Impactofage on Mortality in Stemi Patients during the Sars-Cov2 Pandemic:Data from the Isacs-Stemi Covid-19 Registry

Background: Several reports have described the negative prognostic impact of ageing in patients with ST-Elevation Myocardial Infarction (STEMI) undergoing primary angioplasty. During the COVID-19 pandemic, increased mortality was observed in patients admitted for STEMI. However, there are no data on the impact of ageing on the outcome of this high-risk patients during the pandemic. Objective(s): The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving primary PCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 11920 of March until June 30, 2019 and 2020). Primary study endpoint of this analysis was in-hospital mortality. Secondary endpoints was 30-day mortality. Result(s): Our population is represented by 16083 STEMI patients undergoing mechanical reperfusion, who were divided according to age (< 55 years, n = 4179 (25,98%);55-65 years, n = 4814 (29,93%);65-75 years, n = 4016 (24,97%);75-65 years, n = 2226 (13,84%);>85 years, n = 821 (5,10%). Ageing was linearly and independently associated with in-hospital (figure 1) and 30-day mortality (adjusted p < 0.0001). The COVID pandemic had a significant impact on in-hospital and 30-day mortality (adjusted p < 0.001), that was linearly related to age, particularly for inhospital mortality (Figure 1). Conclusion(s): Our study showed that among STEMI patients undergoing primary angioplasty, age was linearly associated to mortality in both precovid and covid era. The COVID-19 pandemic had a significant impact on mortality, especially in more advanced age.

A post-pandemic look at short-term tourist accommodations and World Heritage Site management

Overtourism is a novel and complicated phenomenon that has hastened the rapid expansion of short-term tourist accommodations (STTA) in many European art cities. This study aims to establish a link between the rapid growth of the STTA and the likely dissemination of novel COVID-19 variations in World Heritage Sites (WHS). Using a comparative case study method, we assert that the atypical evolution of STTA renders WHS more vulnerable to novel COVID-19 variations. The findings highlight that until there are no feasible multi-sectoral and multi-level approaches to management, policy agreements on what overtourism means, and measuring tools for the proper number of visitors, the STTA issue persists, which makes WHS more vulnerable to novel COVID-19 variations in the post-pandemic time.

Therapeutic adherence and quality of care of MS patients during COVID-19 pandemic: an italian multicenter patient-centered survey (COVIMPSAT)

Introduction and aims: Multiple Sclerosis (MS) Centers experienced a significant disruption of their clinical activities during the first waves of COVID-19 pandemic. As part of a national multicenter survey (COVId Ms Patients SATisfaction survey - COVIMPSAT), we collected i) the opinion on quality of care (QoC) received by people with MS (pwMS) from MS Centers (MSC), and ii) data on therapeutic adherence and discontinuation, during the lockdown period (March-May 2020) in Italy. Method(s): In April-May 2021, 16 Italian MSC compiled and sent a digital (35-item) survey to their patients. Statistical analyses were performed with SPSS, version 25. Result(s): 1670 pwMS (67.3% women) completed the survey. Most of them (89.9%) were on disease-modifying therapies (DMTs). The most used DMTs were dimethyl fumarate (18.6%), ocrelizumab (14.4%) and natalizumab (13.9%). During the lockdown period, 88% did not modify their DMT regimen, while 11% reported a change in DMT intake, with a reduction in 7.8% and a drug discontinuation in only 4.2% cases. Almost 9 out of 10 pwMS (89.1%) were able to get in contact with their MSC without difficulties. Thirty-six percent of pwMS contacted their MSC for getting information about COVID-19, while 30% were directly contacted from the MSC personnel to provide information on MS and COVID-19 and preventive behaviours. More than half of the patients (63.5%) performed their check-up visits at the MSC with the same schedule as the pre-pandemic period, while 36.5% of pwMS voluntary skipped follow-up visits mainly because of fear of getting COVID-19 infection (46%) and the sensation of feeling well without an absolute/urgent need of a check-up visit (16.8%). Interestingly, although only 1.3% of pwMS underwent a teleneurology follow-up visit, 80% of patients suggested to invest more in telemedicine programs in order to expand contact channels with MSC. The overall opinion of pwMS on MSC during the pandemic period in Italy was more than positive, with 32% of pwMS declaring a significant increase in trust in their MSC. Conclusion(s): Italian pwMS judged globally well the activity, accessibility and information received by their MSC during the first wave of COVID-19 pandemic. Only 1 out of 10 pwMS underwent a change in their DMT regimen, showing a high drug adherence. Our data also demonstrate that implementing telemedicine programs would further improve the QoC of patients, particularly those with higher disability or living far from the MSC.

