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3.
Cells ; 10(2)2021 02 10.
Article in English | MEDLINE | ID: covidwho-1094233

ABSTRACT

Clinical manifestations of coronavirus disease 2019 (COVID-19) in pregnant women are diverse, and little is known of the impact of the disease on placental physiology. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been detected in the human placenta, and its binding receptor ACE2 is present in a variety of placental cells, including endothelium. Here, we analyze the impact of COVID-19 in placental endothelium, studying by immunofluorescence the expression of von Willebrand factor (vWf), claudin-5, and vascular endothelial (VE) cadherin in the decidua and chorionic villi of placentas from women with mild and severe COVID-19 in comparison to healthy controls. Our results indicate that: (1) vWf expression increases in the endothelium of decidua and chorionic villi of placentas derived from women with COVID-19, being higher in severe cases; (2) Claudin-5 and VE-cadherin expression decrease in the decidua and chorionic villus of placentas from women with severe COVID-19 but not in those with mild disease. Placental histological analysis reveals thrombosis, infarcts, and vascular wall remodeling, confirming the deleterious effect of COVID-19 on placental vessels. Together, these results suggest that placentas from women with COVID-19 have a condition of leaky endothelium and thrombosis, which is sensitive to disease severity.


Subject(s)
/complications , Placenta/blood supply , Placenta/pathology , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Infectious/etiology , Thrombosis/etiology , Adult , Antigens, CD/analysis , /virology , Cadherins/analysis , Claudin-5/analysis , Endothelium/blood supply , Endothelium/pathology , Endothelium/virology , Female , Humans , Infant, Newborn , Microvessels/pathology , Microvessels/virology , Pregnancy , Pregnancy Complications, Cardiovascular/pathology , Pregnancy Complications, Cardiovascular/virology , Pregnancy Complications, Infectious/pathology , Pregnancy Complications, Infectious/virology , Thrombosis/pathology , Thrombosis/virology , Young Adult , von Willebrand Factor/analysis
4.
BMJ Open ; 11(2): e044384, 2021 02 18.
Article in English | MEDLINE | ID: covidwho-1090929

ABSTRACT

OBJECTIVE: The aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London. DESIGN: Observational cohort study. SETTING: London North West Healthcare NHS Trust (LNWH). PARTICIPANTS: Patients tested and/or admitted for COVID-19 at LNWH during March and April 2020 MAIN OUTCOME MEASURES: Descriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19. RESULTS: The outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients. CONCLUSION: The findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.


Subject(s)
/epidemiology , Hospitalization , Adolescent , Adult , Aged , Aged, 80 and over , /mortality , Child , Child, Preschool , Cohort Studies , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Intensive Care Units , London/epidemiology , Male , Middle Aged , Respiration, Artificial , Risk Factors , Young Adult
7.
Ginekol Pol ; 92(1): 57-63, 2021.
Article in English | MEDLINE | ID: covidwho-1082232

ABSTRACT

Rapid spread of severe acute respiratory syndrome coranovirus-2 virus (SARS-CoV-2) caused the pandemic of Coronavirus Disease 19 (COVID-19). Clinical course of the disease presents symptoms mainly from the respiratory system such as: cough, dyspnea and fever, and among some patients, can deteriorate even further to acute respiratory distress syndrome (ARDS), eventually leading to death. This outbreak, as well as previous ones (SARS, MERS) pose a significant challenge for health care managers, epidemiologists and physicians. Below we are presenting the clinical profile of the COVID-19 among special group of patients; pregnant women and newborns, who require special clinical management during hospitalization. In the summary of this manuscript, we present practical guidelines for managing pregnant women infected with SARS-CoV-2, labor and care of the newborn of a positive mother, as well as practical guidelines for COVID-19 vaccinations. It is important to stress, that this manuscript is based on information available as of December 2020.


Subject(s)
/epidemiology , Pregnancy Complications, Infectious/epidemiology , Prenatal Care , /prevention & control , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Poland , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/etiology , Pregnancy Complications, Infectious/prevention & control , Risk Factors
10.
Fam Community Health ; 44(2): 87-98, 2021.
Article in English | MEDLINE | ID: covidwho-1075639

ABSTRACT

The COVID-19 pandemic and related quarantine orders will impact the mental health of millions of individuals in the United States. Mental health difficulties, including depression, anxiety, traumatic stress, and other negative mental health sequelae are likely and likely to persist. These challenges will require response from the psychotherapeutic and medical community that addresses the mental health needs of the population. Using binary logistic regression (n = 322 at time 1, and n = 189 at time 2), researchers in the present study examined promotive factors related to having sought medical or behavioral health treatment during a 30-day period in the midst of the COVID-19 pandemic in the United States. Approximately 10% of the sample indicated having sought either type of help. Results from the binary logistic regressions indicated those who sought counseling or medical help were those who reported increased depression symptoms at time 1. The likelihood of help seeking was heightened for those who reported greater caregiving burden, highlighting the need to consider the availability of services for those caring for children during this community-wide crisis.


