Heat wave, COVID-19, and mortality excess in the 2022 summer: a cohort study on data from Italian surveillances.

We aimed to assess differences in the summer excess of mortality by COVID-19 history using data from the mortality and COVID-19 surveillances. We found 4% excess risk in 2022 summer, compared to 2015-2019. A mortality rate ratio of 1.59 (95%CI 1.39-1.82) for COVID-19 survivors compared to naive, was found. Both were higher in people aged [≥]75 years. During the July heat wave, the excess for COVID-19 survivors decreased and disappeared when excluding people living in nursing homes. Funding statementThis study was partially supported by the Italian Ministry of Health -CCM 2020 - "Sorveglianza epidemiologica e controllo del COVID-19 in aree urbane metropolitane e per il contenimento della circolazione del Sars-CoV-2 nella popolazione immigrata in Italia" and by the Ricerca Corrente 2023 HighlightsO_LIthe excess of mortality in COVID-19 survivors is not exacerbated by heatwaves C_LIO_LIan excess of mortality during the whole summer in COVID-19 survivors aged over 75 suggest that no harvesting effect is appreciable in the older population that survived COVID-19 C_LIO_LIFor COVID-19 survivors aged over 75, a lower mortality than the naive population was observed only during the July heat wave when we stratified by residency C_LI

The impact of the Covid-19 pandemic on Italian population-based cancer screening activities and test coverage: results from national cross-sectional repeated surveys

BackgroundIn Italy, population-based screening programs for breast, cervical and colorectal cancers are mandatory, and Regions are in charge of their delivery. From March to May 2020, a severe lockdown was imposed due to the Covid-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020. MethodsThe regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, investigated the population screening test coverage, before and during the pandemic, accordingly to educational attainment, perceived economic difficulties and citizenship. ResultsA reduction of subjects invited and tests performed, with differences among periods and geographic macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening campaigns. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening campaigns. Compared with the pre-pandemic period, there was a greater difference according to level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests. In addition, foreigners had less access to screening than Italians did. ConclusionsThe lockdown and the ongoing Covid-19 emergency caused an important delay in screening activities. This increased the pre-existing individual and geographical inequalities in access. The opportunistic screening did not mitigate the pandemic impact. FundingThis study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023.

Secondary transmission of SARS-CoV-2 in educational settings in Northern Italy from September 2020 to April 2021: a population-based study

BackgroundWe aimed to quantify the risk of transmission of SARS-CoV-2 in the school setting by type of school, characteristics of the index case and calendar period in the Reggio Emilia province (RE), Italy. The secondary aim was to estimate the promptness of contact tracing. MethodsA population-based analysis of surveillance data of all COVID-19 cases occurring in RE, Italy, from September 1, 2020, to April 4th, 2021, for which a school contact and/or exposure was suspected. Indicator of the delay in contact tracing was computed as the time elapsed since positivity of the index case and the date on which the swab for classmates was scheduled (or most were scheduled). ResultsOverall, 30,184 and 13,608 contacts among classmates and teachers/staff, respectively, were identified and received recommendation for testing; 43,214 (98.7%) performed the test. Secondary transmission occurred in about 40% of the investigated classes, and the overall secondary case attack rate was 4%, slightly higher when the index case was a teacher, but with almost no differences by type of school and stable during the study period. Promptness of contact tracing increased during the study period, reducing the time from index case identification and testing of contacts from 7 to 3 days, as well the ability to identify possible source of infection in the index case. ConclusionsDespite the spread of the Alpha variant during the study period in RE, the secondary case attack rate remained stable from school reopening in September 2020 until the beginning of April 2021.

