ABSTRACT
Background: The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school. Methods: The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports. Results: Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR. Conclusions: Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.
ABSTRACT
Problem On February 24th, 2022, Ukraine was invaded by Russian forces, forcing many Ukrainians to flee from their homes as refugees. More than 55,000 Ukrainians have since arrived on Italian territory. In response to the humanitarian crisis, the Roman Local Health Authority “ASL Roma 1” provided socio-sanitary assistance through first reception centers to more than 7700 refugees, prioritizing people with high social vulnerability. Ukraine’s vaccine hesitancy and different epidemiological landscape represented a major hurdle to be overcome. Practice ASL Roma 1’s practice served to ensure infectious diseases prevention and control, as well as continuity of care for non-communicable diseases and mental health issues. It consisted of repurposing resources, such as COVID-19 Hubs and their personnel, stipulating Public-Private Partnerships and collaborations with the local Ukrainian community, massive training, creating a centralized multidisciplinary team (with Ukrainian members) and a dedicated database/IT system. Results ASL Roma 1 empowered local Ukrainian communities by providing equipment, medical and administrative staff and socio-sanitary assistance. Ukrainian volunteers helped bridge the cultural gap for essential service provision, such as COVID-19 screening, enrolment in the NHS, health and social orientation, vaccinations and a tailored care pathway. Thus, more than 7700 refugees were assisted, with 1830 COVID-19 vaccinations administered and 170 in critical conditions promptly receiving specialized care. Lessons The multidisciplinary and cross-cultural interaction between doctors, nurses, cultural mediators, social workers, and other key actors was essential in ensuring a holistic care pathway. Services catered to Ukrainian refugees need complete integration between primary and centralized care. Flexibility and resilience are fundamental to foster an ecosystem of innovation and optimization of healthcare provision on all levels, from local to supranational. Key messages • The multidisciplinary and cross-cultural interaction between all medical and non-medical key actors is essential in ensuring a holistic care pathway and complete social integration of asylum seekers. • Health system flexibility, resilience and an ecosystem of innovation and optimization of healthcare provision on all levels are fundamental components of preparedness for future refugee crises.
ABSTRACT
Background: The impact of the severe acute respiratory syndrome Coronavirus 2 disease (COVID-19) pandemic on people with systemic autoimmune rheumatic diseases (SARDs) remains to be fully established. It is unclear whether SARDs are an independent risk factor for COVID-19 infection and poor outcome. Objectives: The aim of our study is to assess the incidence and prognosis of test-proven SARS-CoV-2 infection during the frst COVID-19 wave in a large population of SARD patients of the Lazio Italian region. Methods: We retrospectively evaluated in a cohort of 4.716.119 subjects aged over 18 years and affiliated to the health system of the Lazio Italian Region, the incidence and 30-day outcomes of COVID-19 infection in 40.490 SARD pts and compared to the affiliated population as incidence rate ratio adjusted for demographics and comorbidities (adjIRR). SARD diagnosis and comorbidities were derived from medical administrative records using the Chronic Related Group classifcation system. Data on COVID-19 infection were derived from a dedicated regional digital network. Results: The risk of COVID-19 infection was increased in patients with Psoriatic Arthritis (adjIRR=1.21, 95% CI 1.10-1.33) and Undifferentiated Connective Tissue Disease (adjIRR=1.26, 95% CI 1.03-1.54). The risk of hospitalisation was higher in patients with Axial Spondylarthritis (adjIRR=2.16, 95% CI 1.45-3.22), and Systemic Vasculitis (adjIRR=1.81, 95% CI 1.07-3.06) while the risk of Intensive care unit admission was higher in Systemic Erythematous Lupus (adjIRR=3.67, 95% CI 1.52-8.83) and primary Sjögren Syndrome (adjIRR=4.13, 95% CI 1.71-9.96) patients. An increased COVID-19 mortality was reported in patients with Rheumatoid Arthritis (adjIRR=1.50, 95% CI 1.04-2.17), Systemic Erythematous Lupus (adjIRR=2.67, 95% CI 1.10-6.44), primary Sjögren Syndrome (adjIRR=2.51, 95% CI 1.12-5.62), and Scleroderma (adjIRR=4.60, 95% CI 2.06-10.29). Conclusion: The incidence of severe COVID-19 is not increased in the same percentage in SARDs. Each SARD presents a peculiar pattern in terms of increased risk of COVID-19 incidence, hospitalisation, intensive care unit admission and death, that is not linked to the immunosuppressive behaviour of the disease.