Subject(s)
Anxiety Disorders/psychology , Depressive Disorder/psychology , Help-Seeking Behavior , Parents/psychology , Patient Acceptance of Health Care , Stress, Psychological/psychology , Adolescent , Adult , Anxiety/psychology , Child , Child, Preschool , Depression/psychology , Female , Humans , Infant , Infant, Newborn , Logistic Models , Male , Mental Health , Middle Aged , Pandemics , Patient Health Questionnaire , Severity of Illness Index , Surveys and Questionnaires , United States
11.
Bratisl Lek Listy ; 122(2): 152-157, 2021.
Article in English | MEDLINE | ID: covidwho-1073652

ABSTRACT

OBJECTIVES: To evaluate clinical features, laboratory test results, maternal and neonatal outcomes of pregnant patients with the Coronavirus disease (COVID-19). BACKGROUND: COVID-19 is a highly contagious disease caused by a severe acute respiratory coronavirus 2 (SARS-CoV-2). Healthy pregnant women are more susceptible to developing COVID-19. METHODS: We reviewed clinical data from pregnant patients with a laboratory-confirmed SARS-CoV-2, who were admitted to two tertiary care hospitals in Turkey. Demographic, clinical characteristics, laboratory test results, imaging findings, treatment received, maternal and neonatal outcomes were collected. RESULTS: A total of 24 pregnant women were enrolled in this study. The mean maternal and gestational age was 26.9±5.37 years and 24.15±10.61 weeks, respectively. Cough was observed as the most common symptom (n=15; 62.5 %). The lowest lymphocyte percentage was 20.83±13.05 (%). Nine women have delivered by Caesarean section, while one had a vaginal birth. One woman with critical COVID-19 died 2 days later postpartum. The neonate had been transferred to neonatal intensive care unit and died within 24 hours of birth. CONCLUSION: Our findings showed that except for one patient, the clinical course of COVID-19 during pregnancy was mild. Early hospitalization of pregnant women with confirmed and suspected COVID-19, liberal testing for SARS-CoV-2, active management with a multidisciplinary team seemed to be critical to recovery (Tab. 3, Ref. 31).


Subject(s)
Pregnancy Complications, Infectious , Adult , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Pregnant Women , Turkey/epidemiology , Young Adult
12.
Med Sci Monit ; 27: e929123, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1069986

ABSTRACT

BACKGROUND Between April and September 2020, there were <10 000 reported cases of COVID-19 in the Masovia district, Poland, and <1000 new cases daily in Poland. During this period, all new hospital admissions to a maternity unit of a teaching hospital in Warsaw were screened for the COVID-19 infection. This retrospective study presents the findings from the reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19. MATERIAL AND METHODS This study included 838 women admitted for delivery between April 20 and September 20, 2020. All the admitted women were assigned to a low-risk or a high-risk group for COVID-19 and underwent RT-PCR nasopharyngeal swab tests (GeneFinder™-COVID-19-Plus-RealAmpKit. OSANG Healthcare Co., Ltd., Gyeonggi-do, Korea) for COVID-19. The testing protocol included repeated testing in case of inconclusive results or negative results in the symptomatic patients. The maternal and neonatal data from these cases were collected and analyzed. RESULTS All of the 838 women tested negative for COVID-19. Two women (0.24%) were classified as high risk for COVID-19. For 4 (0.48%) women, the results were initially inconclusive and negative when repeated. One hundred and eighty-one (21.5%) women presented with comorbidities, and 60 (7.2%) women were ≥40 years old. CONCLUSIONS The findings from this study show that between April and September 2020, there were no cases of COVID-19 infections at the maternity unit of a teaching hospital in Warsaw, Poland. However, the infection rates for COVID-19 across Europe continue to change. Testing protocols have been developed and established for all hospital admissions and it is anticipated that testing methods will become more rapid and accurate.


Subject(s)
/diagnosis , Hospitalization , Hospitals, Maternity , Mass Screening , /physiology , Adult , Female , Humans , Infant, Newborn , Middle Aged , Poland/epidemiology
13.
Sci Rep ; 11(1): 3354, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1069120

ABSTRACT

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R0, for that model. Applying the [Formula: see text] formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible [Formula: see text] for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a "tunneling" effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity.