COVID-19 course and outcome after three mrna vaccine doses in MS patients treated with high efficacy DMTs

Background: High-efficacy (HE) disease-modifying therapies (DMTs) for Multiple Sclerosis (MS), such as anti-CD20 monoclonal antibodies - i.e., Ocrelizumab (OCR) and Rituximab - may worsen COVID-19 course. Preliminary data suggest that two doses of mRNA COVID-19 vaccine (RNA-Vax) reduce the risk of breakthrough/severe COVID-19 in patients with MS (pwMS) under treatment with HE-DMTs. Little is known about the protective effect of a third booster dose of RNA-Vax in pwMS treated with most commonly used HE-DMTs, such as Natalizumab (NTZ), Fingolimod (FNG), and OCR. Aim(s): To compare COVID-19 course and outcomes in pwMS on NTZ, FNG, and OCR after receiving the third dose of RNA-Vax. Method(s): Inclusion criteria were: >18 years old, being treated with NTZ/OCR/FNG since the first vaccine dose, diagnosis of COVID-19 after a third booster dose of RNA-Vax, not being treated with steroids within the month prior to any vaccine dose or COVID-19. Result(s): 232 pwMS (63 NTZ, 106 OCR, 63 FNG) from 17 Italian MS centers were included in the analysis. pwMS on NTZ (37+/-9) were younger than those on OCR (42+/-10, p=0.026) and FNG (43+/-11, p=0.006);EDSS was higher in pwMS on OCR (3.0, IQR=1.5-5.5) than those on FNG (2.0, IQR=1.0-3.0, p=0.017). COVID-19 was diagnosed 65+/-41 days after receiving the third booster dose. PwMS on OCR compared with those on NTZ showed more frequently (p<0.02-0.001): fever >38degreeC (53.8% vs 20.6%), cough (67% vs 36.5%), dyspnea (18.9% vs 3.2%), longer symptoms duration (9.5+/-8.7 vs 6+/-4.6 days), use of NSAIDs (74.5% vs 52.4%), oxygen (7.5% vs 0%), antibiotics (45.3% vs 14.3%). PwMS on OCR compared with those on FNG needed more frequently the use of oxygen (7.5% vs 1.6%, p=0.002). PwMS on FNG compared with those on NTZ showed more frequently (p<0.03-0.002): fever >38degreeC (39.7% vs 20.6%), cough (65.1% vs 36.5%), dyspnea (15.9% vs 3.2%). There were no differences between the 3 groups of pwMS regarding: COVID-19 treatment with steroids or monoclonal antibodies, hospitalization, and full recovery or death (0%). Discussion and Conclusion(s): Breakthrough COVID-19 after a third booster dose of RNA-Vax was more symptomatic in pwMS on OCR and FNG than those on NTZ. Nevertheless, no deaths were reported and the Covid-19 course in terms of full recovery and hospitalization rates was not different across different HE-DMTs. These results support the efficacy of a third booster dose of RNA-Vax in preventing severe COVID-19 (with hospitalization/ death) in pwMS treated with most common HE-DMTs.

