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1.
Int J Infect Dis ; 121: 157-160, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1821282

ABSTRACT

OBJECTIVES: The effectiveness of a 3-day course of remdesivir to prevent severe disease in patients with COVID-19 who received solid organ transplant (SOT) is unknown. We wanted to study the efficacy of this therapeutic option in patients with COVID-19 who received SOT in preventing both hospitalizations for outpatients and clinical worsening due to COVID-19 for those already hospitalized for other reasons. METHODS: This is a single-center, retrospective, observational study conducted in the Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted all the data of patients with COVID-19 receiving SOT who received and did not receive pre-emptive remdesivir between December 23, 2021, and February 26, 2022. We used a Cox proportional hazard model to assess whether receiving pre-emptive remdesivir was associated with lower rates of hospitalization. RESULTS: A total of 24 patients who received SOT were identified. Among these, seven patients (29, 1%) received pre-emptive remdesivir, whereas 17 (70, 9%) patients did not. Receiving remdesivir significantly reduced the hospitalization rate in outpatients who received SOT and the clinical worsening of the condition of already hospitalized patients who received SOT (hazard ratio 0.05; confidence interval [0.00-0.65], P-value = 0.01). CONCLUSION: In our cohort of patients infected with SARS-CoV-2 who received SOT, pre-emptive remdesivir was effective in reducing the hospitalization rate due to COVID-19 and in preventing the clinical worsening of the condition of patients who received SOT who were hospitalized for reasons other than COVID-19.


Subject(s)
COVID-19 , Organ Transplantation , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19/drug therapy , COVID-19/prevention & control , Humans , Retrospective Studies , SARS-CoV-2 , Transplant Recipients
2.
Clin Infect Pract ; 15: 100144, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1803778

ABSTRACT

Background: Sars-CoV2 can cause severe pneumonia and acute respiratory distress syndrome (ARDS). In COVID-19-associated respiratory failure, lung transplantation might be an option (Bharat A). Case report: A previously healthy 63-year-old man with a nasopharyngeal swab positive for SarsCoV2 and radiological evidence of interstitial lung consolidations developed acute respiratory distress that required intubation and veno-venous extracorporeal membrane oxygenation support (VV ECMO). Because of no recovery of his lung function, he underwent a bilateral lung transplant. ICU stay was complicated by several episodes of bacterial superinfections and an increase of liver function tests (LFTs). Afterward, he faced a progressive clinical worsening associated to severe anemia, further rise of indices of cholestasis, hypertriglyceridemia and hyperferritinemia. Bone marrow smear showed a picture compatible with haemophagocytic lymphohistocytosis (HLH) and first and second line therapy were started. In addition, a transjugular hepatic biopsy was performed with histopathological evidence of portal and periportal fibrosis, compatible with Covid 19-related cholangiopathy. During the hospital stay, he developed several MDR opportunistic infections. The patient died few months later from multiorgan failure secondary to septic shock. A post-mortem confirmed a diagnosis of cholangiopathy, and medullary erythro-haemophagocytosis. Conclusion: Post Covid19 syndrome is a clinical entity that includes novel and old sequelae following recovery from Sars-CoV2 infections. Early identification of these diseases is crucial for adequate management and might influence the long term prognosis of these patients.