Secondary transmission of COVID-19 in preschool and school settings after their reopening in northern Italy: a population-based study

BackgroundSchool closures was one of the main measures undertaken to reduce the number of social contacts during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We aimed to describe the data on secondary transmission of SARS-CoV-2 among students and teachers/personnel after the reopening of preschools and schools in Reggio Emilia, Italy. MethodsThis prospective population-based study included all consecutive cases leading to an investigation in 41 classes of 36 educational institutions (8 infant-toddler centres and preschools, 10 primary and 18 secondary schools) in the period September 1 - October 15, 2020, in Reggio Emilia province, Italy. We report the characteristics of the school, of the index case, including the possible source of infection, the number of contacts (students and teachers/personnel) that were identified and tested and the characteristics of secondary cases. ResultsIn the study period, 994 students and 204 teachers were tested during related investigations due to notification of 43 primary cases (38 among students and 5 among teachers). Of these, 10 students and two teachers created 39 secondary cases, resulting in an attack rate of 3.9%. There were no secondary cases among teachers/stuff. Secondary transmission occurred in one primary school and 8 secondary schools. Except for two students and one teacher, the possible source of infection for all index cases was identified as they had all had previous contact with a positive case; the majority of secondary cases did not report any previous close contact with a positive case. The clusters ranged from one to 22 secondary cases. ConclusionsTransmission at school occurred in a non-negligible number of cases, particularly in secondary schools. Prompt testing and isolation of classmates could probably reduce the risk of transmission in school settings.

COVID-19 patients and cancer in northern Italy

The aim of this population-based study was to evaluate the impact of having had cancer on COVID-19 risk and prognosis during the first wave of the pandemic (27 February - 13 May 2020) in Reggio Emilia Province. Prevalent cancer cases diagnosed between 1996 and December 2019 were linked with the provincial COVID-19 surveillance system. We compared cancer survivors (CS) cumulative incidence of being tested, testing positive for SARS-CoV-2, being hospitalized, and dying of COVID-19 with that of the general population; we compared COVID-19 prognosis in CS and in patients without cancer. 15,391 people (1527 CS) underwent RT-PCR for SARS-CoV-2, of whom 4541 (447 CS) tested positive; 541 (113 CS) died of COVID-19. The cumulative incidences of being tested, testing positive, COVID-19 hospitalization, and death were lower in CS: age- and sex-adjusted incidence rate ratios were 1.28 [95%CI = 1.21, 1.35], 1.06 [95%CI = 0.96, 1.18], 1.27 [95%CI = 1.09, 1.48], and 1.39 [95%CI = 1.12, 1.71], respectively. CS had worse prognosis when diagnosed with COVID-19, particularly those below the age of 70 (age- and sex-adjusted odds ratio (OR) of death 5.03; [95%CI = 2.59, 9.75]), while the OR decreased after age 70. The OR of death was higher for patients with a recent diagnosis, i.e. <2 years (OR=2.92; 95%CI = 1.64, 5.21), or metastases (OR=2.09; 95%CI = 0. 88, 4.93). Cancer patients showed the same probability of being infected, despite a slightly higher probability of being tested, than the general population, nevertheless they were at higher risk of death once infected. Novelty and impactCancer survivors during the first wave of the pandemic showed higher COVID-19 cumulative incidence and mortality. When infected, they had worse prognosis, particularly in people younger than age 70 or those with a recent diagnosis.

Survival of hospitalized COVID-19 patients in Northern Italy: a population-based cohort study by the ITA-COVID19 Network

