[ad_1]
One week after its debut, the monitoring system on the basis of the last DPCM already needs a service. The experts in the control room have put it on paper in the minutes of the last two meetings, in which they speak of the need for verification. And it is understandable, after the intersection of data on infections, outbreaks, hospitalizations, beds, tampons, intensive care and the Rt index has unleashed a storm that makes it even more difficult for Italians to accept limitations in daily life and activities. economic.
Incomplete data for regions, he was late or the governors called him old. The data ended up under the lens of Health Ministry inspectors and data collected by the Nas carabinieri in four hospitals in Naples. A mess marked by street protests, political and institutional confrontations. And to think that on November 4, oblivious to the chaos that would have unleashed the map of a yellow-orange-red Italy, Giuseppe Conte had magnified on live television the choice to divide Italy on the basis of risk bands. Unlike the first wave of Covid-19, the premier explained, the government has a highly articulated curve monitoring plan based on 21 parameters: This plan is the compass that shows us where to intervene, with what differentiated measures and well defined. pointed …. Eight days and many controversies later it seems clear that the compass is stuck and the cardinal points are lost. Now there is a commitment to change to restart on the right foot, also based on the data from the previous day. A substantial novelty decided by the control room, the six experts who since the end of April have been preparing the weekly monitoring on the progress of Covid for the Ministry of Health. But is it really so?
Parameters need to be changed
The decisive meeting to understand the level of confusion is on November 9, at 2:15 p.m. The level of risk should be classified in a timely manner to assess the need for modulations in outbreak response activities. What the six must do, in short, understand how much the virus is running at that specific moment and the situation of hospitals and prevention services, in order to offer the necessary tools to implement the most appropriate countermeasures. All agree that an in-depth analysis of the monitoring system is necessary to better respond to the new requirements imposed by the Decree of the Prime Minister of November 3, in particular evaluating the inclusion of more timely data on the occupancy of beds in the ICU and medical area and the possible inclusion of alerts. of hospital resilience when the probability of exceeding the critical thresholds for bed occupancy exceeds 50% in the projections made at 30 days.
what is written in the minutes of the meeting that the Messenger Servicecould consult: The purpose of these reviews is to be able to provide classifications that better respond to the current situation of the impact of the epidemic on welfare services. The technical language, but the simple meaning: in order to decide in a timely manner in which risk band a region falls – yellow, orange or red – the data must be updated. Therefore, starting tomorrow and every Friday, the control room must evaluate the beds in intensive care and the ordinary admissions updated the day before the meeting, as well as the RT of admissions with the projection for the next 30 days (indicator which is not here today). The experts consider it necessary, and in confidential meetings Minister Speranza would have already asked to use the most recent data photograph possible. As long as the changes remain within the legislative framework of the Dpcm. It remains to be seen whether the Regions will adapt.
Proceedings of the scientists
On November 9, a clear indication of the need to change the CTS also came, which highlighted the criticalities of the system based on the reading of the monitoring parameters and indicators. The explicit report: The CTS underlines the importance of the integrity, correspondence and punctuality of the information flow, which acquires absolute importance in the elaboration of the ordinance of the Minister of Health. The CTS highlights some elements for improvement that, depending on the implementation of the system, can be considered by the national monitoring booth, such as: the possibility of re-evaluating the relative weight of the individual indicators based on the objective situation of the Individual Regions, the opportunity to guarantee operational support to Regions that do not guarantee a timely flow of information, and the option to review and reconsider the value of the 21 original indicators in light of the current epidemic evolution.
Scientists are convinced that to be truly effective, the system must take into account the number of beds available, the number of intensive care beds, and the Rt transmission rate. They agree that RSA data is not strategic for identifying risk factors for entire regions. and they prioritize the reliability of the figures, the updating of the data, but above all a uniform collection criterion, in order to have a single criterion. What has not been so far.
The wrong sum of the tests
At 22.26 on Tuesday, November 10, the Regions received an email signed by Stefano Marro, from the General Directorate of Sanitary Prevention of the Ministry of Health. He asks everyone to provide the total number of rapid antigenic tests carried out between November 2 and 8, the number of positives found and the number of cases uploaded to the ISS platform. Apparently technical communication, which hides a forward flight of some Regions that have decided independently, and in the absence of indications, to change a fact during the race: the swabs made. If only the molecular ones (the prc, gold standard) were inserted into the column, lately at least two Regions, Lazio and Piedmont, have also started to include antigenic tests. A fact, reported by some Regions, that runs the risk of altering the positivity rate, lowering it. In times of suspected accounting tricks, this is no small feat.
The real problem, rather than a supposed regional cunning, the lack of homogeneity. each territory proceeds in no particular order. There is no national directive. There is no uniform rule. The most benevolent argue that it is only a moment of transition.
The numerical question is. If I say that I did 100 tests, including only the molecular ones, and I have 5 positive, I have a 5% positive rate. If in the total number I add 50 antigen tests to the 100 swabs and I have 5 positives, the positive rate collapses. Not at all, because this is one of the parameters that are evaluated to adopt restrictive measures. Fake data? On the contrary, they argue from Piedmont and Lazio. Spallanzani Health Director in Rome, Francesco Vaia, explains: The denominator formed by all the molecular swabs plus the antigenic swabs with cut greater than 10, inserted in the positives. the cut the index that detects antibodies. If it is low, the test should be confirmed with a molecular swab. But which antigenics are we talking about? Only the most reliable, immunofluorescent and non-chromatographic. For the former, at those levels, the case is considered positive, without further confirmation. Regarding the cases of positivity, the total given is the sum of the molecular positive, the molecular confirmations of the positive antigen and the antigen with a cut-off index greater than I 10. Vaia explains: If not all these data were used, then it is that the result would be false.
Too bad this rule still doesn’t apply elsewhere. In Piedmont, where they also provide the aggregated data, they confirm each antigen test with the swab. And they insert into the platform, in addition to molecular ones, only negative antigenic substances, which already have diagnostic value. Veneto, which has also struggled and is struggling to improve antigenic products, has so far only provided the full molecular products. Now Luca Zaia rejoices: the ministry has proved us right. The truth is that nothing is known yet. The regions groped in the dark. And Vaia adds: A homogenization of data collection and reading is welcome. But I think they are already working on that.
The scheme with the 21 criteria Establishing restrictions in the regions appears for the first time in a document of the Ministry of Health of April 30. Even then, governors and mayors complain that the indicators are difficult to decipher and ask for simpler parameters. Six months have passed, Italy in the grip of the second wave. Delays and shortages are still present. Like the virus.
November 12, 2020 (change November 12, 2020 | 08:21)
© REPRODUCTION RESERVED
[ad_2]