3.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-334280

ABSTRACT

Background: the hyperinflammation phase of severe SARS-CoV-2 is characterized by complete blood count alterations. In this context, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) can be used as prognostic factors. We study NLR and PLR trends at different timepoints and compute optimal cutoffs to predict four outcomes: use of Continuous Positive Airways Pressure (CPAP), ICU admission, invasive ventilation and death. Methods: : we retrospectively included all adult patients with SARS-CoV-2 pneumonia admitted from 23 rd January 2020 to 18 th May 2021. Data were extracted using ICD9 codes and our Covid-19 registry. Analyses included descriptive statistics and non parametric tests to study the ability of NLR and PLR to distinguish the patients’ outcomes at each timepoint. ROC curves were built for NLR and PLR at each timepoint (minus discharge) in order to identify cutoffs to distinguish severe and non severe disease and their statistical significance was assessed with the Chi-square test. NLR and PLR were compared with DeLong’s test. Results: : we included 2169 patients. NLR and PLR were higher in severe Covid-19 at all the timepoints, with a difference that gets bigger and a trend that is steeper in more severe disease. Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the curve (AUROC) ranged between 0.59 and 0.81, for PLR, between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value (e.g. NLR 7 for CPAP for males at admission). NLR performed better than PLR. Conclusion: our results are in line with other studies that computed NLR and PLR trends and values in disease, especially with those that distinguished between different grades of severity. Our study is retrospective and single centre, and is limited by selection bias, but includes more than 2000 patients, thus limiting the confounding factors and outliers. Our cutoffs do not only deal with severity and mortality but allow for a more tailored approach. Future prospect include validating our cutoffs in a prospective cohort and comparing their performance against other Covid19 scores.

4.
Heliyon ; 8(2): e08895, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1778151

ABSTRACT

COVID-19 tide had shattered on European countries with three distinct and tough waves, from March and April, 2020; October and November, 2020 and March and April, 2021 respectively. We observed a 50% reduction in the hazard of death during both wave II and III compared with wave I (HR 0.54, 95%CI 0.39-0.74 and HR 0.57, 95%CI 0.41-0.80, respectively). Sex and age were independent predictors of death. We compare in-hospital mortality of COVID-19 patients admitted at our Referral Hospital of Northern Italy during the different waves, discuss the reasons of the observed differences and suggest approaches to the challenges ahead.

5.
Front Psychol ; 12: 820074, 2021.
Article in English | MEDLINE | ID: covidwho-1731829

ABSTRACT

Burnout is a well-documented entity in Care Workers population, affecting up to 50% of physicians, just as it is equally well established that managing an infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, increases Post-Traumatic Stress Disorder (PTSD) and the psychological burden. Mental health support, in the form of formal or remote sessions, has been shown to be helpful to health care staff, despite the organizational difficulties in an emergency. During the first emergence of COVID-19 in Italy, the Scientific Institute for Research, Hospitalization and Health Care Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation (Pavia, Lombardy), the Italian hospital that treated "patient 1," has activated an agreement with the Soleterre Foundation, an international Non-Governmental Organization (NGO) that manages health emergency projects, to provide psychological support. A task force of psychologists was created with the aim of designing and administering a Therapeutic Mental Health Assessment for COVID-19 Care Workers (TMHA COVID-19 CWs) to evaluate and support health care workers' mental health. The assessment battery was developed to evaluate symptoms and behaviors associated with trauma and the corresponding maladaptive behaviors (the National Stressful Events Survey for PTSD-Short Scale "NSESSS" and the Diagnostic and Statistical Manual of Mental Disorders "DSM-5" Self-Rated Level 1 transversal Symptom Measure-Adult). Once the TMHA COVID-19 CWs had been developed, the team of psychologists regularly visited healthcare staff in the ward to administer it. One hundred seven care workers (44 males, mean age 40 ± 15) across Intensive Care Units (ICUs), the emergency room and medical ward were administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as severe for 14%. Severe psychotic symptoms were experienced by 2% and severe suicidal thoughts by 1% of the population. The possibility of acting upon the results of the TMHA COVID-19 CWs allowed an early intervention through individual session beyond the cut-off level (moderate and severe symptoms) for PTSD in NSESSS. In fact, 280 individual support sessions were offered. Therefore, we considered our project a protective and support factor for healthcare workers' mental well-being and we recommend implementing a mental health screening program in ward involved in COVID-19 patients' care.

