COVID-19 Outbreak In Lombardy Research Articles

COVID-19 outbreak in Lombardy: Impact on reducing solid cancer diagnoses in 2020.

Our aim was to analyse, on a population level, the year‐long decline in cancer diagnoses in the region of Lombardy (Italy), and to characterise the tumours with the greatest reduction in diagnosis by patient age, sex and tumour stage at diagnosis. We used the health care utilisation databases of the Lombardy region to identify cancer patients' characteristics (eg, sex, age) and cancer‐related information (eg, cancer site, stage at diagnosis). The frequency of new cancer diagnoses in 2019 and 2020 were compared in terms of percentage differences in undiagnosed cases. We observed two peaks in the decline in cancer diagnoses: March to May 2020 (−37%) and October to December 2020 (−19%). The decline persisted over the course of 2020 and was higher in males and patients aged 74+. Diagnoses of all four common cancers analysed (female breast, lung, colorectal and prostate) remained below pre‐pandemic levels. For breast and colorectal cancers, the decline in diagnoses was high in the age groups targeted by population‐based screening programmes. We observed a reduction in localised stage cancer diagnoses for all four cancers. Our data confirm that timely monitoring of cancer diagnoses and interventions to prevent disruption of routine diagnostic services are needed to mitigate the impact of emergencies on cancer patients.

Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

BackgroundLombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort.MethodsIn this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed.ResultsSeventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p-value = 0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p-value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p-values < 0.05: age at admission, WFNS grade, treatment (none), days in ICU, and ischemia.ConclusionsWe documented a significantly increased “diagnostic delay” for subarachnoid hemorrhages during the first COVID-19 outbreak in Lombardy. However, despite the dramatic situation that the healthcare system was experiencing, the Lombardy regional reorganization model, which allowed centralization of neurosurgical emergencies such as SAHs, avoided a “therapeutic delay” and led to results overall comparable to the control period.

A Full-Scale Agent-Based Model to Hypothetically Explore the Impact of Lockdown, Social Distancing, and Vaccination During the COVID-19 Pandemic in Lombardy, Italy: Model Development.

BackgroundThe COVID-19 outbreak, an event of global concern, has provided scientists the opportunity to use mathematical modeling to run simulations and test theories about the pandemic.ObjectiveThe aim of this study was to propose a full-scale individual-based model of the COVID-19 outbreak in Lombardy, Italy, to test various scenarios pertaining to the pandemic and achieve novel performance metrics.MethodsThe model was designed to simulate all 10 million inhabitants of Lombardy person by person via a simple agent-based approach using a commercial computer. In order to obtain performance data, a collision detection model was developed to enable cluster nodes in small cells that can be processed fully in parallel. Within this collision detection model, an epidemic model based mostly on experimental findings about COVID-19 was developed.ResultsThe model was used to explain the behavior of the COVID-19 outbreak in Lombardy. Different parameters were used to simulate various scenarios relating to social distancing and lockdown. According to the model, these simple actions were enough to control the virus. The model also explained the decline in cases in the spring and simulated a hypothetical vaccination scenario, confirming, for example, the herd immunity threshold computed in previous works.ConclusionsThe model made it possible to test the impact of people’s daily actions (eg, maintaining social distance) on the epidemic and to investigate interactions among agents within a social network. It also provided insight on the impact of a hypothetical vaccine.

Effects of short- and long-term exposure to atmospheric pollution on COVID-19 risk and fatality: analysis of the first epidemic wave in northern Italy

The effects of exposure to atmospheric pollution on the incidence and mortality due to COVID-19 have been studied but not for sulfur dioxide (SO2) in most studies. However, most studies failed to consider important cofounding factors in the estimation of health effects of air pollution. The objective of the study was to assess the short- and long-term effects of air pollution on the COVID-19 risk and fatality in Lombardy and Veneto. Air pollutants were studied based on monitoring station information in Lombardy and Veneto from January 2013 to May 2020. The daily number of cases and deaths of COVID-19 were collected from the reports of the Italian Ministry of Health in Italy. A generalized linear model with the generalized estimating equation method was used to evaluate the effects of short- and long-term exposure to air pollution on the COVID-19 outbreak in Lombardy and Veneto. After adjusting for other covariates, we found that short-term exposure to PM2.5 and PM10 had a tendency to increase the incidence and mortality of COVID-19 than long-term exposure, while for other air pollutants, including SO2 and NO2, long-term exposure was more significant than short-term exposure. Both short- and long-term exposure of SO2 resulted in increased health effects on COVID-19 pandemic. Our findings suggest that exposure to atmospheric pollution has a significant impact on COVID-19 pandemic and call for further researches to deeply investigate this topic.

