. Inequalities in ICU were lower, but analyses only on in-patients discount the hypothesis of preferential access by the most advantaged. Comorbidities contribute to no more than 30% of inequalities. (5) Conclusions: Despite the presence of significant inequities, the pandemic does not appear to have further exacerbated health inequalities, partly due to the fairness of the healthcare system. It is necessary to reduce inequalities in the occurrence of comorbidities that confer susceptibility to COVID-19 and promote prevention policies that limit inequalities in the mechanisms of contagion and improve out-of-hospital timely treatment.

Improvements throughout the Three Waves of COVID-19 Pandemic: Results from 4 Million Inhabitants of North-West Italy.

At the very beginning of the European spread of SARS-CoV-2, Piedmont was one of the most affected regions in Italy, with a strong impact on healthcare organizations. In this study, we evaluated the characteristics and outcomes of the COVID-19 patients in an entire region during the first three pandemic waves, identifying similarities and differences in the SARS-CoV-2 epidemic's timeline. We collected the health-administrative data of all the Piedmont COVID-19 patients infected during the first three pandemic waves (1 March 2020-15 April 2020; 15 October 2020-15 December 2020; 1 March 2021-15 April 2021, respectively). We compared differences among the waves in subjects positive for SARS-CoV-2 and in patients admitted to ICU. Overall, 18.621 subjects tested positive during the first wave (405 patients/day), 144.350 (2366.4 patients/day) in the second, and 81.823 (1778.8 patients/day) in the third. In the second and third waves, we observed a reduction in median age, comorbidity burden, mortality in outpatients, inpatients, and patients admitted to ICU, in intubation, invasive ventilation and tracheostomy, and a parallel increase in the use of CPAP. Our study confirmed a trend towards younger and healthier patients over time but also showed an independent effect of the period on mortality and ICU admission. The appearance of new viral variants, the starting of vaccination, and organizational improvements in tracking, outpatients and inpatients management could have influenced these trends.

Indirect impact of the COVID-19 pandemic and its containment measures on social inequalities in hospital utilisation in Italy.

BACKGROUND: The pandemic may undermine the equity of access to and utilisation of health services for conditions other than COVID-19. The objective of the study is to evaluate the indirect impact of COVID-19 and lockdown measures on sociodemographic inequalities in healthcare utilisation in seven Italian areas. METHODS: In this multicentre retrospective study, we evaluated whether COVID-19 modified the association between educational level or deprivation and indicators of hospital utilisation and quality of care. We also assessed variations in gradients by sex and age class. We estimated age-standardised rates and prevalence and their relative per cent changes comparing pandemic (2020) and pre-pandemic (2018-2019) periods, and the Relative Index of Inequalities (RIIs) fitting multivariable Poisson models with an interaction between socioeconomic position and period. RESULTS: Compared with 2018-2019, hospital utilisation and, to a lesser extent, timeliness of procedures indicators fell during the first months of 2020. Larger declines were registered among women, the elderly and the low educated resulting in a shrinkage (or widening if RII <1) of the educational gradients for most of the indicators. Timeliness of procedures indicators did not show any educational gradient neither before nor during the pandemic. Inequalities by deprivation were nuanced and did not substantially change in 2020. CONCLUSIONS: The socially patterned reduction of hospital utilisation may lead to a potential exacerbation of health inequalities among groups who were already vulnerable before the pandemic. The healthcare service can contribute to contrast health disparities worsened by COVID-19 through more efficient communication and locally appropriate interventions.

Characteristics of patients affecting the duration of positivity at SARS-CoV-2: a cohort analysis of the first wave of epidemic in Italy.