6.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-329622

ABSTRACT

The guidelines on ventilator-associated pneumonia (VAP) recommend an empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) according to its the prevalence rate. Considering the MRSA and MSSA VAP prevalence over the last 9 years in our tertiary care Hospital, we firstly compared patients with MRSA VAP to those with MSSA VAP in terms of length of stay (LOS) in intensive care unit (ICU) and mortality and secondly, we assessed the clinical value of the MRSA nasal-swab screening in either predicting or ruling out MRSA VAP. We extracted the data of 1461 patients with positive bronchoalveolar lavage (BAL). Regarding the MRSA nasal-swab screening, 170 patients were positive for MRSA or MSSA. Overall, MRSA had a high prevalence in our ICU. Despite the COVID pandemic, there was a significant downward trend in MRSA prevalence, while MSSA remained steady over time. Having VAP due to MRSA did not have any impact on LOS and mortality. Finally, the MRSA nasal-swab testing demonstrated a very high negative predictive value for MRSA VAP. Our results suggested the potential value of a patient-centered approach to improve antibiotic stewardship.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325523

ABSTRACT

Objectives: An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. Methods: All consecutive hospitalised patients from February 21 st to March 30 th , 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. Results: 426 adult patients (median age 68 (IQR, 56 to 77 years) were admitted with confirmed COVID-19 over a 5-week period;292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4 th were independent risk factors associated with in-hospital mortality. Conclusions: Olderage, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323211

ABSTRACT

The relationship between SARS-CoV-2 and host immunity is unknown. We show here that patients with COVID-19 had an altered immune phenotype, with an expansion of adaptive FceRIg neg NK cells, and inflammatory CD14 + CD16 + monocytes. T cells were reduced and overexpressed the Tim-3 exhaustion molecule. Low frequencies of CD8 T cells and NKG2A + NK cells, and expansion of mature CD57 + NK cells were associated with poor prognosis. These findings unveil a unique immunological profile in COVID-19 patients.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-320843

ABSTRACT

Objective: to analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of CXR in detecting pulmonary alterations. Materials: and Methods : CXR of 240 symptomatic patients (70% male, mean age 65±16 years), with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: A (0-2 days) 49 patients, B (3-5) 75 patients, C (6- 9) 85 patients and D (>9) 31 patients. Alteration’s type (reticular/opacification/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-squared test. Results: among 240 CXR, 60 (25%) were negative (A 36.7%, B 28%, C 18.8%, D 16.1%). Opacification was observed in 124/180 (68.8%), reticular alteration in 113/180 (62.7%), consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p<0.01). Distribution among groups was: reticular alteration (A 70.9%, B 72.2%, C 57.9%, D 46.1%), opacification (A 67.7%, B 62.9%, C 71%, D 76.9%), consolidation (A 35.5%, B 31.4%, C 47.8%, D 38.5%). Alterations were bilateral in 73.3%. Upper, middle and lower fields were involved in 36.7%, 79.4%, 87.8%. Lesions were peripheral in 49.4%, central in 11.1% or both in 39.4%. Upper fields and central zones were significantly less involved (p<0.01). Conclusions: the most frequent lesions in COVID-19 patients were opacification (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, with middle/lower predominance. Overall rate of negative CXR is 25%, progressively decreased over time.

10.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-317967

ABSTRACT

Many countries are managing COVID-19 epidemic by switching between lighter and heavier restrictions. While an open-close and a close-open cycle have comparable socio-economic costs, the former leads to a much heavier burden in terms of deaths and pressure on the healthcare system. An empirical demonstration of the toll ensuing from procrastination was recently observed in Israel, where both cycles were enforced from late August to mid-December 2020, yielding some 1,600 deaths with open-close compared to 440 with close-open.

11.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312124

ABSTRACT

The novel coronavirus (SARS-CoV-2) has led to a pandemic. The current testing regime based on Reverse Transcription-Polymerase Chain Reaction for SARS-CoV-2 has been unable to keep up with testing demands, and also suffers from a relatively low positive detection rate in the early stages of the resultant COVID-19 disease. Hence, there is a need for an alternative approach for repeated large-scale testing of SARS-CoV-2/COVID-19. We propose a framework called CovidDeep that combines efficient DNNs with commercially available WMSs for pervasive testing of the virus. We collected data from 87 individuals, spanning three cohorts including healthy, asymptomatic, and symptomatic patients. We trained DNNs on various subsets of the features automatically extracted from six WMS and questionnaire categories to perform ablation studies to determine which subsets are most efficacious in terms of test accuracy for a three-way classification. The highest test accuracy obtained was 98.1%. We also augmented the real training dataset with a synthetic training dataset drawn from the same probability distribution to impose a prior on DNN weights and leveraged a grow-and-prune synthesis paradigm to learn both DNN architecture and weights. This boosted the accuracy of the various DNNs further and simultaneously reduced their size and floating-point operations.