Management of ocrelizumab in MS patients during the COVID-19 pandemic: an observational registry-based study

Introduction: Concerns have emerged during Covid-19 pandemic about management of Disease Modifying Therapies (DMTs) in patients with Multiple Sclerosis (pwMS). In particular, Ocrelizumab (OCR)-treated pwMS faced possible delays of scheduled infusions due to disruption of MS Centers activities as well as safety worries during lockdown periods. Objective(s): To assess changes of OCR infusion schedule in Italian pwMS during the first wave of COVID-19 pandemic (observation period: February-June 2020) and to investigate predictive factors determining delaying of OCR infusions. Material(s) and Method(s): Data were extracted from the Italian MS Register database. pwMS with an OCR infusion scheduled during the observation period and at least two previous OCR infusions were selected. Demographics (age, gender), disease characteristics (MS phenotype, disease duration, Expanded Disability Status Scale score, number of previous OCR infusions) and location of MS Centers among three Italian macro-regions (North, Center, South) were tested as potential predictors for treatment delay using univariable and multivariable linear model analyses. Result(s): Five-hundred ninety-nine pwMS (343 F/256 M;411 Relapsing MS/188 Progressive MS) from 65 MS centers were included in the analysis. Mean interval between two OCR infusions was 28.1 weeks (SD 2.72) before the observation period compared to 30.8 weeks (SD 5.45) during the observation period, with a mean delay of 2.7 weeks (p <0.001). No clinico-demographic factors emerged as predictors of infusion postponement, except for location of MS centers in the North of Italy (4.7 weeks vs 1.5 in the Center and 1.6 in the South). Such a difference was confirmed in multivariate analysis (p < 0.001) adjusting for prelockdown mean OCR infusion schedule. Conclusion(s): This large registry-based study shows that OCR infusions were significantly delayed during the first wave of COVID-19 pandemic in Italy. The location of the MS Centers in Northern Italy was the only predictor of OCR infusion postponement. This geographical area corresponds to the region in Italy that was hit first and more strongly by Covid-19 pandemic. The observed delay in OCR infusions disruptions of MS centers activities due to a drastic reduction of healthcare workers availability (because of infection/quarantine and/or reallocation in Covid Units) and concerns about using an immunosuppressive DMT like OCR during a new virus pandemic with many uncertainties.

Exploring the reasons behind Ocrelizumab infusions delay during the first wave of COVID-19 pandemic in Italy: results of a survey among MS centers

Introduction: MS centers (MSc) activities related to OCR management were strongly and diffusely hit during the first wave of COVID-19 pandemic. Concerns were mainly related to its immunosuppressive effects and the need for in-hospital administration. Objective(s): To investigate changes in OCR schedule among Italian MS centers participating to the Italian MS Register during the first wave of COVID-19 pandemic and to identify factors determining such changes. Material(s) and Method(s): A quick online survey was sent to 65 Italian MSc in order to collect from them the following data: macro-region (North, Center, South) location, number of OCRtreated patients, modifications of OCR schedule and a list of factors potentially influencing the postponement of OCR infusions (i.e. age, co-morbidity, MS phenotype, number of previous OCR cycles, disease severity/activity, CD-20 lymphocytes count, distance to MS center, fear of infection, inclusion in a research trial, infections trend, shortage of medical/paramedical staff for reallocation/ infection). Result(s): Among 55 MSc who answered the survey, 50 (91%) declared to have suspended or extended OCR interval dosing for at least one patient. The MSc that didn't modify OCR schedule were all from the South of Italy (33% of all South MSc). Main factors influencing OCR schedule delay were advanced age/comorbidity (70%) and pandemic trend in the area (72%), while recent MS-disease activity hindered OCR schedule modifications (65%). Conclusion(s): This study shows that most Italian MSc decided either to delay or suspend OCR treatment during the first wave of COVID-19 pandemic. Advanced age and co-morbidity and no evidence of recent MS-disease activity were the most relevant patient-dependent predictors of OCR postponement. Among patient-independent factors the most relevant factor was the local trend of infections. Contrary to what expected, the shortage of medical and/or paramedical staff in MSc did not come out as relevant. The disruption of OCR schedule during the first COVID-19 pandemic wave in Italy mostly reflected the geographical distribution and the impact on the National Health System of COVID- 19 pandemic.

