The latest mess in Covid numbers – Time

The governors continue to protest but, in some cases, they have transmitted incomplete data, the Minister of Health Roberto Speranza tries to explain, without success, why some Regions have been classified as red and others, with parameters that seem worse, yellow. Everyone, including virologists, gives (their) numbers. Although the calculation that summarizes the famous 21 criteria that determine the “risk coefficient” of each area and, therefore, the measures to deal with Covid, remains a mystery. Welcome to the last Italian pasticcio. A mixture of superficiality, understatement, partisan interests and a lack of transparency. So much so that Prime Minister Giuseppe Conte himself ran into hiding: “I wanted a provision to be included in the bis decree of restorations that helps make the monitoring mechanism even clearer and more transparent, so that the scientific community and all citizens can access this information, “he told Corriere della Sera yesterday.

The indicators developed by the “ghost” algorithm that divides the individual zones into the three colors decided by Palazzo Chigi were chosen more than six months ago, included in the decree approved last April 30, but they never had much publicity (only two days Minister Speranza reiterated them in the Chamber). That the government is in difficulties is also attested by the fact that the same number one of the dicastery has not yet responded to the urgent interpellation presented on November 3 by one of the parties that support the majority -Italia Viva- that has precisely requested expose data and criteria that led the premier to sign the provision that established the new restrictive measures. “There is a lack of data, we would like to have them all: to know who enters and who leaves hospitals, age groups, the severity of their conditions, when and how they recover and all the other parameters that remain mysterious,” argue the Renzians. If we add to this that the data that reaches the control room, made up of three experts appointed by the Conference of the Regions, and also in the Scientific Technical Committee, are usually partial, then the confusion is understood.

“In last week’s report, on which the government relied, 5 regions had a non-calculable risk percentage, having not provided all the data,” attacked Piedmont President Alberto Cirio. There is no shortage of extravagances: in Campania the free places in intensive care were 113 on October 19, the day before yesterday they had risen to 590. A magic. In Calabria, 4 thousand swabs would still be blocked in the Catanzaro laboratories and could obviously have a significant impact on the data for the region already included, however, between the red areas. Liguria, Veneto, Abruzzo and Basilicata would have delivered partial numbers to the control room, the values ​​of one or more indicators would be missing. The Region led by Luca Zaia, however, has asked to change the monitoring system, which is inadequate.

In short, the algorithm would feed on wrong numbers and the 21 criteria would have to be changed. For now, they are divided into three areas that concern monitoring capacity, diagnostic evaluation and contact management and, finally, the results related to the stability of transmission and the resilience of health services. Here they are specifically: 1. Number of symptomatic cases reported per month; 2. Number of cases reported per month with a history of hospitalization (in rooms other than IT). 3. Number of cases reported per month with a history of transfer / admission to the intensive care unit (ICU); 4. Number of cases notified per month in which the municipality of domicile or residence is notified / total of cases notified to the surveillance system in the same period. 5. Number of weekly checklists administered to residential and healthcare facilities (optional). 6. Number of residential and healthcare facilities that respond to the weekly checklist with at least one criticality found (optional). 7. Percentage of positive swabs excluding as much as possible all screening and “retesting” tests of the same subjects per month. 8. Time between the date of appearance of symptoms and the date of diagnosis. 9. Time between the date of appearance of symptoms and the date of isolation (optional). 10. Number, type of professionals and time / person dedicated to locating contacts in each territorial service. 11. Number, type of professional figures and time / person dedicated in each territorial service to sampling / sending activities to reference laboratories and monitoring of close contacts and cases placed in quarantine and isolation respectively. 12. Number of confirmed cases of infection in the region for which a periodic epidemiological survey has been 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 on the basis of the integrated surveillance ISS. 15. Number of cases reported to COVID-net sentinel surveillance per week (optional). 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; 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 SP with a classification compatible with syndromic frameworks attributable to COVID-19 (optional). 20. Occupancy rate of total ICU beds for COVID-19 patients 21. Occupancy rate of total beds in the medical area for COVID-19 patients.

The pressure to resolve the data mess comes from the opposition, but also from the majority. Luigi Marattin, first signatory of the urgent interpellation to Minister Speranza, explains that “in relation to Covid-19 it is estimated that between contagion and hospitalization in intensive care an average of ten days elapse, therefore the number of entries registered in a given day can be considered proportional to the number of infections that occurred about ten days before; This latency implies that the data on the daily variation in the number of intensive therapies should be understood as an index of the epidemiological situation existing in the previous ten days, offering information on the effectiveness of the containment measures prepared at that time, but not on those prepared on the day the change is recorded (which will be seen in the next ten days). “Therefore,« fundamental to understand the evolution of infections and verify the effectiveness of containment measures is to analyze the daily variation intensive care in a disaggregated way, that is, by analyzing the number of net accesses of discharges registered in the same period; however, these data are not available, since the daily variation in intensive care admissions is reported exclusively by aggregate form, attributing two disconnected and interdependent variables to a single item; this makes it difficult to fully understand the situation epidemiological and, above all, it runs the risk of hindering the evaluation of the effectiveness and adequacy of the measures adopted by the government ”. Iv also requests to have the data on admissions and discharges of all the other departments, to evaluate the strength of the health system. To avoid the rush to take measures to deal with the Coronavirus by exposing assistance in other health areas. A risk that affects all regions, given that non-urgent visits and surgery have been postponed for a few months.