Subject(s)
/epidemiology , Models, Statistical , Pandemics , Quarantine/methods , Adolescent , Adult , Aged , Basic Reproduction Number , /virology , Canada/epidemiology , Child , Child, Preschool , China/epidemiology , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Markov Chains , Mexico/epidemiology , Middle Aged , Niger/epidemiology , Public Health , Time Factors , Young Adult
15.
J Coll Physicians Surg Pak ; 31(1): 14-20, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1068267

ABSTRACT

OBJECTIVE:   To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. STUDY DESIGN: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. METHODOLOGY: Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. RESULTS: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. CONCLUSION: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.


Subject(s)
Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Diagnostic Tests, Routine , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pakistan , Radiography, Thoracic/methods , Tertiary Healthcare , Young Adult
16.
Epidemiol Prev ; 44(5-6 Suppl 2): 400-406, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068164

ABSTRACT

BACKGROUND: scientific literature indicates that there are sex, and gender differences in the development, symptomatology and evolution of different diseases, in the response to drugs and in the therapeutic pathways. Even in the COVID-19 epidemic some sex/gender differences emerged. OBJECTIVES: to analyze COVID-19 epidemic data by gender and age in Italy, Germany, Spain, and Sweden, characterized by having implemented different pandemic containment policies, with the aim of observing any characteristics that can be interpreted with the lens of sex/gender differences. MATERIALS AND METHODS: we used confirmed cases and deaths associated with COVID-19 for Italy, Spain, Germany, and Sweden from respective national surveillance databases. Mortality data for Italy were also analysed. The period of investigation was March-May 2020. As indicators, we used the case fatality ratio adjusted for time delay and SMR for mortality. RESULTS: women are more vulnerable to COVID- 19 infection in the 30-60-year age group. Case fatality ratio is higher in men than women, with a ratio men/women equal to 1.7 in Italy, Spain, and Sweden and 1,4 in Germany. The ratio increases in the lower age groups. The analysis of the mortality data observed/expected in Italy in the same period with respect to 2015-2019 shows a comparable excess with SMR equal to 132 for men and 127 for women. CONCLUSIONS: COVID-19 affects both genders with some differences in the incidence, higher in women, and lethality, higher in men. These differences highlight the need to better understand the sex/gender and age interaction both for epidemiological surveillance and for a better gender-appropriateness of the ongoing prophylactic and therapeutic treatments. This would be possible if all health indicators (symptoms, past illnesses, primary and hospital-level health care, hospitalization, etc.) were provided by age and gender. Analysis of the causes of death could help to better understand the increase in mortality for both genders, in particular for women, for whom a lower lethality for COVID-19 appears from data.


Subject(s)
/mortality , Pandemics , Sex Distribution , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Cause of Death , Child , Child, Preschool , Databases, Factual , Female , Germany/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Mortality/trends , Quarantine , Spain/epidemiology , Sweden/epidemiology , Time Factors , Young Adult
17.
Epidemiol Prev ; 44(5-6 Suppl 2): 323-329, 2020.
Article in English | MEDLINE | ID: covidwho-1068154

ABSTRACT

OBJECTIVES: to study the cumulative incidence, the demographics and health conditions of the population tested for COVID-19, and to map the evolving distribution of individual cases in the population of the Friuli Venezia Giulia Region (North-Eastern Italy). DESIGN: population-based observational study based on a record linkage procedure of databases included in the electronic health information system of the Friuli Venezia Giulia Region. SETTING AND PARTICIPANTS: the study group consisted of individuals who resided in the Friuli Venezia Giulia Region and who underwent COVID-19 testing from 01.03 to 24.04.2020. The study group was identified from the laboratory database, which contains all the microbiological testing performed in regional facilities. Tested people were categorized into positive or negative cases, based on test results. MAIN OUTCOME MEASURES: probability of being tested for and cumulative incidence of COVID-19. RESULTS: the cumulative probability of being tested for COVID-19 was 278/10,000 inhabitants, while the cumulative incidence was 22 cases/10,000. Out of 33,853 tested people, 2,744 (8.1%) turned out to be positive for COVID-19. Women were tested more often than men (337 vs 216/10,000), and they showed a higher incidence of infection than men (25 and 19 infected cases/10,000 residents, respectively). Both cumulative incidence and cumulative probability of being tested were higher in the elderly population. About 25% of infected people was hosted in retirement homes and 9% was represented by healthcare workers. Thirty seven percent of positive cases had hypertension, 15% cardiologic diseases, while diabetes and cancer characterized 11.7% and 10% of the infected population, respectively. The geographic distribution of positive cases showed a faster spread of the infection in the city of Trieste, an urban area with the highest regional population density. CONCLUSIONS: the COVID-19 pandemic did not hit the Friuli Venezia Giulia Region as hard as other Northern Italian Regions. In the early phase, as documented in this study, the COVID-19 pandemic particularly affected women and elderly people, especially those living in retirement homes in Trieste.


Subject(s)
/epidemiology , Pandemics , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , /statistics & numerical data , Child , Child, Preschool , Comorbidity , Databases, Factual , Female , Geography, Medical , Homes for the Aged/statistics & numerical data , Hospitalization/statistics & numerical data , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Procedures and Techniques Utilization , Retrospective Studies , Sex Distribution , Young Adult
18.
Epidemiol Prev ; 44(5-6 Suppl 2): 315-322, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068153

ABSTRACT

OBJECTIVES: to evaluate the effects of a pre-existing condition of diabetes and of the use of antidiabetic drugs in the Sicilian population on different outcomes of the COVID-19 disease. DESIGN: a retrospective observational study based was used. Data deriving from the COVID-19 epidemic surveillance and from the collection of information on drugs consume by Sicilian residents. SETTING AND PARTICIPANTS: due to the data availability, the study was calibrated on the Region and included all population distinguishing by gender and age groups. MAIN OUTCOME MEASURES: the risks of cumulative incidence for COVID-19 were investigated in people who had diabetes comorbidities to incur a hospitalization for COVID-19, to be treated within an intensive care unit, and lethality. The role of previous antidiabetic drug treatments with respect to each study outcome was also investigated. RESULTS: in Sicily, from 01.03.2020 to 26.06.2020, a number of 172 cases of COVID-19 disease with diabetes comorbidity were diagnosed. The data did not show any difference in the cumulative incidence for COVID-19 between diabetics (64.2/100,000 inhabitants) and non-diabetics (56.9/100,000 inhabitants) patients. Diabetes increases the risk of hospitalization in the under 80 in both men and women (men: OR 2.62; women OR 4.31), for treatment in intensive care (men: OR 4,41; women: OR 7.74), and for death (men: OR 5.21; women OR 5.92). The analysis of drug using showed risks effect of insulin (OR 2.13) on hospitalization, sulfonylureas/glinides (OR 2.58) on intensive care and protective of metformin on death both in single component (OR 0.44) and in multicomponent (OR 0.43). CONCLUSIONS: data availability made it possible to monitor the occurrence and explore some of the characteristics of the cases with COVID-19 in Sicily. Diabetes does not seem to represent a risk factor for SARS-CoV-2 infection in Sicily, while previous diabetes condition seems to determine greater risk of hospitalization, treatment in intensive care, and lethality among over 80. There are also gender differences with almost double risks in women for hospitalization and intensive care only. Among the antidiabetic drugs investigated, there was a risk for hospitalization and intensive care while protective for deaths. This study represents an important tool for the activation of intervention programmes in the area aimed at populations with greater health risk deriving from the effects of this new pandemic.


Subject(s)
/epidemiology , Diabetes Mellitus/epidemiology , Hypoglycemic Agents/adverse effects , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , /therapy , Child , Child, Preschool , Comorbidity , Diabetes Mellitus/drug therapy , Female , Humans , Hypoglycemic Agents/therapeutic use , Incidence , Infant , Infant, Newborn , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Retrospective Studies , Risk Factors , Sicily/epidemiology , Survival Analysis , Treatment Outcome , Young Adult
19.
Epidemiol Prev ; 44(5-6 Suppl 2): 288-296, 2020.
Article in English | MEDLINE | ID: covidwho-1068150

ABSTRACT

OBJECTIVES: to provide a description of inequalities in overall and COVID-19 mortality by ecological socioeconomic measures (ESEMs) during the first outbreak peak (March and April 2020) in Emilia-Romagna Region. DESIGN: cross-sectional study based on the record linkage of the COVID-19 notification system, the regional population health register and the 2011 census data. SETTING AND PARTICIPANTS: residents in Emilia-Romagna who were grouped according to three ESEMs calculated at census block level: the index of deprivation, the household crowding, and the percentage of the foreign resident population. MAIN OUTCOME MEASURES: counts of all deaths and those directly attributable to COVID-19. The association between mortality and ESEMs was assessed through rate differences and mortality rate ratios, estimated through Poisson models. RESULTS: during the outbreak peak, the nine provinces of the Emilia-Romagna Region were unequally hit by the COVID-19 outbreak, with Piacenza recording the highest COVID-19 absolute death toll and Ferrara the lowest. The overall and COVID-19 mortality burden was unequal also in terms of ecological socioeconomic measures. Percentage differences in the age-standardised mortality rates between the least and the most disadvantaged census blocks were greater for COVID-19 mortality than for overall mortality, suggesting that the Coronavirus outbreak has had a stronger impact on the most socioeconomically deprived areas. Although clear gradients were not always present, people living in the most disadvantaged census blocks experienced the highest absolute and relative risk of dying. Rate differences were larger among men, but mortality rate ratios were not always greater among men than women, especially for the COVID-19 mortality. CONCLUSIONS: these descriptive yet informative results are relevant to document inequalities and inform regional public health policies and interventions in case of new COVID-19 surges.


Subject(s)
/mortality , Mortality/trends , Pandemics , Poverty Areas , Socioeconomic Factors , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Crowding , Emigrants and Immigrants/statistics & numerical data , Family Characteristics , Female , Humans , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Social Determinants of Health/statistics & numerical data , Vulnerable Populations/statistics & numerical data , Young Adult
20.
Epidemiol Prev ; 44(5-6 Suppl 2): 128-135, 2020.
Article in Italian | MEDLINE | ID: covidwho-1068132

ABSTRACT

OBJECTIVES: to investigate the role of gender, age, province of residence, and nursing home residency on the risk of death for residents in the Friuli Venezia Giulia (FVG) Region (Northern Italy) tested positive for Covid-19, considering recovery as a competing event. The secondary objective is to describe the impact of the Covid-19 epidemic in FVG and in the Regions of Northern and Central Italy in terms of incidence and mortality compared to the national data. DESIGN: retrospective cohort study. SETTING AND PARTICIPANTS: resident population in FVG in the period between 29 February and 25 June 2020. MAIN OUTCOME MEASURES: in order to describe the impact of the Covid-19 outbreak in FVG, in terms of incidence and mortality compared to the national data, the standardized incidence (SIR) and mortality (SMR) ratios and their respective 95% confidence intervals (95%CI) were calculated compared to the Italian population for the northern and central Regions of Italy and the autonomous Provinces (PA) of Trento and Bolzano. A retrospective cohort study was conducted on subjects residing in FVG to whom at least one naso-oropharyngeal swab (hereafter, named swab) resulted positive for Covid-19. For each subject included in the cohort, the observation period started with the first positive swab and ended with the first of the following events: death, recovery or censored, which means that at the end of the observation period the subject was still alive and positive. The cause of death was assigned to Covid-19 if a subject had not yet recovered at the time when the event occurred. Cohort members were considered recovered after two negative consecutive swabs. The sub-hazard ratio (SHR) was estimated by applying the regression model of competing risks by Fine and Gray, in which the event of interest was the death caused by Covid-19 and the competing event was recovery. The explanatory variables included in the multiple models are: gender, age at the beginning of the observation period, the Province of residence, and nursing home residency. The cause-specific hazard was estimated using Cox proportional hazard regression. RESULTS: during the observation period, 3,305 cases and 345 deaths were recorded in FVG; SIR and SMR resulted, respectively, equal to 0.64 (95%CI 0.61-0.68) and 0.43 (95%CI 0.37-0.50). The FVG was the Northern Region one with the lowest incidence and mortality. The cohort consisted of 3,121 residents in FVG with at least one swab with a positive Covid-19 result during the study period. The SHR of dying for Covid-19 is equal to 16.13 (95%CI 9.73-26.74) for people with age 70-79 years and 35.58 (95%CI 21.77-58.15) with age >=80 years respect those with age <70 years. It is higher in males (SHR 1.71; 95%CI 1.34-2.17). There is no evidence that being resident in a nursing home affects the SHR (SHR 0.91 and 95%CI 0.69-1.20). As regards the province as an explanatory variable, the sub-hazard of death in the province of Trieste appears to overlap to the sub-hazard of Pordenone used as a reference; for the provinces of Udine and Gorizia the sub-hazards seem lower than the reference. CONCLUSIONS: while other Northern Regions and autonomous Provinces show higher standardized incidence and mortality compared with Italy, FVG and Veneto do not. In FVG, male gender and age are important determinants of death while there is no evidence that the condition of guest in a nursing home increases the sub-hazard of death.


Subject(s)
/mortality , Pandemics , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Geography, Medical , Humans , Incidence , Infant , Infant, Newborn , Italy/epidemiology , Male , Middle Aged , Nursing Homes/statistics & numerical data , Proportional Hazards Models , Residence Characteristics , Retrospective Studies , Risk Assessment/statistics & numerical data , Risk Factors , Sex Factors , Young Adult
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