The COVID MS patients satisfaction survey (COVIMPSAT): COVID-19 outcomes in people with multiple sclerosis and the role of multiple sclerosis centers during the pandemic

Introduction, objectives and aims: COVID-19 pandemic caused a significant disruption of clinical activities at Multiple Sclerosis (MS) Centers. As part of a national multicenter survey (COVId Ms Patients SATisfaction survey - COVIMPSAT) aimed at collecting patients' opinion regarding the quality of care and information received from MS Centers (MSC) during the pandemic, we report data about COVID-19 infections and vaccination cycle and how they were managed by the MSC. Material(s) and Method(s): In April-May 2021, 16 Italian MSC developed and sent a digital (35-item) survey by email to their patients. Statistical analyses were performed with SPSS, version 25. Result(s): 1670 people with MS (pwMS;67.3% women) completed the survey. 169 (10.1%) reported a diagnosis of COVID-19 infection: 63% were symptomatic, while 37% were not. As regards treatment for COVID-19, only 3% of the patients were hospitalized. The impact of COVID-19 infection on MS-related neurological symptoms was as follow: 69.3% of pwMS stated that the severity of their MS-related symptoms remained stable, 21.5% reported a worsening of pre-existing symptoms, 7.4% affirmed that new neurological symptoms emerged, while only 1.8% reported an improvement of MS-related symptomatology. At the time of the survey, 60.6% of pwMS were inoculated at least one dose of COVID-19 vaccine. Vaccination appointments were scheduled by: MSC staff alone (44.9%), MSC staff together with the general practitioner (17.5%), the general practitioner alone (16.1%), other Institutions (12.1%), and by the patients themselves (9.3%). At the moment of the survey 39.4% of pwMS were not vaccinated yet. The three major reasons for not being vaccinated yet were: being already on a vaccination list (40.8%), willing to be vaccinated but without an appointment (17.6%), still undecided or not willing to be vaccinated (19.3%). Conclusion(s): The results of this multicentre survey revealed a low hospitalization rate of pwMS, in line with previous studies (Moghadasi et al, 2021). In the majority of the sample, COVID-19 symptomatology did not have a significant impact on MS-related neurological symptoms. MSC promoted and facilitated vaccination procedures and scheduling, alone or in combination with the general practitioner, in more than half of pwMS.

LONG-TERM SURVEY STUDY of the IMPACT of COVID-19 on SYSTEMIC AUTOIMMUNE DISEASES. LOW DEATH RATE DESPITE the INCREASED PREVALENCE of SYMPTOMATIC INFECTION. ROLE of PRE-EXISTING INTERSTITIAL LUNG DISEASE and ONGOING TREATMENTS

