Evaluating the effect of COVID-19 incidence on Emergency Departments admissions. Results from a retrospective study in Central Italy during the first year of pandemic.

Introduction: The COVID-19 pandemic has had a major impact on the Healthcare System, changing the patterns of Emergency Department access. In fact, accesses for trauma and less severe cases decreased significantly. This decline has generally been attributed to both the effects of the lockdown, imposed by the government, and the fear of being infected by SARS-CoV-2 in the hospital. However, the correlation between these elements is not yet clear, since the accesses to the Emergency Department did not increase either at the end of the lockdown or in the summer when the epidemiological situation was more favorable. Aim: To evaluate the association between trends of Emergency Department accesses and COVID-19 incidence in 2020. Methods: Data on Emergency Department accesses, by month and severity triage code, from 14 hospitals in southeastern Tuscany (Italy) were obtained from hospitals' data warehouse. Official data on new cases of COVID-19 infection were used to calculate incidence. Hospitals were classified into 4 categories. Differences in Emergency Department access by month, triage code, and hospital type were investigated using Kruskal-Wallis analysis. Association between Emergency Department accesses and COVID-19 incidence was evaluated using a random-effect panel data analysis, adjusting for hospital type and triage code. Results: The trend of 268,072 Emergency Department accesses decreases substantially at the first pandemic peak; thereafter, it increased and decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to be overlapping with an inverse direction. Monthly differences were significant (p<0.01) except for most severe codes. There was a significant inverse association between Emergency Department accesses and COVID-19 incidence (Coef. =-0.074, p<0.001) except for most severe cases (triage code 1: Coef. =-0.028, p=0.154). Conclusion: Emergency Department admissions trend followed the COVID-19 incidence, except for the most severe cases. Fear of infection seems to discourage patients from accessing Emergency Department for illnesses perceived as not serious.

Argentine social policy during the first year of the COVID-19 pandemic: non-contributory cash transfers, household incomes and poverty

With a focus on the emergency measures taken by the federal government, this article discusses Argentine social policy during the first year of the COVID-19 pandemic. Using the Permanent Household Survey microdata, the essay studies the main noncontributory cash transfer programs and their effects on household income, broken down by household characteristics. Data shows an expansion in the coverage and sum of social transfers, which had moderate effects on the increase in poverty and extreme poverty caused by the pandemic-related crisis. © 2022 Grupo Editor Yocavil. All rights reserved.

Precocious puberty and other pubertal disorders in females during the Italian lockdown and the coronavirus 2019 (COVID-19) pandemic

Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.

Facemasks and Public Health: analysis of bacterial contamination in FFP2 masks : Gaia Papale

Background Facemasks (FM), due to the Covid-19 pandemic, are extensively used and often worn beyond the recommended time. This has led to questions about the negative impact persistent contamination on FMs might have on public health. The study aims to assess the level of contamination reached in a small cohort of subjects after the recommended use (8 h) of FM. Methods This descriptive study was carried out between January and April 2022 on 17 people: 9 women and 8 men aged between 25-45 years. These two groups were divided into two micro-groups: women were selected according to their skincare habits (no skincare and skincare with cosmetics). In contrast, men were selected according to the length of their beards (thick or short beard). The FM was worn for 8 h in a controlled office setting, to avoid possible uncontrolled variables. Then, the FM was cut, placed in a tube with a recovery medium and centrifuged. The supernatant was removed and the pellet resuspended. Aliquots were plated on Petri plates and incubated for 48 h at 36 °C to count the Colony Forming Units (CFU). The statistical analysis was conducted using Stata software, performing the Wilcoxon matched-pairs and setting a significance level of p < 0.05. Results Women had higher FM contamination than men (= 4960 vs 3130 CFU/ml). Also, we found more colonies (= 18890 vs 3420 CFU/ml) in the FMs of women without skincare (p = 0.06), while among men, more colonies were reported for those with a thicker beard than for those with a shorter one (= 3300 vs 2960 CFU/ml). Conclusions Extensive FM use increases bacterial contamination exponentially. This could lead to changes in the facial microbiome, inducing skin conditions (such as allergic dermatitis and acne). Facial skin conditions are important public health issues for people wearing FMs daily. In addition, responsible handling of this equipment is essential to avoid the spread of SARS-CoV-2 through contact with these items, which can persist for many days. Key messages • Gender and physical characteristics may influence the level of contamination present on FFP2 face masks. • There is a need to increase community awareness on the proper handling of facemasks, prevent health problems for users, and limit the spread of infection to those around them.