OBJECTIVES: to investigate the characteristics of patients affecting the duration of positivity test by RT-PCR in the population of Piedmont, a Region of North-West of Italy. DESIGN: observational cohort study. SETTING AND PARTICIPANTS: from the administrative database of the regional SARS-CoV-2 surveillance system, a cohort of all patients who tested positive by a RT-PCR assay to SARS-CoV-2 occurring from 22.02.2020 to 30.09.2020 in the Piedmont Region (N. 29,292) was obtained. The cohort has been linked to the hospital discharge database and to the vital statistics database. MAIN OUTCOMES MEASURES: outcome of the study was the risk of non negativization, estimated by fitting Generalizing Estimating Equation model (GEE), a longitudinal model which consider for each subject several records collected on fixed time intervals 15, 30, 45 or 60+ days from the first positive test. Negativization was defined as the condition in which two consecutive samples taken from the patient at least 24 hours apart were negative for the presence of SARS-CoV-2. RESULTS: the median duration of positive RT-PCR was 27 days. A higher median of days until positive persistence was observed in people over 80 (34 days, IQR 25-49), female (28 days, IQR 18-40), symptomatic patients (28 days, IQR 19-40), hospitalized people (32 days, IQR 21-44), patients with Charlson's index >0 (34 days, IQR 23-49), patients host of elderly nursing homes (37 days, IQR 25-51). In the GEE multivariable model, the variables associated to the non negativization at all times intervals were: older age (at 15th day: class 65+, OR 2.56, 95%CI 2.39-2.74), female gender (at 15th day: OR 1.12, 95%CI 1.06-1.18), and to be hospitalized for COVID-19 (at 15th day: OR 1.38, 95%CI 1.29-1.48). The presence of comorbidities and of symptoms were associate with the non negativization at 15th day (respectively, class 4+: OR 1.29, 95%CI 1.08-1.56 and symptoms: OR 1.20, 95%CI 1.13-1.27), but not at 45th day. CONCLUSIONS: older age, female gender, presence of comorbidities and severity of disease (proxy hospitalization for COVID-19) were risk factors for non negativization at all times intervals. The presence of symptoms was a risk factors for the non negativization after 2 weeks from the first diagnosis and not at 45th day. Using a longitudinal model for the analysis of the dataset, it is possible to compare the weight of the variables included in the model at different times and correct an overestimation of the attributable risk after the first considered time interval.

The role of socioeconomic and educational determinants in the context of COVID-19

The Ministry of Health has committed a health inequalities impact assessment of the pandemic and policy response to the pandemic in Italy. The document reviewed the knowledge available to estimate the effect of the main mechanisms for generating health that primarily deserve mitigation. The results recommend to give priority to interventions of proportionate universalism that avoid in short term the social discrimination related to a) the recovery of non-COVID-19 treatments that have been displaced due in the lockdown, b) the access to prevention, immunization and territorial care for people most susceptible to unfavourable outcomes of COVID-19 due to comorbidity and most vulnerable to social disadvantage due to lockdown;c) the loss of social support for fragile and disabled people. In the medium to long term priorities are to protect those with low income and precarious work from social exclusion and the effects on mental and physical health;enable children from families at risk of poverty to benefit from suitable development opportunities;promote resilient and inclusive local communities to reduce isolation and generate help resources;also valuing the beneficial aspects of the pandemic: trust assets to health and adherence to health promotion, more physical exercise, etc. The report has also identified priorities for research including mechanisms that are more difficult to investigate, such as studying the interaction between environmental risks and the risk of COVID-19 infection and progression and the unequal mental health effects of the pandemic and confinement.

From swab testing to health outcomes within the T2DM population: Impact of diabetes background on COVID19 progression.

BACKGROUND: We aimed to study the impact of diabetes background on COVID-19 progression from swab testing to health outcomes in type 2 diabetes (T2DM). METHODS: From the database of the diabetes units of Piedmont-Italy we extracted records of T2DM patients, which were linked with the swab-testing-database, and the database of hospital discharges. Five outcomes (PCR testing, PCR testing positivity, hospitalization, Intensive Care Unit (ICU), death) were evaluated using robust Poisson models. RESULTS: Among 125,021 T2DM patients, 1882 had a positive PCR test. Of these patients, 49.4% were hospitalized within 30 days, 11.8% were admitted to an ICU, and 27.1% died. Greater probability of death was associated with age, male sex, liver and renal impairment, Hba1c above 8%, and former smoking. Hospitalization and ICU admission were mainly affected by age, male sex, hypertension, and metabolic control. Notably, ICU admissions were reduced in very elderly people. No outcomes were associated with educational level. CONCLUSIONS: Hospitalization and ICU admission are heavily affected by age and local triage policy. A key finding was that men who were > 75 years old and poorly compensated were highly vulnerable patients. Renal and/or hepatic impairment are additional factors. This information may be useful for addressing intervention priorities.

A structural equation model to examine the clinical features of mild-to-moderate COVID-19: A multicenter Italian study.

The purpose of this study was to evaluate the clinical features of mild-to-moderate coronavirus disease 2019 (COVID-19) in a sample of Italian patients and to investigate the occurrence of smell and taste disorders. Infected individuals with suspected (clinical diagnosis) or laboratory-confirmed COVID-19 infection were recruited. Patients completed a survey-based questionnaire with the aim of assessing their epidemiological and clinical characteristics, general otorhinolaryngological symptoms, and smell and taste disorders. A total of 294 patients with mild-to-moderate COVID-19 completed the survey (147 females). The most prevalent general symptoms included fever, myalgia, cough, and headache. A total of 70.4% and 59.2% of patients reported smell and taste disorders, respectively. A significant association between the two above-mentioned disorders was found (rs: 0.412; P < .001). Smell disorders occurred before the other symptoms in 11.6% of patients and was not significantly associated with nasal obstruction or rhinorrhea. Interestingly, our statistical analysis did not show any significant difference, either for general symptoms or otorhinolaryngological features, between the clinical diagnosis group and the laboratory-confirmed diagnosis (polymerase chain reaction) group. The structural equation model confirmed significant standardized paths (P < .05) between general symptoms, comorbidities, and general otorhinolaryngological complaints in the absence of a significant correlation between these elements and smell and taste alterations. The prevalence of smell and taste disorders in mild-to-moderate Italian COVID-19 patients is significant both in suspected and laboratory-confirmed cases and reveals a strong correlation between these clinical signs regardless of the presence of general or otorhinolaryngological symptoms, such as nasal obstruction or rhinorrhea.