Background: Patients with autoimmune systemic diseases (ASDs) can be counted among frail populations as regards the predisposition to COVID-19 due to the frequent visceral organ involvement and comorbidities, as well as the ongoing immunomodulating treatments. Objectives: Our long-term multicenter telephone survey prospectively investigated the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients during the frst 3 pandemic waves. Methods: A large series of 3,918 ASD patients (815 M, 3103 F;mean age 59±12SD years) was consecutively recruited at the 36 referral centers of COVID-19 & ASD Italian Study Group. In particular, ASD series encompassed the following conditions: rheumatoid arthritis (n: 981), psoriatic arthritis (n: 471), ankylosing spondylitis (n: 159), systemic sclerosis (n: 1,738), systemic lupus (172), systemic vasculitis (n: 219), and a miscellany of other ASDs (n: 178). The development of COVID-19 was recorded by means of telephone survey using standardized symptom-assessment questionnaire (1). Results: A signifcantly increased prevalence of COVID-19 (8.37% vs 6.49%;p<0.0001) was observed in our ASD patients, while the cumulative death rate revealed statistically comparable to the Italian general population (3.65% vs 2.95%;p: ns). In particular, among the 328 ASD patients complicated by COVID-19, 57 (17%) needed hospitalization, while mild-moderate manifestations were observed in the large majority of individuals (83%). In addition, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular manifestations. Interestingly, a signifcantly higher COVID-19-related death rate was observed in systemic sclerosis patients compared to the Italian general population (6.29% vs 2.95%;p=0.018). Other adverse prognostic factors to develop COVID-19 were the patients' older age, male gender, pre-existing ASD-related interstitial lung involvement, and chronic steroid treatment. Conversely, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a signifcantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%;p=0.000), as well as the chronic administration of low dose aspirin in a subgroup of SSc patients (with 5.57% vs without 27.84%;p=0.000). Conclusion: The cumulative impact of COVID-19 on ASD patients after the frst 3 pandemic waves revealed less severe than that observed during the frst phase of pandemic (1), especially with regards to the death rate that was comparable to the Italian general population in spite of the increased prevalence of complicating COVID-19 in the same ASD series. Ongoing long-term treatments, mainly csDMARDs, might usefully contribute to generally positive outcomes of in this frail patients' population. Of note, a signifcantly increased COVID-19-related mortality was recorded in only SSc patients' subgroup, possibly favored by pre-existing lung fbrosis. Among different ASD, SSc deserves special attention, since it shares the main pathological alterations with COVID-19, namely the interstitial lung involvement and the endothelial injury responsible for diffuse microangiopathy. Besides SSc, the patients' subgroups characterized by older age, chronic steroid treatment, pre-existing interstitial lung disease, and/or impaired COVID-19 vaccine response (1-3), may deserve well-designed prevention and management strategies.

ECHOCARDIOGRAPHIC EXAMINATION ON AGONIST ATHLETES WITH RECENT PAUCISYMPTOMATIC SARS COV 2 INFECTION, FOR THE RENEWAL OF AGONIST SPORT ACTIVITY ELIGIBILITY: PLAUSIBLE ROLE AND UTILITY OF GLS ANALYSIS THROUGH SPECKLE TRACKING

Background The aim of this work is to highlight whether or not the methodical echocardiography done through the analysis of global and segmental longitudinal deformation (GLS–SLS) can be useful to identify subclinical myocardial lesions in paucisymptomatic young agonist athletes with recent SarsCov2 infection before they return to agonist practice. Material and Methods From 12/2020 to 12/2021 84 agonist athletes with previous SarsCov2 infection have been examined at “Cardiomed Center” Maglie (Lecce, IT), as part of screening for their return to sport practice;all of them under standard echocardiographic analysis associated to GLS analysis, Holter–ECG analysis with 24h on 12 derivations. Results The base echocardiographic examination didn’t show any myocardial cynesis anomalies in any patient. In 5 patients there was a presence of a light pericardial effusion, how it was supposed to be as an outcome of a previous inflammatory ingjury The GLS analysis, that resulted in reliability considering the optimal acoustic window, showed a slightly lower medium value compared to the values cited in the literature (19.4 ± 2.9) and particularly 4 patients show considerable deficit reductions of segmentary strain. In these patients Holter analysis showed the presence of a moderate non–complex extrasystolic arrhythmia. These elements–that are a reduced GLS with marked regional anomaly, coupled with the presence of ventricular arrhythmia even in absence of segmentary dissinergyes– led to cardiac RMN evaluation. In 2 out of 4 patients there have been flaws that were compatible to modest myocardial lesions, in one case it was observed a marked flaw in medium–apical–lateral region that was correlated to the described areas at the specle tracking. Conclusion Our experience at the Cardiology and Sports integrated clinic, although it relied on a meager population of patients, it still demonstrated how echocardiographic analysis through GLS evaluation and the highlighting of sectorial alterations even in absence of cynesis anomalies can be used as a parameter to suppose the presence of miocarditic lesions that might be sent to the next RMN examination for confirmation, in young athletes with recent paucisymptomatic Covid–19 infection.

