A systematic review about skin lesions in children affected by Coronavirus Disease 2019 (excluding multisystem inflammatory syndrome in children): study protocol. (preprint)

COVID-19 disease can give a range of skin manifestations, some of which specific to children and young patients. Given the different nature of the lesions in specific stages of the disease and the fact that they may be the only or predominant symptom of the disease, it is of great importance for the pediatrician and dermatologist to be familiar with COVID-19 skin lesions. The aim of this systematic review, conducted according to the PRISMA statement, is to investigate COVID-19-associated cutaneous involvement in children in terms of type of skin lesions, frequency, and time of onset, with the exclusion of those associated with multisystem inflammatory syndrome in children. A comprehensive literature search will be performed through PubMed between December 2019 and December 2021. The quality of each study will be assessed according to the STROBE tool for observational studies. This systematic review will provide evidence about the dermatological manifestations of COVID-19 disease in children published up to the end of year 2021. Recognizing skin symptoms as potential manifestations of COVID-19 in children is important for a non-delayed diagnosis, with prompt activation of the adequate tracing, isolation, and hygienic measures, and for timely treatment of unlikely but possible serious complications.

ROCCA study protocol and interim analysis on safety of Sputnik V vaccine (Gam-COVID-Vac) in the Republic of San Marino: an observational study using active surveillance (preprint)

OBJECTIVE To assess the safety of the Sputnik V (Gam-COVID-Vac) COVID-19 vaccine through participant-based active surveillance from the Republic of San Marino vaccination campaign. DESIGN AND SETTING This is a nation-wide cohort study in the Republic of San Marino to monitor any Adverse Events Following Immunisation (AEFI) with the Sputnik V. PARTICIPANTS Adults aged 18-89 years who had at least one dose of Sputnik V administered and who responded or accessed to an e-questionnaire sent via email, QR-code or were live/phone interviewed about the 7 days after the first vaccine dose (n=2,558) and 7 days after the second dose (n=1,288). Exclusion criteria were inability to understand nor to answer the questionnaire properly. MAIN OUTCOME MEASURES Rates of overall AEFI short-term and long-term (3 months). Secondary outcomes focus on subgroups of the population presenting specific comorbidities. Being this an interim analysis, long-term data (3 months) is still being collected, especially for vulnerable populations, including subjects with comorbidities and the youngest age groups. RESULT The median age of participants was 68 years. 56% were females. After the first dose, vaccine recipients described both local and systemic reactions in 16.4% of cases, 25.8% reported systemic reactions only, and 10.2% reported local symptoms only. After the second dose, both local and systemic reactions were reported in 31.9% of cases, 18.5% reported systemic reactions only, and 16.1% reported local symptoms only. Main symptoms were local pain (24.8% for first dose and 43.8% for the second), asthenia (23.8% and 31.9%), headache (18.5% and 21.0%), and joint pain (16.5% and 21.9%). In the population over 60, recipients having reported AEFI after the first dose could be a predictor of AEFI recurrence after the second dose (p<0.001). 81.8% of those reporting second-dose AEFI, reported AEFI after the first dose, while amongst those not having reported any AEFI after the first dose, 18.2% reported AEFI after the second dose. CONCLUSION The ROCCA interim analysis confirmed a good tolerability profile in the over 60 years age group after both doses regarding short-term solicited AEFI to Sputnik V (Gam-COVID-Vac).

Assessing knowledge, concerns, and risk perceptions among Italian medical students during the SARS-CoV-2 pandemic. (preprint)

ABSTRACT OBJECTIVE During the first phase of COVID-19 pandemic, Italian medical students transitioned from in-person to remote learning. This study was carried out to early assess students' sources of information, perceived risk of infection, knowledge and preventive practices in order to resume academic activity. The impact of training and volunteer work was also assessed. METHODS A cross-sectional online survey was conducted in May 2020 among medical students enrolled in the School of Medicine and Surgery, Bologna University. RESULTS The analysis included 537 responses. On average students used seven sources of information on COVID-19. Scientific journals were considered the most trustworthy but they ranked only 6th in the frequency of use. Perceived risk of infection was higher for academic activities, especially in the hospital than daily living activities. Less than 50% of students reported being trained on biological risk and use of PPE. Training received was significantly associated with both perceived risk of infection and confidence in the use of PPE. Students engaged in volunteer work had higher confidence in PPE usage. INTERPRETATION Accessible scientific information and students' engagement in spreading correct knowledge play an important role in challenging misinformation during the pandemic crisis. Students showed suboptimal knowledge about PPE use, calling for additional training. We found a moderate-high perceived risk of infection that could be mitigated with specific educational programs and by promoting voluntary work. Students' engagement in public health emergencies (PHE) could potentially be beneficial for their training and as well as for the healthcare system.