Therapy With Agents Acting on the Renin-Angiotensin System and Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Exposure to agents acting on the renin-angiotensin system was not associated with a risk increase of COVID-19 infection in 2 Italian matched case-control studies, 1 nested in hypertensive patients and the other in patients with cardiovascular diseases or diabetes.

[Temporal variations in excess mortality during phase 1 and phase 2 of the COVID-19 epidemic in Italy]. / Variazioni temporali della mortalità totale e nei decessi per COVID-19 durante la fase 1 e la fase 2 dell'epidemia in Italia.

OBJECTIVES: to assess the temporal variation in excess total mortality and the portion of excess explained by COVID-19 deaths by geographical area, gender, and age during the COVID-19 epidemic. DESIGN: descriptive analysis of temporal variations of total excess deaths and COVID-19 deaths in the phase 1 and phase 2 of the epidemic in Italy. SETTING AND PARTICIPANTS: 12 Northern cities and 20 Central-Southern cities from December 2019 to June 2020: daily mortality from the National Surveillance System of Daily Mortality (SiSMG) and COVID-19 deaths from the integrated COVID-19 surveillance system. MAIN OUTCOME MEASURES: total mortality excess and COVID-19 deaths, defined as deaths in microbiologically confirmed cases of SARS-CoV-2, by gender and age groups. RESULTS: the largest excess mortality was observed in the North and during the first phase of the epidemic. The portion of excess mortality explained by COVID-19 decreases with age, decreasing to 51% among the very old (>=85 years). In phase 2 (until June 2020), the impact was more contained and totally attributable to COVID-19 deaths and this suggests an effectiveness of social distancing measures. CONCLUSIONS: mortality surveillance is a sensible information basis for the monitoring of health impact of the different phases of the epidemic and supporting decision making at the local and national level on containment measures to put in place in coming months.

Clinical characteristics and management of COVID-19 patients accessing the emergency department in a hospital in Northern Italy in March and April 2020.

BACKGROUND: the emergency due to SARS-CoV-2 pandemic struck the national and regional health system that needed an effort to reorganise and increase resources to cope with a sudden, uncertain, and previously unknown situation. This study was conducted in the immediate aftermath of this difficult period. OBJECTIVES: to describe clinical characteristics, short-term outcomes, and management of SARS-CoV-2 positive patients that accessed the emergency department (ED) of the San Luigi Gonzaga hospital of Orbassano (Turin district, Piedmont Region, Northern Italy) in March and April 2020. Furthermore, this study aimed at investigating if a difference in patients characteristics, clinical management, and outcomes was present during time. DESIGN: comparison of different periods in a clinical cohort. SETTING AND PARTICIPANTS: for each patient who accessed the ED and tested positive for SARS-CoV-2 swab, the ED medical record was collected and a descriptive analysis was performed on demographical characteristics, pre-existing comorbidities, parameters measured at triage, imaging exams results, lab tests results, separately for patients admitted at the ED in four different periods. MAIN OUTCOME MEASURES: discharge from ED, admission to hospital wards (low and high intensity of care), short term in-hospital mortality, hospital length of stay. The association between patients' characteristics and the main outcomes was measured using multivariable logistic models. RESULTS: age of patients increased significantly from March to April, together with female prevalence and associated comorbid conditions. A significant difference in symptoms at presentation was not observed nor it was in laboratory test results. Severity at triage and need of intensive care resources were higher in the first weeks, together with the typical clinical presentation with respiratory failure and imaging with signs of bilateral interstitial pneumonia. Accordingly, in-hospital mortality was higher in the first period. Nevertheless, nearly half of patients in the first period were discharged directly from ED showing mild COVID-19 cases. On the contrary, in April an increasing need of hospitalisation in low intensity of care beds was observed, whereas mild cases stopped to access the ED. CONCLUSIONS: the results of this study suggest that in few weeks of COVID-19 epidemic both management of the patients at the hospital level - and probably at territorial level resulting in a different population who accessed to the ED - and the clinical characteristics of the COVID-19 patients changed.