COVID-19 incidence on Emergency Departments accesses. Health need and fear of infection, what wins? : Roberta Bosco

Introduction The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law. Aim To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January - 31 December 2020. Material and methods The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code. Results A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p < 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p < 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154). Conclusions ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious. Key messages • The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department. • The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.

Don’t be scared to touch! Effectiveness of a new disinfection technology based on Ag ions & Zeolite : Valerio Peruzzi

Background Disinfection of contact surfaces has become common practice since the two-year Covid-19 pandemic. The transmission of microbial agents has long been the focus of public health and hygiene awareness campaigns. Indeed, the development of new disinfection technologies and approaches is attracting considerable interest in the scientific community. Mixed plastic powders with antimicrobial properties and silver ions that compromise the metabolism of microorganisms could reduce the contamination of the contact surfaces. We aimed to evaluate an inorganic antimicrobial agent (IAA) based on Ag ions and zeolite mixed in a resin. Methods This experimental study was carried out at the University of Siena, Italy. Different objects were produced in two versions: i) with an IAA mixed in plastic resin;ii) with a standard plastic mixture. To the eye, the two versions were indistinguishable and were randomly contaminated with the hands of several operators. After the hand contamination, T0, we sampled the objects using RODAC plates at T1 (1h) and T2 (6h), incubating at 36 °C for 48 hours. Comparisons of the biocidal effect were made at T1 and T2. Statistical analysis was carried out with Stata. Results The mean level of contamination of the objects made with standard plastic were, respectively 50 CFU (SD 36.5) at T1 and 20 CFU (SD 13.6) at T2. In comparison, the objects made with IAA resin showed a mean level of contamination of 10 CFU (SD 5.9) at T1 and 6 CFU (SD3.6) at T2. The objects made with IAA resin have shown a mean percentage reduction of contamination of 79.5% at T1 and 78.3% at T2. Conclusions IAA resin reduced contamination on objects that came into contact with hands. Antimicrobial plastic blends, are a valuable aid in counteracting the spread of infection related to contact with surfaces and fomites. The public health system could support and raise awareness for using these innovative materials for everyday applications and in healthcare facilities. Key messages • Inorganic antimicrobial agent based on Ag ions and Zeolite mixed in a resin are efficient in reducing the contamination on different items in a real-life context. • Public health system have to support and sensitize to production with inorganic materials with proven antimicrobial properties.

Promote equal access to COVID19 vaccination: strategies of the Local Authority Toscana SudEst, Italy : Domitilla Marconi

Background In the area of the Local Health Authority Toscana Sud-Est (LHA) 13,5% of residents are foreigners. We aim to assess the impact of our intervention to COVID-19 vaccination coverage. Methods Since summer 2021, LHA has promoted vaccination sessions dedicated to foreign residents with free walk-in access, multilingual forms, flyers and TV interventions, cultural mediators and trained healthcare workers. We collected data about vaccination status of residents (28 December 2020-31 January 2022) and we analysed them using the software STATA to assess vaccine coverage by nationality and the effectiveness of our intervention. The results were adjusted for age and sex. We set significance level at p < 0.05. Results On 31 July 2021, 78% of Italian residents (N = 685289) had received the first dose of vaccine, compared to only 43% of foreign residents (N = 106370). There was a 35% gap. On 31 January 2022, after our intervention, 89% of Italian residents and 71% of foreign residents had received the first dose of the vaccine. The gap was 18%. On 31 January 2022, 50% of residents of all nationalities had received two doses of the vaccine. A significant difference between Italian and foreign residents is still observed after adjustment for age and sex (OR 0.41 95% IC 0.40-0.41). Vaccination adherence is lower in females than males, for both Italian (OR 0.90 0.89-0.91) and foreign residents (OR 0.82 0.79-0.84). This is accentuated within some ethnic groups: Macedonians, Kosovars, Pakistanis. Conclusions The creation of dedicated service guaranteed to reach a high vaccination coverage in all the nationalities and to reduce the gap between host and foreign residents. In foreigners it is lower than in the hosts, so it is necessary to investigate possible cultural factors that may influence hesitancy. A lower vaccination coverage in females, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap. Key messages • The creation of dedicated interventions guaranteed to achieve high vaccination coverage in all nationalities. • A lower vaccination adherence in females than males, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Flu and Covid-19: is there adherence to vaccination in target groups? : Domitilla Marconi

