Dry Eye symptoms during the COVID-19 era

Purpose : Preliminary evidences from the literature, together with our everyday clinical practice and patients reporting, led us to hypothesize that dry eye (DED) symptoms related to some COVID-19 mitigation measures might be a common problem and a relevant issue. We designed this study in order to assess and to monitor DED symptoms' changes from 2019 to 2021, in both DED patients and healthy subjects, and to investigate their relationship with homeworking and facemask wearing. Methods : We retrospectively reviewed the medical records of patients who, between November and December 2019 (V19), had undergone an eye exam including quantification of Ocular Surface Disease Index (OSDI) score at the Eye Clinic San Giuseppe Hospital, Milan. Between November and December 2020, we performed a telephone survey (V20) contacting these patients. The survey was repeated between November and December 2021 (V21). The telephone survey included the OSDI 12-items and a custom-made questionnaire exploring type of job or occupation, home working, screen time, type and average time of face mask-wearing, and recent onset and worsening of DED-related symptoms. We investigated the difference among V21, V20 and V19 DED symptoms, the rate of subjects with OSDI increase > OSDI minimal clinically important difference (MCID), and associations between DED symptoms, face masks wearing, VDT usage and home working. Results : Of 120 subjects with V19 OSDI≤12, 43 (36%) and 39 (32%) showed OSDI>12 at V20 and at V21, respectively. OSDI was significantly correlated with duration of face masks use (V20 r= 0.29;P<0.01. V21 r= 0.23;P<0.01) and heavy mask users had a significantly higher OSDI (P<0.05). V20 and V21 OSDI was significantly higher in home-workers (P<0.05) but we did not find a significant correlation between V21 OSDI and referred number of VDT use (r= 0.07;P=0.41). Of 70 patients with V19 OSDI>12, 18 (26%) and 24 (34%) showed symptoms worsening >MCID at V20 and V21, respectively. The percentage of OSDI worsening >MCID was significantly higher among heavy face masks users (73% vs 12%;P<0.01, Fisher test). The percentage of OSDI worsening >MCID was significantly higher in home workers at V20 but not at V21. Conclusions : Some COVID-19 mitigation strategies seem to have a significant role in triggering DED symptoms onset or worsening. This issue persisted during the second pandemic year, with weaker correlation to presumed trigger factors.

Differences in the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals using routine data.

OBJECTIVES: This study was to compare the incidence and clinical outcomes of SARS-CoV-2 infection between Italian and non-Italian nationals. STUDY DESIGN: We retrospectively analysed data from the COVID-19 Italian integrated surveillance system (14 September 2020 to 17 October 2021). METHODS: We used multivariable Cox proportional hazards models to estimate the hazard ratio (HR) of infection and, among cases, the HRs of death, hospitalisation and subsequent admission to intensive care unit in non-Italian nationals relative to Italian nationals. Estimates were adjusted for differences in sociodemographic characteristics and in the week and region of diagnosis. RESULTS: Of 4,111,067 notified cases, 336,265 (8.2%) were non-Italian nationals. Compared with Italian nationals, non-Italians showed a lower incidence of SARS-CoV-2 infection (HR = 0.81, 95% confidence interval [CI]: 0.80-0.81). However, once diagnosed, they were more likely to be hospitalised (HR = 1.90, 95% CI: 1.87-1.92) and then admitted to intensive care unit (HR = 1.08, 95% CI: 1.04-1.13), with differences larger in those coming from countries with a lower human development index. Compared with Italian cases, an increased rate of death was observed in non-Italian cases from low-human development index countries (HR = 1.41, 95% CI: 1.23-1.62). The HRs of SARS-CoV-2 infection and severe outcomes slightly increased after the start of the vaccination campaign. CONCLUSIONS: Underdiagnosis and delayed diagnosis in non-Italian nationals could explain their lower incidence compared with Italians and, among cases, their higher probability to present clinical conditions leading to worse outcomes. Facilitating early access to vaccination, diagnosis and treatment would improve the control of SARS-CoV-2 transmission and health outcomes in this vulnerable group.

Salivary molecular tests for the diagnosis of SARS-CoV-2 infection: an experimental monitoring approach in Italian schools throughout the 2021-2022 school year

Introduction: The widespread of SARS-CoV-2 infection has raised concerns about the potential role of schools in community transmission. In Italy, a national screening test strategy was implemented throughout the 2021-2022 school year to monitor virus circulation in schools. Materials and methods The National Plan for Monitoring the circulation of SARS-CoV-2 virus in primary and secondary schools aims at testing students attending a sample of primary and secondary schools in each Italian Region, by means of molecular salivary testing, every two weeks. We report preliminary data for the period 13/9/2021-13/2/2022 comparing them with the trend of the incidence rate in the Italian population aged 6-13 years. Results A total of 486,206 students from across the country were invited for the screening 273,738 (55.3%) underwent the test and 1086 (0.40%) came back positive. The highest participation rate (> 60%) was recorded on January 2022. Incidence rate was low (< 5 x 10,000 students tested) between September and December 2021, it increased steadily on January 2022 (20.8 x 10,000) and it began to slowly decrease on February 2022. A similar trend was recorded in general population. Of note, a national average of 10% of tests performed on saliva gave indeterminate results. Discussion and conclusions The heterogeneous adherence of Regions to the Plan, the low testing acceptance by students and the high rate of indeterminate results suggest that saliva sampling should be considered carefully when planning a screening campaign in schools. Screening tests in schools emerged as a useful strategy in detecting and contrasting the spread of SARS-CoV-2, but more research is needed on the determinants of student participation and saliva sampling methods.

A retrospective study on the impact of the first wave of the COVID-19 pandemic on the Health Care Workers in Italy

Introduction: The COVID-19 pandemic had a huge impact on Health Care Workers (HCWs) as they played an essential role in the management of the pandemic. The Italian Workers’ Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyse COVID-19 cases among HCWs during the first wave. The aim of this study is to understand trends and characteristics of infections among HCWs. Materials and Methods: Data were collected retrospectively and anonymously from administrative source of Regions between May-September 2020, referring to HCWs infected from the beginning of the pandemic until 30 April 2020. We used a questionnaire asking socio-demographic and occupational information and characteristics of contagion and disease outcome. Results: We received 15,926 valid questionnaires, 63.7% from Lombardy. The mean age is 49 years;67.4% are women. 47.9% are nurses, 20.5% doctors and 19.7% health and social care professionals. 78.0% work in hospital setting, 13.3% in local setting, 8.7% in other fields. Regarding hospital setting, the medical area counts 21.2% of cases, followed by 15.6% in the departments converted to COVID-19 care and 10.2% in surgical area. 22.8% of HCWs were hospitalized, 1.2% were hospitalized in intensive care and 0.4% died. Conclusions: This study highlights the main reasons of the overload put on the national health system by the first wave of the pandemic. Improved knowledge, availability of PPE and a tight vaccination campaign for HCWs strongly changed the trend of infections among health workers, with substantial elimination of serious and fatal cases.