New models of living and proximity spaces in the reorganisation of the city structure

This article starts from a reinterpretation of the effects of the Covid-19 pandemic on cities, questioning the ways in which it has called into question both the organisational space of living and the public-relational space, also questioning the dynamics of sharing spaces inside homes, but at the same time reinterpreting public space as an extension of private spaces to guarantee collective services. The article discusses two proposals: one centred on Harmonic Innovation Living, currently being applied in the Municipality of Falerna, in Calabria;the other on the planning devices for reorganising the urban structure of the Metropolitan City of Florence, through the Metropolitan Territorial Plan currently being drafted, which introduces the concept of a 'platform' of intervention to redefine mobility and proximity services. Copyright © FrancoAngeli.

The risk of COVID-19 in people with multiple sclerosis: A case-control study from the Italian MS Register

Background: Data collected from several international platforms provided important information about risk factors, including treatment exposure, impacting COVID-19 severity in people with multiple sclerosis (PwMS). However, up to now, factors increasing the risk of getting SARS-CoV2 infection in PwMS are not known. MS registers represent a suitable tool to provide denominators for risks assessment. Objectives: To assess risk factors for SARS-CoV2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods: A case-control (1-2) study was set-up. PwMS with (cases) and without (controls) COVID-19 were identified within the IMRS and propensity-score matched by the date of COVID-19 diagnosis (cases) and the date of last visit (controls) and for the region of residence. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The role of DMTs exposure was assessed in 3 different models including: last recorded DMT or DMT sequences (induction strategy/escalation strategy/only first line DMT exposure/ never treated) or last DMTs grouped according to the place of administration (at hospital or self-administered at home). A minimal treatment exposure for each DMT was defined on the basis of the recognized minimal time required to be potentially effective. Results: A total of 779 [median (IQR) age: 42.40 years (33.00- 50.80);30.17% male] confirmed COVID-19 cases were matched to 1558 controls [46.90 years (37.50-55.70);35.82% male]. In all models, comorbidities, female sex and age were significantly associated (p<0.02) to a higher risk of getting COVID-19. Patients receiving Natalizumab as last DMT (OR (95% CI): 2.38(1.66-3.42), p<0.0001) and those who underwent an escalation treatment strategy (1.57 (1.16-2.13), p=0.003) were at significant higher COVID-19 risk. Moreover, the group of PwMS receiving last DMTs requiring hospital access (1.65(1.34-2.04), p<0.0001) showed a significant higher risk than those taking selfadministered DMTs at home. Conclusions: This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to increase significantly the risk SARS-CoV2 infection in PwMS.

B-Cellrepopulation after ocrelizumab in multiple sclerosis patients

Objective: To determine the time to B-cell repopulation after ocrelizumab infusion in people with multiple sclerosis (pwMS) Background: At the onset of the Covid-19 pandemic, there was uncertainty over the risk of infection and Covid-19 disease outcomes in pwMS treated with B-cell depleting therapy, namely ocrelizumab. Data is emerging from various global and national registries that exposure to ocrelizumab portends a more severe course of Covid-19. The implications of ocrelizumab exposure for immunisation when a vaccine against Covid-19 becomes available remain uncertain. In multiple sclerosis (MS), ocrelizumab is administered as a fixed 600mg dose at six monthly intervals (≈180days). Previous research indicates that there is inter-individual variability in time to B-cell repopulation after B-cell depletion therapies. To balance the risks of suboptimal MS treatment against the uncertain risks of ocrelizumab during the pandemic, we offered B-cell depletion monitoring with the aim of ocrelizumab re-infusion when peripheral B-cells were detected. Design/Methods: Prior to Covid-19, lymphocyte subsets were measured before each 6 monthly ocrelizumab treatment cycle. During the pandemic, we aimed to measure peripheral lymphocyte subsets at monthly intervals starting from the infusion due date. B-cell repopulation was defined as the first detection of CD19 cell percentage of total lymphocytes ≥1 by flow cytometric analysis. Results: Our cohort consisted of 32 pwMS. Out of a total of 48 treatment cycles, 15 demonstrated B-cell repopulation with the time to B-cell repopulation ranging from 160 to 321 days. Two pwMS had a CD19+ cell count >1% prior to the 6 monthly infusion due date at 160 and 176 days. Data collection is ongoing and will be presented when available. Conclusions: Our data indicates that B-cell repopulation after ocrelizumab exposure demonstrates inter individual variability, as has been observed with rituximab. Monitoring of Bcell subsets prior to dosing could help identify and tailor dosing schedules to minimise risk of ocrelizumab exposure.

