all indicators in the Red Zone

The controversy rages in almost all Lombard cities, after the inclusion of our Region in the red zone and the new blockade imposed on the entire territory. It is not just the categories affected by the new Dpcm – the exhibitors and merchants forced to lower the blinds for at least the next 14 days – to complain. The first to attack the new restrictions was Governor Fontana, who called Conte’s decision “serious and unacceptable: a slap in the face of Lombardy and all Lombards.”

Even the mayors of Brescia, on the afternoon of this Thursday, expressed all the perplexities and dissatisfaction with the criteria that led the executive to make the entire regional territory a red zone, clamoring for the parameters used to define the risk areas (yellow , orange and red) are declined at the provincial level and greater transparency in the data used.

The color assignment was defined on the basis of monitoring data from the Higher Institute of Health. But what are the indicators used for evaluation?

How the division into risk zones works

During a conference, the president of the Higher Institute of Health (Iss), Silvio Brusaferro explained in detail how the division by colors works: ” The new Dpcm is part of a path shared by the Regions, the Ministry of Health and the CTS, which is inspired by international models and is described in a three-step process. ” Each of the three scenarios is associated with a different coronavirus risk. The first “scenario” is with Rt below the value 1, then between 1 and 1.25 where the “epidemic” is still manageable, and then between 1.25 and 1.50 where the epidemic runs fast. These scenarios determine the speed at which an infection is transmitted. The combination of risk scenarios acts as the main driver for the definition of the measures that we do not have to invent, but are defined in the documents ”, specified Brusaferro on the analysis of the data from the regional monitoring of the control room and the analysis in depth of the indicators that have been brought into the ministry’s ordinance.

“In the last week, the scenario classified Italy with some regions of high risk and others of moderate – added Brusaferro – On this basis, each Region shared this type of evaluation and received a communication from the Ministry of Health with its evaluation. and directions “.

But at the press conference no updated data was given: “the control room produces them weekly, they will be produced in the next 48 hours. We want to illustrate and share the tools that accompany this phase of the epidemic in the follow-up. We are in a transition phase, we must intervene to control the spread of the virus to return it at a more controlled speed and to be able to face the coming months, “said Brusaferro.” The flow of information that is identified through indicators is generated in the services general health. The “data” comes from the ASL, collected by the regions, then sent partly to the Institute and partly to the ministry. They are then assembled as a synthesis and evaluated according to a risk division in the specific regional context. This is done weekly, in close collaboration between the regional health services, the ISS and the ministry. The control room also includes 3 representatives of the Conference of State Regions: they are representatives of Lombardy, Umbria and Campania, “he said.

It is not only Rt that counts, the infectivity index that we now know. In order to monitor the trend of Covid-19 in Italy, “and quickly classify the level of risk in order to assess the need for modulations in the response to the epidemic, some indicators with thresholds and alerts have been designed that should be monitored, through coordinated surveillance systems at the national level, to obtain aggregated national, regional and local data. ”To illustrate the 21 indicators,“ divided into three main categories, ”there is a note from the General Directorate of Sanitary Prevention and the General Directorate of Health Planning of the Ministry of Health of April 30.

The 21 indicators used

These “indicators do not aim at an evaluation of the efficiency / effectiveness of the services – specifies the document – but a collection of data and a better understanding of the quality of the same”, in order to be able to achieve a rapid risk classification in the most correct way possible. according to the National Institute of Health and the Regions. As Brusaferro explained, there are three main categories: process indicators on the monitoring capacity, process indicators on the diagnostic capacity, investigation and contact management, and finally result indicators related to the stability of the transmission and stability. health services. . This is what they are:

1. Number of symptomatic cases reported per month indicating the date of symptomatic onset / total symptomatic cases reported to the surveillance system in the same period.
2. Number of cases reported per month with a history of hospital admission (in rooms other than IT) indicating the date of admission / total cases with a history of hospital admission (in rooms other than IT) reported to the surveillance system in the same period.
3. Number of cases reported per month with a history of transfer / admission to the ICU indicating the date of transfer or admission in Tl / total cases with a history of transfer / admission to the ICU notified to the surveillance system during the same period
4. Number of cases notified per month in which the municipality of domicile or residence is notified / total cases notified to the surveillance system in the same period
5. Number of checklists administered weekly to residential and healthcare facilities
6. Number of residential socio-sanitary structures that responded to the weekly checklist with at least one criticality found
7. Percentage of positive swabs excluding, as far as possible, all detection and “reevaluation” activities of the same subjects, in general and by macro context (territorial, HCP / hospital, others) per month.
8. Time between the date of appearance of symptoms and the date of diagnosis.
9. Time between the date of onset of symptoms and the date of isolation (optional).
10. Number, type of professional figures and time / person dedicated in each territorial service to follow up contacts.
11. Number, type of professional figures and time / person dedicated in each territorial service to the activities of sampling / sending to reference laboratories and monitoring of close contacts and cases placed respectively in quarantine and isolation.
12. Number of confirmed cases of infection in the region for which a periodic epidemiological investigation was carried out with a search for close contacts / total of new confirmed cases of infection.
13. Number of cases reported to Civil Protection in the last 14 days.
14. Rt calculated based on integrated ISS surveillance (two indicators will be used, based on the date of onset of symptoms and the date of hospitalization).
15. Number of cases reported to Covid-net sentinel surveillance per week
16. Number of cases by date of diagnosis and date of onset of symptoms reported to the integrated surveillance of Covid-19 per day.
17. Number of new transmission outbreaks (2 or more epidemiologically linked cases or an unexpected increase in the number of cases at a defined time and place).
18. Number of new cases of confirmed SARS-CoV-2 infection per region not associated with known transmission chains.
19. Number of accesses to the PD with an ICD-9 classification compatible with syndromic frameworks attributable to Covid-19 (optional).
20. Occupancy rate of total ICU beds (code 49) for patients with Covid-19. twenty-one
21. Occupancy rate of the total beds in the medical area for patients with COVID-19.

Source: Today.