BackgroundCOVID-19 case fatality rate in hospitalized patients varies across countries and studies, but reliable estimates specific for age, sex, and comorbidities are needed to design trials for COVID-19 interventions. Aim of this study is to provide population-based survival curves of hospitalized COVID-19 patients. MethodsA cohort study was conducted in Lombardy, Veneto, and Reggio Emilia using COVID-19 registries linked to hospital discharge databases containing patient clinical histories. All patients with positive SARS-CoV-2 RT-PCR test on oral/nasopharyngeal swabs hospitalized from 21st February to 21st April 2020 were identified. Kaplan Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex and Charlson Index. FindingsOverall, 42,926 hospitalized COVID-19 patients were identified. Patients median age was 69 years (IQR: 57-79), 62{middle dot}6% were males, 69{middle dot}4% had a Charlson Index of 0. In total, 11,205 (26{middle dot}1%) patients died over a median follow-up of 24 days (IQR: 10-35). Survival curves showed that 22{middle dot}0% of patients died within 14 days and 27{middle dot}6% within 30 days of hospitalization. Survival was higher in younger patients and in females. Younger patients with comorbidities had a lower survival than older ones with comorbidities. InterpretationOver 27% of hospitalized COVID-19 patients died within one month in three areas of Northern Italy that were heavily affected by SARS-CoV-2 infection. Such a high fatality rate suggests that trials should focus on survival and have follow-up of at least one month. FundingThe study did not receive any external funding. Research in contextEvidence before this study Two recent systematic reviews with meta-analyses report case fatality rates of three to four percent in COVID-19 patients. Most studies on hospitalized cohorts report only slightly higher figures. These figures do not correspond to those derived from routinely collected clinical data in most European countries, reporting a 10% case fatality rate which has been increasing over time since the epidemic started. Robust and precise survival estimates of hospitalized COVID-19 patients which take into account prognostic factors such as age, sex and burden of comorbidities are needed to design appropriate phase II and phase III clinical studies of drugs targeting COVID-19. Added value of this studyIn this study we present the first survival estimates by age, sex and Charlson index for a large population-based cohort of Italian hospitalized COVID-19 patients. Implications of all the available evidenceOver 27% of COVID-19 patients died within one month from hospital admission. Such a high fatality rate suggests that studies should prioritize mortality as primary outcome. Furthermore, we found that the fatality rate reaches a plateau 30 days after hospitalization, suggesting that studies should have at least one month of follow up to observe deaths; shorter follow-up could lead to overestimation of treatment benefits.

Characteristics and outcomes of a cohort of SARS-CoV-2 patients in the Province of Reggio Emilia, Italy

ObjectivesTo describe the age- and sex-specific prevalence of SARS-CoV-2 disease (COVID-19) and its prognostic factors. DesignPopulation-based prospective cohort study on archive data. SettingPreventive services and hospital care in the province of Reggio Emilia, Northern Italy. ParticipantsAll 2653 symptomatic patients who tested positive for SARS-CoV-2 from February 27 to April 2, 2020 in the province of Reggio Emilia. Main outcome measuresHospitalization and death up to April 2, 2020. ResultsFemales had higher prevalence of infection than males below age 50 (2.61 vs. 1.84 {per thousand}), but lower in older ages (16.49 vs. 20.86 {per thousand} over age 80). Case fatality rate reached 20.7% (22/106) in cases with more than 4 weeks follow up. After adjusting for age and comorbidities, men had a higher risk of hospitalization (hazard ratio (HR) 1.4 95% confidence interval (95% CI) 1.2 to 1.6) and of death (HR 1.6, 95% CI 1.2 to 2.1). Patients over age 80 compared to < age 50 had HR 7.1 (95% CI 5.4 to 9.3) and HR 27.8 (95% CI 12.5 to 61.7) for hospitalization and death, respectively. Immigrants had a higher risk of hospitalization (HR 1.3, 95% CI 0.99 to 1.81) than Italians and a similar risk of death. Risk of hospitalization and of death were higher in patients with heart failure (HR 1.6, 95% CI 1.2 to 2.1and HR 2.3, 95% CI 1.6 to 3.2, respectively), arrhythmia (HR 1.5, 95% CI 1.2 to 1.9 and HR 1.8, 95% CI 1.3 to 2.5, respectively), dementia (HR 1.2, 95% CI 0.9 to 1.8 and HR 1.8, 95% CI 1.1 to 2.8, respectively), ischemic heart disease (HR 1.3, 95% CI 1.0 to 1.7 and HR 1.7, 95% CI 1.2 to 2.5, respectively), diabetes (HR 1.5, 95% CI 1.3 to 1.9 and HR 1.6, 95% CI 1.1 to 2.2, respectively), and hypertensions(HR 1.4, 95% CI 1.2 to 2.6 and HR 1.6, 95% CI 1.2 to 2.1, respectively), while COPD increased the risk of hospitalization (HR 1.9, 95% CI 1.4 to 2.5) but not of death (HR 1.1, 95% CI 0.7 to 1.7). Previous use of ACE inhibitors has no effect on risk of death (HR 0.97, 95% CI 0.69 to 1.34) ConclusionsThe mechanisms underlying these associations are mostly unknown. A deeper understanding of the causal chain from infection, disease onset, and immune response to outcomes may explain how these prognostic factors act.