Factors Associated with Access and Use of PPE during COVID-19: A Cross-sectional Study of Italian Physicians (preprint)

ObjectivesDuring the course of the Novel Coronavirus (SARS-CoV-2) pandemic, Italy has reported one of the highest number of infections. Nearly ten percent of reported coronavirus infections in Italy occurred in healthcare workers. This study aimed to understand physicians access to personal protective equipment (PPE) and to information about their use, risk perception and strategies adopted to prevent contracting the infection. MethodsWe undertook a cross-sectional, online self-reported survey implemented between March 31 and April 5 2020 of Italian physicians. ResultsResponses were received from 529 physicians, only 13% of which reported to have access to PPE every time they need them. Approximately half of the physicians reported that the information received about the use of PPE was either clear (47%) or complete (54%). Risk perception about contracting the infection was influenced by receiving adequate information on the use of PPE. Access to adequate information on the use of PPE was associated with better ability to perform donning and doffing procedures [OR=2.2 95% C.I. 1.7-2.8] and reduced perception of risk [OR=0.5, 95% C.I. 0.4-0.6]. ConclusionsResults from this rapid survey indicate that while ramping up supplies on PPE for healthcare workers is certainly of mandatory importance, adequate training and clear instructions are just as important.

Forecasting COVID-19-Associated Hospitalizations under Different Levels of Social Distancing in Lombardy and Emilia-Romagna, Northern Italy: Results from an Extended SEIR Compartmental Model (preprint)

The outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China, in December 2019. As of April 17, 2020, more than 2 million cases of COVID-19 have been reported worldwide. Northern Italy is one of the world’s centers of active coronavirus cases. In this study, we predicted the spread of COVID-19 and its burden on hospital care under different conditions of social distancing in Lombardy and Emilia-Romagna, the two regions of Italy most affected by the epidemic. To do this, we used a Susceptible-Exposed-Infectious-Recovered (SEIR) deterministic model, which encompasses compartments relevant to public health interventions such as quarantine. A new compartment L was added to the model for isolated infected population, i.e., individuals tested positives that do not need hospital care. We found that in Lombardy restrictive containment measures should be prolonged at least until early July to avoid a resurgence of hospitalizations; on the other hand, in Emilia-Romagna the number of hospitalized cases could be kept under a reasonable amount with a higher contact rate. Our results suggest that territory-specific forecasts under different scenarios are crucial to enhance or take new containment measures during the epidemic.

Analysis of the scientific literature in the first 30 Days of the novel coronavirus outbreak. (preprint)

Introduction: Recent events highlight how emerging and re-emerging pathogens are becoming global challenges for public health. In December 2019, a novel coronavirus has emerged. This has suddenly turned out into global health concern. Objectives: Aim of this research is to focus on the bibliometric aspects in order to measure what is published in the first 30-days of a global epidemic outbreak Methods: We searched PubMed database in order to find all relevant studies in the first 30-days from the first publication. Results: From the initial 442 identified articles, 234 were read in-extenso. The majority of papers come from China, UK and USA. 63.7% of the papers were commentaries, editorials and reported data and only 17.5% of the sources used data directly collected on the field. Topics mainly addressed were epidemiology, preparedness and generic discussion. NNR showed a reduction for both the objectives assessed from January to February. Conclusions: Diagnosis and effective preventive and therapeutic measures were the fields in which more research is still needed. The vast majority of scientific literature in the first 30-days of an epidemic outbreak is based on reported data rather than primary data. Nevertheless, the scientific statements and public health decisions rely on these data.