Background In Italy, the flu vaccine is recommended and free for target groups (adults≥60 years old, fragile people, healthcare workers, pregnant women). During the 2020/2021 flu season, an increased vaccination coverage (+6,9%) was observed compared to the previous season, also due to the Covid-19 pandemic. We aimed to investigate how strong the adherence to the flu vaccine was by the vulnerable groups and assess if the Covid-19 vaccination campaign may have influenced the rate of flu vaccines. Methods At the beginning of autumn 2021 we conducted an online survey among the population of Tuscany. We collected data on demographics, health status (pregnancy, vulnerable), flu and COVID-19 vaccinations coverage and health information sources. In addition, we performed a descriptive and a risk factors analysis to assess correlation between our variables with R v 4.0.0. Significance level was set at p < 0.05. Results Among 408 participants, 248 (61%) belong to a vulnerable group and are recommended to receive the flu vaccine, 229 (56%) usually get the flu vaccine, 386 (95%) got the Covid-19 vaccine, 267 (65%) choose and trust the general practitioner (GP) as their health information source. There is a statistically significant association between being part of a vulnerable group and getting the seasonal flu vaccine (OR 6.63 95% CI 4.26-10.3 p < 0.001). In addition, getting the Covid-19 vaccine increases the likelihood of receiving the flu vaccine (2.90 95% CI 1.16-7.28 p = 0.018). Moreover, participants who trust their GP as their health information source (OR 1.63 CI 1.08-2.46 p = 0.019) are more likely to receive the flu vaccine;other information sources (TV, newspaper, social media) are not associated with the flu vaccine. Conclusions Our research shows that vulnerable groups get vaccinated against the flu. The increase in flu vaccine coverage may be due to the COVID-19 vaccines campaign. GPs play a crucial role in the health promotion, prevention and health literacy of patients. Key messages GP plays a crucial role in the prevention and health literacy of patients. COVID-19 vaccines campaign may have positively influenced the flu vaccination campaign. However, we must continue to maintain the coverage we have managed to achieve in the future.

Which one to choose? A cost-effectiveness analysis between different technologies of air purifiers : Marco Sparacino

Introduction CoViD19 pandemic highlighted the importance of air purifiers and, in commercialization, their performance and price influence the choice. Since primary focus concerns only performance in terms of CADR (Clean Air Delivery Rate), this study aims to compare: I) levels of declared air purifications according to different types of air purification technologies;II) price of them to evaluate if, with similar group-mean CADR (within +/- 1 SD), there are significant differences in selling prices. Methods A review of several devices was carried out, collecting data in January-April 2022. Four different types of air purifiers were considered, divided into as many groups: those equipped with HEPA filters + UV lamps, only with HEPA filters, only with UV lamps and those using other technologies. We applied Kruskal-Wallis test to evaluate statistical differences among prices normalized by CADR, at significant level of 0.05. Results Analysis was carried out on 186 devices: I) 37 had HEPA filters + UV lamps, II) 117 only HEPA filters, III) 11 only UV lamps and IV) 21 other technologies. Eight system had HEPA H11 (95% reduction of particle matter 0.5 μm), 8 had HEPA H12 (99.5%), 70 had HEPA H13 (99.95%), 11 had HEPA H14 (99.995%). The mean normalized costs of each group devices, in Euros/CADR were I) 1.22 (SD 2), II) 1.49 (SD 1.4), III) 7.63 (SD 7.38), IV) 1.22 (SD 0.99), respectively. Statistical comparison of four-group selling prices show significant differences (p < 0.05) due to the devices equipped with only UV lamps. Conclusions Comparison between technologies analyzed by mean price normalized to CADR showed significant differences between those that used only UV lamps compared to all the others. This is reasonably due to the fact that the use of only UV lamps requires radiant powers considerably greater than all the others, therefore also higher costs (about 5-6 times). In all cases, the level of disinfection reached, as declared, was always > 95%. Key messages • With the same mean price normalized to CADR, the selling price is significanly different only for devices equipped with UV lamps compared to all the others. • Choice of devices with a certain level of declared air purifications can be directed towards those with HEPA+UV/HEPA/other without the mean price normalized to CADR undergoing significant differences.