COVID19 outbreak in Lombardy, Italy: An analysis on the short-term relationship between air pollution, climatic factors and the susceptibility to SARS-CoV-2 infection

Short-term exposure to air pollution, as well as to climate variables have been linked to a higher incidence of respiratory viral diseases. The study aims to assess the short-term influence of air pollution and climate on COVID19 incidence in Lombardy (Italy), during the early stage of the outbreak, before the implementation of the lockdown measures. The daily number of COVID19 cases in Lombardy from February 25th to March 10th, 2020, and the daily average concentrations up to 15 days before the study period of particulate matter (PM10, PM2.5), O3, SO2, and NO2 together with climate variables (temperature, relative humidity – RH%, wind speed, precipitation), were analyzed. A univariable mixed model with a logarithm transformation as link function was applied for each day, from 15 days (lag15) to one day (lag1) before the day of detected cases, to evaluate the effect of each variable. Additionally, change points (Break Points-BP) in the relationship between incident cases and air pollution or climatic factors were estimated. The results did not show a univocal relationship between air quality or climate factors and COVID19 incidence. PM10, PM2.5 and O3 concentrations in the last lags seem to be related to an increased COVID19 incidence, probably due to an increased susceptibility of the host. In addition, low temperature and low wind speed in some lags resulted associated with increased daily COVID19 incidence. The findings observed suggest that these factors, in particular conditions and lags, may increase individual susceptibility to the development of viral infections such as SARS-CoV-2.

Learn from the First Wave to Surf the Next One Optimally

Kahlberg et al.1 report on the experience of four centres dedicated to vascular surgery during the first seven weeks of the COVID-19 outbreak in Lombardy, Italy, one of the areas most affected by the pandemic in Europe. The authors present details of a specific infection control arrangement centred on having four vascular surgery hubs associated with a number of afferent centres. They provide a very interesting picture with two main findings: (1) acute limb ischaemia (ALI) was the most frequent vascular disease requiring surgical treatment; and (2) patients with associated COVID-19 had a fourfold increased risk of death and a threefold increased risk of major adverse events (MAEs).

Management of acute coronary syndromes during the COVID-19 outbreak in Lombardy: The "macro-hub" experience.

BackgroundDuring the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience.Methods and ResultsThis is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45–124) minutes for STEMI and 1262 (IQR 643–2481) minutes for NSTEMI.A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41–310) versus 160 (IQR 67–1220) minutes, P = 0.001, and 61 (IQR 23–98) versus 80 (IQR 47–126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively).ConclusionsDuring the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.

COVID-19 Outbreak in Lombardy, Italy: An Analysis of the Short-Term Role of Air Pollution and Meteorological Factors

Background: Short-term exposure to air pollution, as well as to climate variables could be linked to a higher incidence of respiratory viral diseases. The objective of the study is to assess the short-term impact of air pollution and climate on COVID19 incidence in Lombardy (Italy), during the initial outbreak.Methods: The daily number of COVID19 cases in Lombardy from February 25th to March 10th 2020, and the daily average concentrations of particulate matter (PM10, PM2·5), O3, SO2, and NO2 together with climate variables (temperature, relative humidity – RH%, wind speed, precipitation), were analyzed. A mixed model with a logarithm transformation as link function was applied to evaluate the relationship between all the variables. Additionally, change points (Break Points; BP) in the relationship between incident cases and air pollution or climatic factors were estimated.Findings: The analysis showed a two-phase effect of PM10 on COVID19 incidence, with a negative association at the beginning of the examined period and a positive one later on, while a positive relationship was observed for O3. The COVID19 spread in Lombardy showed to be influenced positively by RH%, and negatively by wind speed. A BP at 40 µg/m3 was observed for PM10 at lag8, and for O3 at lags 3-8 and 10.Interpretation: PM10, O3, RH% and wind speed showed a short-term association with the COVID19 incidence. Air pollution and climate conditions should be considered as part of an integrated approach when containment measures against SARS-CoV-2 are adopted.Funding: The study did not receive any fund.Declaration of Interests: The Authors declare no conflict of interest.

An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19 Outbreak: Initial Experience Under Real-World Suboptimal Conditions

Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system. Therefore, we rapidly developed a customized pathway to allocate patients to the appropriate hospital ward, and treat them according to ACS severity and risk of suspected SARS-CoV-2 infection. We present here the protocol dedicated to ACS patients adopted in our center since March 13, 2020, and our initial experience in the management of ACS patients during the first 4 weeks of its use. Certainly, the protocol has room for further improvement as everyone’s experience grows, but we hope that it could be a starting point, adaptable to different realities and local resources.

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy