A novel stream of collaborative National portals to enhance preparedness and informed choices : Fabrizio Carinci

Issue/problem AGENAS supports the implementation of health policies in direct collaboration with Italian Regions and Autonomous Provinces. To improve public reporting, we aimed to complement the production of technical reports with new forms of timely communication, using National Portals. Description of the problem Between October-December 2020, we designed and implemented the Covid-19 National Portal, including a suite of targeted indicators, fully automated via ad hoc scripts written in php and R on top of a relational database using internal and external data sources. Targeted information was widely communicated and continuously updated. Dedicated sections on forecasting and resilience were delivered in collaboration with specialised academic institutions. In 2021, we deployed the Portal for the Transparency of Health Services, broadly oriented towards health issues, the location of services and performance indicators. Results Pre-post comparisons of web analytics for Jan-Apr 2020-2022 showed clear advantages of Covid-19 Portal. By Apr 2020, Italy had introduced national lockdown, while AGENAS covered the topic traditionally, recording 48,122 users overall, with daily peaks below 5,000 sessions. In 2021-2022, the number of users skyrocketed at 436,280, with daily peaks of 100,000 sessions, and 421,123 respectively, with daily peaks of 150,000 sessions. Visits to the Transparency Portal were considerably more limited. Lessons To be widely used, public health information needs to be relevant (responding to personal need close to home), understandable, accurate and timely. National Portals can gain efficiency through the mediation of search engines, enhanced by: targeted naming (url), coherent semantic perimeter (third level domain in a highly referenced institutional website), continuous updating, and impact factor (linked by authoritative websites). The Transparency Portal will take stock of these lessons to succeed in a new funded program of NextGenerationEU. Key messages • Relevant, understandable, accurate and timely dissemination for different types of audience may be effectively organised through National Portals. • Productive collaboration between health specialists and communication experts can enhance usability and actionability of National Portals for public health.

A novel plot for the early alert of epidemic growth using regional targets: the doubling plot : Fabrizio Carinci

Background During the pandemic, restrictions set by the Italian Government were primarily based on the regional level of key parameters including hospitalization and incidence rates. We aimed to build a specific plot to monitor trends and trigger early alerts, with daily updates publicly available on a National Portal. Methods A multidisciplinary team conceived and implemented a new composite plot, developing ad hoc R scripts on top of a specialised database, built in collaboration with the Ministry of Health. We calculated the doubling time Td as log(2)/log(1+r/100), where r is the daily change of target parameters and Td ranges between (0,+-infinity), and not determined for constant or missing values. We calculated Td daily, as either doubling (growth) or halving (decrease) time. To visualize trends, we assembled two different types of graphs: a bivariate plot showing the path of each point (Td, target parameter) over time, and a line plot of Td over time. The Y axis was inverted for doubling times, as lower Td indicate higher alert in this case. The two graphs were arranged in lines, using cutoffs for excessive high values for doubling times and low values for halving times. A third line was included to display trends of the target parameter over time. Results The plot was successfully realized and published on the Portal for all regions in February 2021 (https://www.agenas.gov.it/covid19/web/index.php?r=english%2Fdoubling&q=ITA&t=0). Since July 2021, we used the doubling plot to monitor the three main parameters adopted to set restrictions for Covid-19: a) occupancy rates in intensive care;b) occupancy rates in medical wards;c) weekly incidence rates. The plot highlighted growth trends and early alerts, particularly in the initial phases of growth. Conclusions The doubling plot can provide useful information to trigger early responses for pandemic control in decentralised governance. R code is available open source from AGENAS for free use. Key messages • The doubling plot was conceived and implemented on a National Portal to trigger early alerts of Covid-19 progression in Italian Regions and Autonomous Provinces. • The plot could be rapidly adapted to legislative parameters and can be useful in different situations to monitor epidemic growth and support public health policies.

Convalescent plasma for haematological patients with SARS-CoV-2 pneumonia and severe depletion of B-cell lymphocytes following anti-CD20 therapy: a single-centre experience and review of the literature

Convalescent plasma (CP) therapy might be effective in patients with haematological malignanciesand B-cell depletion. We report a single-centre experience of COVID-19 patients with non-Hodgkinlymphoma and absence of B-cells as a consequence of anti-CD20 therapy successfully treated withCP from October 2020 to May 2021. CP was given in the presence of pneumonia with respiratoryfailure despite standard treatment and consisted of three infusions on an alternate-day basis. A reviewof the current literature on this topic was also performed. Six patients were identified (medianage 59.5 years (range 50-73)). The last anti-CD20 drug administration occurred 60 days before infection(range 0-360). CP was administered after a median of 51 days (range 9-120) from SARS-CoV-2diagnosis, with an early improvement in all but one subject. We suggest a possible clinical benefitof convalescent CP treatment in COVID-19 patients with haematological malignancies and B-celldepletion having persistent/recurrent pneumonia.

Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature.

INTRODUCTION: The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only two cases of Chlamydia pneumoniae have been reported in a large US study so far. METHODS: In the present report, we describe a series of seven patients where co-infection with C. pneumoniae (n = 5) or M. pneumoniae (n = 2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. RESULTS AND CONCLUSION: An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.