Emergency Department: Analysis of Patient Flow and Length of Stay Variations : Elisa Fanti

Background Crowding in Emergency Departments(ED)is a severe public health issue.Length of stay(LOS)is not a direct measure of crowding,but it is an essential indicator for monitoring emergency care quality.LOS in ED can be associated with delays in treatment,decreased patient satisfaction and adverse outcomes.The aim of this study is to analyze ED LOS in the Teaching Hospital of Siena for further strategies. Methods A retrospective observational study was conducted between January 1,2019, and December 31,2021.To manage admissions and discharges, all patients’ data admitted to ED of the University Hospital of Siena were accessed by Aurora,the IT system.In addition,a descriptive analysis was performed, collecting the following variables:sex,age,arrival mode,ED visit reasons,triage code,discharge mode,hospital admission area and LOS(cut-off>8hours).The analysis was carried out using STATA 17:variables were analyzed with ANOVA test. Results Our sample consisted of 152.393 patients (F49.47% M50.53%),and the average age was 50.51(SD ± 26.07).During the years total ED visits decreased:65.426(2019);40.318(2020);46.649(2021),and there was a significant increase (p < 0.001) of patients with LOS>8 hours:13.96%(2019);21.51%(2020);23.10%(2021).In the years 2019,2020 and 2021, admissions of patients with LOS>8 hours were respectively: 25.92%;43.95% and 37.09%, with the following percentage in medical areas:69.96% in 2019;70.51% in 2020;64.55% in 2021.A progressive increase of admissions in COVID area resulted since 2020(2.23%-2020;6.07%-2021). Conclusions The spread of COVID-19 and the containment measures,such as lockdown,caused a significant decrease in ED access.The increase LOS>8h could be primarily due to the time needed to perform laboratory investigations for the search for SARS-CoV-2 but also to the overflow of SARS-CoV-2-infected patients rapidly saturating the ED boxes and hospital bed capacity,with the need sometimes to dedicate other medical areas to manage COVID patients. Key messages • ED-LOS is a proxy indicator to monitor emergency care quality. • Further investigations should be performed to analyze the leading causes of ED LOS increase during the pandemic period.

Impact of lockdown on football players’ injuries : Vittorio Falcone

Background The global outbreak of COVID-19 has resulted in the closure of stadiums and the interruption of Serie A for three months. Many studies have evaluated the effects of COVID on population health, but few have evaluated the effects of containment measures on the health of football players. With this study, we evaluated the impact of this break on Serie A football players. Methods This cross-sectional study was conducted considering a timespan of three Serie A seasons (2018-19;2019-20;2020-21). The information was obtained from the German website Transfermarkt. All the players who had played at least one match during each of the Serie A season were identified. For each of the players, data concerning the number of days lost due to injury, both before and after the stop in the championship due to Covid, were collected. Statistical analysis was performed using Stata 17 Software. Results According to the selection criteria, 264 players were selected. This group was subsequently skimmed to 256 players after eliminating all players who did not suffer physical injuries over the timespan considered (non-purely orthopedic surgery;COVID;Intestinal problems;Infections). 256 players were analysed, 228 had skipped at least one day for pre-lockdown due to physical injury (median=37,5), while 227 missed a day for post-lockdown (median=27). Wilcoxon signed-rank test between days lost due to injuries before and after lockdown highlighted significant differences (p < 0.05). Conclusions Comparing pre-lockdown and post-lockdown periods, we noticed that there were fewer days skipped due to physical injury post lockdown. Statistical evidence suggests that the same players were more susceptible to suffer physical injuries in the pre-lockdown period. This is probably because some players have worked with home coaching by spending more time in the gym and less time on the field. Also tapis roulant and cyclettes were often delivered to football players’ homes. Key messages In this phase of coexistence with COVID-19 it is of fundamental importance to understand the impact that public health measures have on the population. Although, with vaccination, there has been a reduction in the number of cases, it is critical to strengthen preparedness against all possible epidemic scenarios.

A time-varying SIRD model for dynamic vaccination strategies against COVID-19 : Valentina Lucarelli

