ABSTRACT
In Northern Italy the coronavirus infection has spread since February 2020: the increase in admissions of COVID-19 patients corresponded to a drastic decrease in admissions of regular patients to the Emergency Room (ER). This retrospective study was conducted by Academy of Emergency Medicine and Care (AcEMC). During the lockdown period the accesses were reduced by more than 50%, and in the following months of May and June 2020, there was a recovery clearly below (70%) previous year's numbers. We have observed a drastic reduction in white and green codes, a fair reduction in yellow codes, while red codes remained stable. The decrease in access to the ER mainly concerned patients with low priority color codes, but also the reduction in the number of accesses of yellow and red codes, insignificant at a superficial glance, is notable. If we consider that yellow and red codes during the months of the lockdown included many patients with COVID-related respiratory insufficiency, it is evident that there was a clear reduction in the number of serious illnesses not COVID-related. This is certainly another serious consequence of the COVID-19 pandemic.
ABSTRACT
To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO(2). Patients with RAPID-Covid score >= 5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score >= 5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED;1/185 (0,5%) died at home after first ED-dismissal;37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home;22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1 +/- 2,6days from first discharge. Follow-up was 16,7 +/- 6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.
ABSTRACT
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first pandemic caused by a coronavirus. Respiratory/aerial droplets transmission and the high number of "hidden" asymptomatic cases play a critical role in the rapid spread of the virus across countries. The seroprevalence of SARS-CoV-2 antibodies in the general population is currently unknown. It has been estimated that undocumented infections were the source for #80% of the documented cases before traveling restriction policies took place. Serological evaluation is essential for investigating the extent of SARS-CoV-2. Even more, assessing the prevalence of anti-SARSCoV-2 in hospital staff offers a unique opportunity to study the correlation between seroconversion and immunization because of their occupational exposure and at higher risk of contagious. Methods: The study enrolled a total of 3242 employees of our hospital, "Policlinico Riuniti" of Foggia. The employees' group was stratified in 3 subgroups according to their relative exposure to SARS-CoV-2 (high, intermediate, and low-risk groups). We used a chemiluminescent immunoassay (CLIA, Shenzhen YHLO Biotech) to study the seroprevalence of SARS-COV-2 specific antibodies (IgG and IgM against nucleocapsid and spike proteins). The cut-off was set to 8 AU/mL for both IgG and IgM (specificity of 98,8% and 100%, respectively). A control group of 83 samples sera collected before the Italian COVID-19 outbreak (2018-19) was also tested. Healthcare workers with IgG or IgM concentration above 6.0 and below 8.0 AU/mL were considered borderline. Nevertheless, all of them were tested for the SARS-CoV-2 viral RNA presence (Allplex™ 2019 n-CoV Assay, Seegene). Results: Sixty-two individuals (1.9%, 1.4-2.3%, 95% CI) tested positive for at least one antibody anti-SARS-CoV-2. Five individuals (8.0% of the positive) had IgG and IgM positive test results, while 32 and 25 had only IgG and only IgM positive results. Instead, viral RNA was detected in only nine individuals (13.8% of Ig positive) by RTPCR. The cumulative proportion of individuals who tested positive (IgG and/or IgM) varied between 1-2.4%. The seroprevalence was lower in the high-risk group 1.4% (6/428,0.5-2.6%, 95% CI) vs. intermediate-risk group 2.0 % (55/2736, 1.5-2.5%, 95% CI). Only one participant (1.3%, 0-3.8%, 95% CI) of the low-risk group tested positive for SARS-CoV-2 IgM antibodies. Conclusions: The low level of seropositivity (1.9%) shows that the COVID-19 containment measures adopted were adequate and effective. Moreover, the combination of both serological and molecular tests can improve the likelihood of identifying asymptomatic subjects.