The impact of COVID-19 prevention measures on epidemiology of orthopedic injuries: the outbreak ages fractures!

BACKGROUND: The application of stringent prevention measures for contrasting COVID-19 spread generated changes not only in the outbreak course, but also in epidemiology of traumatic fractures. The aim of this study was to report the epidemiologic characteristics of surgically-treated fractures during the COVID-19 outbreak over a six-month period, and to describe the variation in volumes and types of injuries, by comparing them with fractures which occurred during the same period in 2019. METHODS: We retrospectively analyzed all surgically-treated fractures which were admitted from the January 1st 2020 to June 30th 2020, and compared these data to those of the corresponding timeframe in 2019. The collected data of interest included demographics, such as age and gender, fracture location, time lapse between presentation at Emergency Department and admission in the ward, length of stay. RESULTS: A total of 117 patients were admitted with a diagnosis of facture and surgically treated, with no cases of COVID-19 positive patients. In the corresponding period of 2019, the number of patients admitted for the same reasons was 129. This decrease was more significant in the period between March and April (-30.6%), during which time prevention measures were more stringent. The only statistically significant discrepancy between the two study groups was the mean age, which was significantly higher in 2020. The location of examined injuries were similar in the two study groups, with proximal femur fractures representing the most frequent injuries. CONCLUSIONS: This study demonstrated significant changes of epidemiologic patterns of fractures during COVID-19 outbreak. These data should provide support for clinicians and government to evaluate the management and prevention strategies of traumatic not only during outbreak but also in non-outbreak period.

Publisher Correction to: Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities.

An amendment to this paper has been published and can be accessed via the original article.

Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities.

BACKGROUND: Standardized mortality surveillance data, capable of detecting variations in total mortality at population level and not only among the infected, provide an unbiased insight into the impact of epidemics, like COVID-19 (Coronavirus disease). We analysed the temporal trend in total excess mortality and deaths among positive cases of SARS-CoV-2 by geographical area (north and centre-south), age and sex, taking into account the deficit in mortality in previous months. METHODS: Data from the Italian rapid mortality surveillance system was used to quantify excess deaths during the epidemic, to estimate the mortality deficit during the previous months and to compare total excess mortality with deaths among positive cases of SARS-CoV-2. Data were stratified by geographical area (north vs centre and south), age and sex. RESULTS: COVID-19 had a greater impact in northern Italian cities among subjects aged 75-84 and 85+ years. COVID-19 deaths accounted for half of total excess mortality in both areas, with differences by age: almost all excess deaths were from COVID-19 among adults, while among the elderly only one third of the excess was coded as COVID-19. When taking into account the mortality deficit in the pre-pandemic period, different trends were observed by area: all excess mortality during COVID-19 was explained by deficit mortality in the centre and south, while only a 16% overlap was estimated in northern cities, with quotas decreasing by age, from 67% in the 15-64 years old to 1% only among subjects 85+ years old. CONCLUSIONS: An underestimation of COVID-19 deaths is particularly evident among the elderly. When quantifying the burden in mortality related to COVID-19, it is important to consider seasonal dynamics in mortality. Surveillance data provides an impartial indicator for monitoring the following phases of the epidemic, and may help in the evaluation of mitigation measures adopted.

COVID-19 infection and diffusion among the healthcare workforce in a large university-hospital in northwest Italy.

Backgroud: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, healthcare workers (HCWs) have been the workers most likely to contract the disease. Intensive focus is therefore needed on hospital strategies that minimize exposure and diffusion, confer protection and facilitate early detection and isolation of infected personnel. METHODS: To evaluate the early impact of a structured risk-management for exposed COVID-19 HCWs and describe how their characteristics contributed to infection and diffusion. Socio-demographic and clinical data, aspects of the event-exposure (date, place, length and distance of exposure, use of PPE) and details of the contact person were collected. RESULTS: The 2411 HCWs reported 2924 COVID-19 contacts. Among 830 HCWs who were at 'high or medium risk', 80 tested positive (9.6%). Physicians (OR=2.03), and non-medical services -resulted in an increased risk (OR=4.23). Patient care did not increase the risk but sharing the work environment did (OR=2.63). There was a significant time reduction between exposure and warning, exposure and test, and warning and test since protocol implementation. HCWs with management postitions were the main source of infection due to the high number of interactions. DISCUSSION: A proactive system that includes prompt detection of contagious staff and identification of sources of exposure helps to lower the intra-hospital spread of infection. A speedier return to work of staff who would otherwise have had to self-isolate as a precautionary measure improves staff morale and patient care by reducing the stress imposed by excessive workloads arising from staff shortages.