Management of patients undergoing chronic hemodialysis during the covid-19 pandemic: Fondazione policlinico a. gemelli's experience

BACKGROUND AND AIM: COVID-19 (COronaVIrus Disease 19) is an acute respiratory disease caused by SARS CoV 2 virus. The correlation between SARS-CoV2 infection and comorbidities is complex;patients with multiple comorbidities present often with the most severe symptoms that could potentially lead to death. Patients undergoing hemodialysis are generally frail and immunodeficient. This leads to a greater risk of contracting infectious diseases. In the literature, the estimated incidence of SARS-CoV2 infection is 3.24% in chronic hemodialysis patients. METHOD: Fondazione Policlinico A. Gemelli is a COVID hospital. During the pandemic patients from several dialysis centers converged in our hospital. FPG has two dialysis centers, one for outpatients and one for inpatients. Patients admitted for COVID-19 infection have been treated in three different settings: 1. isolation room within the dialysis center;2. Bedside;3. In a COVID-19 dialysis center. We retrospectively collected data of patients treated from March 2020 to January 2021 and analyzed the SARS-CoV2 incidence in our center's chronic hemodialysis patients. RESULTS: 66 hemodialysis patients affected by COVID-19 have been treated in our hospital from March 2020 to January 2021, 60 patients undergoing chronic dialysis and 6 patients diagnosed with acute kidney injury (AKI) stage III non-intensive care unit. Among chronic patients, 64 underwent chronic hemodialysis and 2 patients underwent peritoneal dialysis. Median age was 68.19 (46 males, 20 females), all patients had multiple comorbidities: 37.8% of patients had diabetes mellitus;72.7% cardiovascular diseases and 16.6% a positive clinical history for cancer. Among the 6 AKI cases, 3 patients regained total kidney function;the other 3 had to continue renal replacement therapy. The mean hospital stay length was 18.5 days with a mean time of COVID-19 infection of 21.23 days. The overall mean Charlson Comorbidty Index was 6.21. Among the 66 treated patients, 43 were diagnosed with COVID-19-related pneumonia, 14 had the infection, no pulmonary involvement, but presented with other complications, and 5 patients resulted positive although asymptomatic. Among the 116 hemodialysis outpatients, only 4 presented with SARS-CoV2 infection, 3 were contacts of a positive family member and 1 resulted positive during a hospital stay for Clostridium Difficile infection. All patients required hospitalization. 14 (21%) patients died. Among the deceased patients, the mean age was 76.90 years (9 males, 3 females), mean Charlson Comorbidity Index was 7.3, mean hospital stay length was 9 days. Among patients who survived the disease the mean age was 76.92 years (34 males, 14 females), mean Charlson Comorbidty Index was 5.87 and mean hospital stay length was 19.47 days. Statistical significance was reached for age (p value 0.005) and Charlson Comorbidty Index (p value 0.39), but not for mean hospital stay length (p value 0.13). All COVID-19 patients were treated with bicarbonate hemodialysis and a Theranova 400 Baxter® filter. This filter was chosen for its efficiency on medium-size molecules removal (between 25 kDa and 60 kDa) that may be associated with inflammation. Bedside treatments were performed using the GeniusVC Fresenius system. Each treatment lasted 180 minutes, in order to reduce the time of exposure to COVID-19 of medical staff and the risk of virus spread on one hand, but still ensuring an optimal and complication-free treatment to patients. CONCLUSION: Our experience seems to confirm the national data collected so far, both in terms of patients' outcomes and mortality rate. Our study confirms that age is a risk factor for mortality. How to properly manage chronic hemodialysis patients affected by COVID-19 remains a challenging and burdensome question. However, there is the need of new flexible solutions that guarantee the patients and the medical staff's safety on one hand and a personalized management on the other.