Access to SARS-CoV-2 diagnostic tests: are there barriers for the immigrants in Italy?

OBJECTIVES: to describe the epidemiology of SARS-CoV-2 infection in relation with the use of nasal swabs in the immigrant population in Italy, using data from the COVID-19 national surveillance system and to verify if a difference is present comparing natives and immigrant. DESIGN: descriptive study based on longitudinal health-administrative data. SETTING AND PAR TICIPAN TS: general population of six Italian Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio) covering about 55% of the resident population and 72% of foreigners' population. MAIN OUTCOME MEASURES: regional rates of access to at least a nasal swab, separately by country of origin. RESULTS: across all the periods, a lower rate in the foreigners' group was observed, with the only exception of the period May-June 2021. Considering separately High Migratory Pressure Countries (HMPCs) and Highly Developed Countries (HDCs), a higher proportion of nasal swabs performed in people coming from HDC with respect to HMPCs and natives was noticed. This observation is consistent in males and females. CONCLUSIONS: during the first wave of the pandemic, Italians have had a higher proportion of nasal swabs compared to migrants across all Regions. This difference disappeared in the following periods, probably due to a major availability of diagnostic tests.

Do newly arrived migrants represent a COVID-19 burden? Data from the Italian information flow : Leuconoe Grazia Sisti

Background Migrants who reach host countries irregularly are often perceived as increasing the COVID-19 burden. Italy is a transit and destination country for migrants who cross the Central Mediterranean route. During the pandemic, all migrants who disembarked on the Italian shores have been COVID-19 tested and quarantined. To investigate the incidence of SARS-CoV-2 infection in this population, the INMP, together with the Italian Ministry of the Interior, set a specific information flow collecting data about the infection and possible outcomes. Methods The observation period was from January 2021 to January 2022. COVID-19 tests used were molecular and antigenic. Positive cases detected both at the arrival and during the quarantine period, have been registered on an ad hoc INMP online platform. Migrants’ SARS-CoV-2 incidence rate (per 1,000) - with 95% CI - was therefore calculated. The Incidence Ratio (IR) was used to compare the migrants’ incidence rate with that of the resident population in Italy, in the same period and corresponding age group. Results Among 70,512 migrants (91% males and 9% females, all <60years old) who landed in Italy during the observation period, 2,861 tested positive, with an incidence rate of 40.6 (39.1-42.1) cases per 1,000. In the same period, an incidence rate of 177.6 (177.5-177.8) has been recorded in the resident population, with an IR of 0.22 (0.22-0.23). 89.9% of cases were males and almost half (49.6%) belonged to the age group 25-39years old. 99% of cases reported no symptoms, no relevant comorbidity has been reported and no cases have been hospitalized. Conclusions Our findings clearly highlight the low rate of SARS-CoV-2 infection in migrants reaching Italy by sea with an incidence rate that is roughly a quarter of that of the resident population, encouraging the opportunity to investigate the reasons for such an observation. Moreover, our study confirms the “healthy migrant effect” in migrants reaching Italy by sea. Key messages Irregular migrants arriving in Italy did not increase the COVID-19 burden in the country, thus alarmism is not justified. Further studies are needed to investigate the reasons for the lower incidence observed.

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.

Activity of a Phase I Clinical Unit during the COVID-19 pandemic

Background: Enrolment of patients in phase 1 trials is a difficult task everywhere and at every time. It is reported that on average less than one patient per month is enrolled worldwide in phase 1 trials. COVID-19 pandemic has been a further problem during 2020, with many trials closed by the sponsors for logistic reasons and for the fear of causing a fatal infection in cancer patients. Materials and methods: We reviewed the activity of our phase 1 unit in terms of enrolment of new patients during six months, three before and three during COVID-19 pandemia, and of treatment of patients enrolled before the pandemic. Results: Out of 8 trials active at our unit, only one did not close the possibility of enrolling new patients during the pandemic. No treatment was stopped because of the pandemic. During the pandemic we enrolled three new patients in the only one open trial. The same number of new patients had been enrolled during the previous three months. In addition, three further patients were pre-screened during the pandemic resulting not eligible. Operatively, an intensive strategy of testing healthcare workers (nurses, doctors, study coordinators, biologists) with blood testing for anti-COVID19 IgM and IgG, and pharyngeal and nasal swabs was applied. In addition, patients were managed with a triage protocol that similarly included blood testing at each access and swab testing in case of IgM/IgG presence. Overall, no one of the health coworkers resulted positive to blood or swap testing and only one patients was positive to IgM testing, with negative swap and subsequently negative blood testing, possibly representing a false positive case. Sanitization of phase 1 rooms was also performed regularly, once per week or more frequently at need in case of patients or health workers resulting positive to blood testing. Conclusions: Our phase 1 unit was able to maintain the same level of activity during the pandemic, thanks to one trial that was not suspended by the sponsor and this goal was reached thanks to organization and preventive measures set up by the Institutional dedicated professionals. Overall, a good result was achieved in terms of safety of both patients and healthcare workers.