12.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-311193

ABSTRACT

Despite the progress in medical care, combined population-wide interventions (such as physical distancing, testing and contact tracing) are still crucial to manage the SARS-CoV-2 pandemic, aggravated by the emergence of new highly transmissible variants. We combine the compartmental SIDARTHE model, predicting the course of COVID-19 infections, with a new data-based model that projects new cases onto casualties and healthcare system costs. Based on the Italian case study, we outline several scenarios: mass vaccination campaigns with different paces, different transmission rates due to new variants, and different enforced countermeasures, including the alternation of opening and closure phases. Our results demonstrate that non-pharmaceutical interventions (NPIs) have a higher impact on the epidemic evolution than vaccination, which advocates for the need to keep containment measures in place throughout the vaccination campaign. We also show that, if intermittent open-close strategies are adopted, deaths and healthcare system costs can be drastically reduced, without any aggravation of socioeconomic losses, as long as one has the foresight to start with a closing phase rather than an opening one.

13.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-311192

ABSTRACT

In late December 2019, a novel strand of Coronavirus (SARS-CoV-2) causing a severe, potentially fatal respiratory syndrome (COVID-19) was identified in Wuhan, Hubei Province, China and is causing outbreaks in multiple world countries, soon becoming a pandemic. Italy has now become the most hit country outside of Asia: on March 16, 2020, the Italian Civil Protection documented a total of 27980 confirmed cases and 2158 deaths of people tested positive for SARS-CoV-2. In the context of an emerging infectious disease outbreak, it is of paramount importance to predict the trend of the epidemic in order to plan an effective control strategy and to determine its impact. This paper proposes a new epidemic model that discriminates between infected individuals depending on whether they have been diagnosed and on the severity of their symptoms. The distinction between diagnosed and non-diagnosed is important because non-diagnosed individuals are more likely to spread the infection than diagnosed ones, since the latter are typically isolated, and can explain misperceptions of the case fatality rate and of the seriousness of the epidemic phenomenon. Being able to predict the amount of patients that will develop life-threatening symptoms is important since the disease frequently requires hospitalisation (and even Intensive Care Unit admission) and challenges the healthcare system capacity. We show how the basic reproduction number can be redefined in the new framework, thus capturing the potential for epidemic containment. Simulation results are compared with real data on the COVID-19 epidemic in Italy, to show the validity of the model and compare different possible predicted scenarios depending on the adopted countermeasures.

14.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-328806

ABSTRACT

Background: the hyperinflammation phase of severe SARS-CoV-2 is characterized by complete blood count alterations. In this context, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) can be used as prognostic factors. We study NLR and PLR trends at different timepoints and compute optimal cutoffs to predict four outcomes: use of Continuous Positive Airways Pressure (CPAP), ICU admission, invasive ventilation and death. Methods: we retrospectively included all adult patients with SARS-CoV-2 pneumonia admitted from 23 rd January 2020 to 18 th May 2021. Data were extracted using ICD9 codes and our Covid-19 registry. Analyses included descriptive statistics and non parametric tests to study the ability of NLR and PLR to distinguish the patients’ outcomes at each timepoint. ROC curves were built for NLR and PLR at each timepoint (minus discharge) in order to identify cutoffs to distinguish severe and non severe disease and their statistical significance was assessed with the Chi-square test. NLR and PLR were compared with DeLong’s test. Results: we included 2169 patients. NLR and PLR were higher in severe Covid-19 at all the timepoints, with a difference that gets bigger and a trend that is steeper in more severe disease. Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the curve (AUROC) ranged between 0.59 and 0.81, for PLR, between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value (e.g. NLR 7 for CPAP for males at admission). NLR performed better than PLR. Conclusion: our results are in line with other studies that computed NLR and PLR trends and values in disease, especially with those that distinguished between different grades of severity. Our study is retrospective and single centre, and is limited by selection bias, but includes more than 2000 patients, thus limiting the confounding factors and outliers. Our cutoffs do not only deal with severity and mortality but allow for a more tailored approach. Future prospect include validating our cutoffs in a prospective cohort and comparing their performance against other Covid19 scores.