Introduction The COVID-19 pandemic has demonstrated how the optimal allocation of the limited doses of vaccine available represents one of the main useful measures to mitigate the transmission of the infection and reduce the mortality associated with it, especially at an early stage of the pandemic. The use of a compartmental model allows us to understand which population groups to vaccinate and to what extent to act depending on the type of health or social objective to be achieved. Methods A time-varying susceptible-infected-recovered-deceased (SIRD) compartmental model, stratified into ten age groups, was developed on Italian data. Simulations were performed every 15 days from December 2020 to April 2021. An optimal vaccination strategy was achieved by minimizing deaths or infected, considering the total vaccine doses available. Results We showed how the effects of a vaccination campaign can be planned in a way that maximizes lives saved and/or minimizes infections. Regarding the minimization of deaths, the model prioritizes the elderly (>80 years) and then those between 60 and 80 years, in all simulations. Regarding the cost function of new infections, the first simulation assigns all available doses to those over 90 years of age. In the later simulations, the doses are assigned mainly to the 20-29-year-old and the 89+ year old. Conclusions Optimal allocation of available vaccine doses is useful in mitigating transmission of infection and reducing mortality. Application of the mathematical model can be useful at the beginning of an epidemic caused by a new pathogen, when data are scarce, and it is therefore necessary to introduce a standardized approach. This kind of simulation is useful to understand whether the implemented vaccination strategy needs to be recalibrated, too. Key messages • Time-varying compartmentalised models can be used both to continuously inform decision-makers about changes in epidemic traits and to simulate the effects of targeted pandemic containment strategies. • The application of compartmental models can be very useful at the onset of an epidemic to more successfully contain it and structure the health, political, and economic plan.

Is it really possible to leave sars-cov-2 outside the door? : Bianca Maria Bocci

Background In this historical period, it has become very important to live in healthy environments. By using everyday objects, cross-contamination is possible because of prolonged microbial persistence on surfaces. UV-C irradiation is an environmentally friendly method to disinfect objects as no harmful chemicals or heat are involved. This study aims to determine the virucidal activity, against SARS-CoV-2, of UV-C irradiation occurring in a designed UV device, ‘Purity Capsule'. Methods An experimental study was performed in September 2020. The ‘Purity capsule’ has an 11 W lamp (3.5W UV-C) positioned in the centre of the device. The lamp has a dome covered with a reflective, protective coating. Three metal carriers were placed at the maximum distance from the UV-C lamp in three different positions and tested at 30 and 60 seconds 3 times. The carriers were inoculated with 100 µL of SARS-CoV-2 viral suspension with a concentration of 106.5 TCID50 /mL. After treatment, laboratory procedures were used to transfer the treated virus from carriers to multiwell plates. The samples were compared with positive controls (not exposed to UV-C light) after incubation, at 37 °C in 5% COÕ · in a humidified atmosphere, for 3 days. The residual viral activity was tested by assessing the 50% infectious dose per tissue culture (TCID50%). Results Tests performed at 30 seconds of UV-C irradiation show an average viral reduction of 4.0 Log10 (99.99%). All three tests performed at 60 seconds reached the maximum measurable log10 viral reduction: 5.0 Log10 (99.999%). Conclusions The study assessed the effectiveness of the device in significantly reducing the viral load on all carriers regardless exposure time and distance from the UV-C light source, with no impact on the level of environmental pollution. Key messages • UV-C light has the property of inactivating viral growth;its physical approach is considered a good compromise between cost and effectiveness. • The device was effective in disinfecting all small everyday objects tested.

The possible impact of COVID-19 on respiratory muscles structure and functions: a literature review

The impact of SARS-CoV-2 infection on respiratory muscle functions is an important area of recent enquiry. COVID-19 has effects on the respiratory muscles. The diaphragm muscle is perturbed indirectly due to the mechanical-ventilation-induced-disuse, but also by direct mechanisms linked with SARS-CoV-2 viral infection. In this sense, a deeper understanding of the possible links between COVID-19 and alterations in structure and functions of the respiratory muscles may increase the success rate of preventive and supportive strategies. Ultrasound imaging alongside respiratory muscle strength tests and pulmonary function assessment are valid approaches to the screening and monitoring of disease, for mild to severe patients. The aim of the present review is to highlight the current literature regarding the links between COVID-19 and respiratory muscle functions. We examine from the pathophysiological aspects of disease, up to approaches taken to monitor and rehabilitate diseased muscle. We hope this work will add to a greater understanding of the pathophysiology and disease management of respiratory muscle pathology subsequent to SARS-CoV-2 infection.

The Italian Health Service at the Rendez-Vous with the Pandemic: Structural Weaknesses and Prospects for Reform

We describe the evolution of the Italian health system before the COVID-19 crisis (with particular reference to the trend in health supply and demand, as well as the institutional context) and the measures implemented to tackle the pandemic. We focus on the main critical issues that should be addressed in the perspective of a structural reform of the health system aimed at improving its resilience in the post-epidemic phase, in particular with reference to the coherence of the governance framework and the opportunity to enhance the services of territorial medicine.