Web-based surveillance of respiratory infection outbreaks: retrospective analysis of Italian COVID-19 epidemic waves using Google Trends.

Introduction: Large-scale diagnostic testing has been proven insufficient to promptly monitor the spread of the Coronavirus disease 2019. Electronic resources may provide better insight into the early detection of epidemics. We aimed to retrospectively explore whether the Google search volume has been useful in detecting Severe Acute Respiratory Syndrome Coronavirus outbreaks early compared to the swab-based surveillance system. Methods: The Google Trends website was used by applying the research to three Italian regions (Lombardy, Marche, and Sicily), covering 16 million Italian citizens. An autoregressive-moving-average model was fitted, and residual charts were plotted to detect outliers in weekly searches of five keywords. Signals that occurred during periods labelled as free from epidemics were used to measure Positive Predictive Values and False Negative Rates in anticipating the epidemic wave occurrence. Results: Signals from "fever," "cough," and "sore throat" showed better performance than those from "loss of smell" and "loss of taste." More than 80% of true epidemic waves were detected early by the occurrence of at least an outlier signal in Lombardy, although this implies a 20% false alarm signals. Performance was poorer for Sicily and Marche. Conclusion: Monitoring the volume of Google searches can be a valuable tool for early detection of respiratory infectious disease outbreaks, particularly in areas with high access to home internet. The inclusion of web-based syndromic keywords is promising as it could facilitate the containment of COVID-19 and perhaps other unknown infectious diseases in the future.

Improving Accessibility and Usability in the Built Environment. Case Study: Guide Lines by the Lombardy Region, Italy.

Accessibility of the built environment, including open spaces, products and services, is essential for people with disabilities and people with special needs such as the elderly and children to access, move, use and enjoy the services and the urban spaces, exercise their rights and fully participate in social life. Local administrations can, and must, identify strategies and tools that are useful for achieving this goal, with effectiveness, efficiency and satisfaction. The case study of the "Lombardy Region Guidelines for Accessibility Plans" that each Municipality of the Region is required to draw up and implement will be illustrated. The Guidelines were drawn up in a very short time, promoting a participatory method, involving decision makers and stakeholders since the very beginning, and providing indications for building up Accessibility for All, inclusive and non-discriminatory. The founding concept was that of a City for All or of a "Plan for the accessibility and usability of the built environment, social inclusion and environmental well-being". Considering the different characteristics, abilities, needs, conditions and preferences of people, this concept extends the recipients of the Plan to all citizens, as well as to occasional visitors such as tourists. They were approved by the Regional Council in November 2021. The approach adopted complied with the most recent normative, legislative and cultural indications, both national and international. Training courses have been scheduled for municipal officials, technicians and plan editors. Synergies have been established with universities and UNI, the Italian standardization body.