15.
Int J Infect Dis ; 112: 243-246, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1654540

ABSTRACT

INTRODUCTION: There is ongoing debate regarding the role of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in asthma exacerbation, and its long-term impact on the lung function of individuals with asthma. In contrast, the potential impact of coronavirus disease 2019 (COVID-19) vaccination on asthma is entirely unexplored. CASE STUDY: This study examined a challenging case of severe asthma exacerbation in a 28-year-old female following two doses of the mRNA-based vaccine BNT162b2 (Pfizer-BioNTech) at IRCCS Policlinico San Matteo in Pavia, Italy. The patient, a fourth-year resident at the hospital, was vaccinated in early 2021. She was an occasional smoker with a 10-year history of asthma and seasonal allergic rhinitis. She tested negative for SARS-CoV-2 on several molecular swabs and serology tests. RESULTS: After receiving the second dose of vaccine, the patient started to experience worsening of respiratory symptoms. Following several episodes and a severe asthma attack, the patient required treatment with mepolizumab, a biologic drug (interleukin-5) antagonist monoclonal antibody. CONCLUSION: This single case study is insufficient to draw conclusions about the association between asthma exacerbation and the COVID-19 vaccine. While the cause-effect link between vaccination against SARS-CoV-2 and worsening of asthmatic disease might only be suggested at present, this case is a valuable prompt for further investigation. This is particularly true from the perspective of mass vaccination of adolescents and children currently underway across the globe.


Subject(s)
Asthma , COVID-19 , Adolescent , Adult , COVID-19 Vaccines , Child , Female , Humans , SARS-CoV-2 , Vaccination
16.
iScience ; 25(2): 103743, 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1611783

ABSTRACT

Information concerning the longevity of immunity to SARS-CoV-2 following natural infection may have considerable implications for durability of immunity induced by vaccines. Here, we monitored the SARS-CoV-2 specific immune response in COVID-19 patients followed up to 15 months after symptoms onset. Following a peak at day 15-28 postinfection, the IgG antibody response and plasma neutralizing titers gradually decreased over time but stabilized after 6 months. Compared to G614, plasma neutralizing titers were more than 8-fold lower against variants Beta, Gamma, and Delta. SARS-CoV-2-specific memory B and T cells persisted in the majority of patients up to 15 months although a significant decrease in specific T cells, but not B cells, was observed between 6 and 15 months. Antiviral specific immunity, especially memory B cells in COVID-19 convalescent patients, is long-lasting, but some variants of concern may at least partially escape the neutralizing activity of plasma antibodies.

17.
Front Immunol ; 12: 748881, 2021.
Article in English | MEDLINE | ID: covidwho-1551504

ABSTRACT

Olfactory and taste disorders (OTD) are commonly found as presenting symptoms of SARS-CoV-2 infection in patients with clinically mild COVID-19. Virus-specific T cells are thought to play an important role in the clearance of SARS-CoV-2; therefore the study of T cell specific immune responses in patients with mild symptoms may help to understand their possible role in protection from severe disease. We evaluated SARS-CoV-2-specific T cell responses to four different peptide megapools covering all SARS-CoV-2 proteins during the acute phase of the disease in 33 individuals with mild or no other symptom beside OTD and in 22 age-matched patients with severe infection. A control group of 15 outpatients with OTD and consistently negative nasopharyngeal SARS-CoV-2 RNA swabs and virus-specific IgG serology was included in the study. Increased frequencies of virus-specific CD4+ and CD8+ T cells were found in SARS-CoV-2 positive patients with OTD compared with those with severe COVID-19 and with SARS-CoV-2 negative OTD individuals. Moreover, enhanced CD4+ and CD8+ T-cell activation induced by SARS-CoV-2 peptides was associated with higher interferon (IFN)γ production. Increased frequencies of Spike (S1/S2)-specific CD4+ T cells showing enhanced IFNγ secretion and granzyme B content were associated with serum spike-specific IgG in the OTD group. In conclusion, patients with SARS-CoV-2 induced OTD develop highly functional virus-specific CD4+ and CD8+ T cells during the symptomatic phase of the disease, suggesting that robust and coordinated T-cell responses provide protection against extension of COVID-19 to the lower respiratory tract.


Subject(s)
Ageusia/pathology , Anosmia/pathology , Antibodies, Viral/blood , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , SARS-CoV-2/immunology , Antibodies, Viral/immunology , CD4 Lymphocyte Count , COVID-19/immunology , COVID-19/pathology , Cytokines/blood , Humans , Interferon-gamma/blood , Interferon-gamma/immunology , Spike Glycoprotein, Coronavirus/immunology
18.
Maturitas ; 158: 34-36, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1531644

ABSTRACT

The severity and mortality rate of COVID-19 differ between the sexes. Several biopsychosocial determinants may account for the better outcomes in women. The notion that sex steroid hormones account for the gender disparity is reasonable but not proven; the same is true of the role of menopause as a risk factor. A retrospective analysis of patients (=1764) hospitalized in Italy showed a higher mortality (HR 1.58, 95%CI 1.30-1.91, adjusted for age and multi-comorbidities) in males only after the age of 65 (the rate is twice as high in the 65-79-year age group and 1.5-fold higher in those aged over 80). The higher mortality of men is mostly evident among those aged over 65 years, long after the average age of menopause.


Subject(s)
COVID-19 , Aged , Female , Gonadal Steroid Hormones , Humans , Male , Menopause , Retrospective Studies , SARS-CoV-2
19.
Epidemics ; 37: 100528, 2021 12.
Article in English | MEDLINE | ID: covidwho-1520903

ABSTRACT

BACKGROUND: In the night of February 20, 2020, the first epidemic of the novel coronavirus disease (COVID-19) outside Asia was uncovered by the identification of its first patient in Lombardy region, Italy. In the following weeks, Lombardy experienced a sudden increase in the number of ascertained infections and strict measures were imposed to contain the epidemic spread. METHODS: We analyzed official records of cases occurred in Lombardy to characterize the epidemiology of SARS-CoV-2 during the early phase of the outbreak. A line list of laboratory-confirmed cases was set up and later retrospectively consolidated, using standardized interviews to ascertained cases and their close contacts. We provide estimates of the serial interval, of the basic reproduction number, and of the temporal variation of the net reproduction number of SARS-CoV-2. RESULTS: Epidemiological investigations detected over 500 cases (median age: 69, IQR: 57-78) before the first COVID-19 diagnosed patient (February 20, 2020), and suggested that SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities with sustained transmission across all the Lombardy provinces. We estimated the mean serial interval to be 6.6 days (95% CrI, 0.7-19). Our estimates of the basic reproduction number range from 2.6 in Pavia (95% CI, 2.1-3.2) to 3.3 in Milan (95% CI, 2.9-3.8). A decreasing trend in the net reproduction number was observed following the detection of the first case. CONCLUSIONS: At the time of first case notification, COVID-19 was already widespread in the entire Lombardy region. This may explain the large number of critical cases experienced by this region in a very short timeframe. The slight decrease of the reproduction number observed in the early days after February 20, 2020 might be due to increased population awareness and early interventions implemented before the regional lockdown imposed on March 8, 2020.


Subject(s)
COVID-19 , Aged , Communicable Disease Control , Humans , Italy/epidemiology , Retrospective Studies , SARS-CoV-2
20.
Lancet Infect Dis ; 21(5): e112, 2021 05.
Article in English | MEDLINE | ID: covidwho-1510459

Subject(s)
COVID-19 , SARS-CoV-2 , Fomites , Humans , Risk
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