Covid monitoring. The national Rt still rises to 0.93. Six regions above 1. “Holding the line of rigor even after the holidays”

by Luciano Fassari

For the third week in a row, the virus transmission rate continues to rise. In Calabria, Liguria, Veneto, Basilicata, Lombardy and Puglia Rt index greater than or equal to 1. “The incidence in Italy is still very high and the impact of the epidemic is still strong in most of the country.” Iss and the Ministry ask to maintain the line of rigor also because today Italy would be all yellow after the holidays.

DEC 30 – “The signal of counter-trend in the transmission index reported in the previous two weeks continues throughout the country. This is achieved in a European context characterized by a new increase in the number of cases in many European countries and the appearance of viral variants reported with a potential greater transmission ”. This is what we read in the new monitoring of the Covid 19 epidemic regarding the period 21 / 12-27 / 12.

The Rt index for the third consecutive week rose to 0.93 from 0.90 last week and 0.86 15 days ago. There are 6 Regions with a Rt greater than 1 (Calabria 1.09, Liguria 1.07, Veneto 1.07, Basilicata 1.09, Lombardy 1, Puglia 1) and 3 with a very close index (Emilia 0.98, Friuli 0.96, Marche 0.99). The weekly incidence is 135 cases x 100 thousand inhabitants. A value still far from the levels (50 cases per 100,000 in seven days) that would allow the complete reestablishment of the identification of cases and the tracing of their contacts throughout the national territory. This situation confirms the need to maintain the strict line of mitigation measures adopted during the Christmas holidays ”. A warning, therefore, to the Government and the Regions so that the measures are tightened even after the Befana, also because after this report it is evident that at the end of the holidays all of Italy will be in the yellow zone (Abruzzo according to data from today it would go from orange to yellow).

Synthesis

“The epidemic in Italy – the Report reads – remains serious due to a high impact on welfare services. Three Regions / PPAA (Veneto, Liguria, Calabria) have a punctual Rt greater than 1 even at the lowest value, therefore compatible with a type 2 scenario, another 3 (Basilicata, Lombardy and Puglia) exceed it in value average, and three others touch it (Emilia Romagna, Friuli Venezia Giulia and Marche). This, together with the high incidence that is still registered in almost the entire territory, is of special concern and for this reason we urge you to consider the application of the planned measures, for the levels of risk attributed, even beyond the current deadlines, as described in the document “Prevention and response to Covid-19: evolution of the strategy and planning in the transition phase for the autumn-winter period” transmitted with the Circular of the Ministry of Health of 12/10/2020 Prot 32732. In general, the incidence in Italy is still very high and the impact of the epidemic still remains in most of the country “.

Veneto is always concerned that “in addition to a punctual Rt greater than one, it is accompanied by a particularly high incidence. This is especially worrying, so we again urge you to urgently apply the measures provided for the level of risk attributed in accordance with the document “Prevention and response to Covid-19: evolution of the strategy and planning in the transition phase for the autumn-winter “transmitted with the Circular of the Ministry of Health of 12/10/2020 Prot. 32732”

The report then “observes a general decline in the impact of the epidemic on health services, with occupancy rates in ICU beds and medical areas below the critical threshold nationwide for the first time since late October. However, still 10 Regions / HAPPs have an employment rate in intensive care and / or medical areas above the critical threshold. Overall, the number of people admitted to intensive care decreased slightly from 2,731 (12/21/2020) to 2,565 (12/28/2020); the number of people hospitalized in medical areas also decreased from 25,145 (12/21/2020) to 23,932 (12/28/2020). This trend at the national level underlies strong interregional variations ”.

Although – it continues – there is a decrease in the incidence at the national level in the last 14 days (305.47 per 100,000 inhabitants (12/14/2020 – 12/27/2020) vs 329.53 per 100,000 inhabitants in period 7 / 12 / 2020-20 / 12/2020, ISS flow data), the value is still far from levels that would allow the complete reestablishment of the identification of cases and the follow-up of their contacts throughout the national territory. This approach showed the first signs of criticality when the national value exceeded 50 cases per 100,000 in seven days (currently the national incidence in 7 days December 21-27, 2020 updated to December 29 is equal to 134.97 per 100,000 inhabitants; this value could be underestimated due to the low number of tampons on vacation “

As we said in the period from December 8 to December 21, 2020, the average Rt calculated on symptomatic cases was equal to 0.93 (range 0.89 – 1.02), a slight increase in the last three weeks.

There is also “an increase in resilience alerts with 10 Regions / HAPPs reporting a resilience alert (versus 4 the previous week). This is primarily due to an increase in positivity rates which may reflect the fewer tests performed during the holiday period. No Region / PPAA reports multiple alerts ”.

“Although improving – reads the report -, there is still a general difficulty to maintain a high quality of the data reported to the integrated surveillance system, both due to timeliness (delay in the notification of cases reported to the surveillance system on aggregate data coordinated by the Ministry of Health) and for its completeness. This week, for the first time in four weeks, a Region did not exceed the critical integrity threshold of indicator 1.1. The epidemiological data analyzed correspond to the week of December 21-27, which at this time is the most recent consolidated data available. As a consequence, this can lead to a possible underestimation of the transmission speed and incidence.

“There was a decrease in the number of cases not attributable to known transmission chains (31,825 vs 38,154 the previous week), with a slight increase in the percentage of cases detected through contact tracing activities to 26.0% (vs 25 , 4% the previous week). On the other hand, a slight decrease is observed in the percentage of cases detected due to the appearance of symptoms (32.4 vs 33.0% the previous week). Finally, 30.0% of the cases were detected through screening activities and in 11.6% the reason for the diagnostic evaluation was not reported “

“It is complex – Iss and the Ministry say – to predict the impact that the Christmas period could have, however, the greater mobility and interpersonal interaction typical of sociability this season could determine a significant increase in the transmission of SARS-CoV-2 . In the situation described, this would lead to a consequent rapid increase in cases to levels potentially higher than that observed in November in a context in which the impact of the epidemic on health workers, services and the population remains significantly high ” .

Iss and the Ministry confirm “the need to maintain the drastic reduction of physical interactions between people. It is essential that the population avoid all opportunities for contact with people outside their home that are not strictly necessary and that they stay at home as long as possible. We remind you that it is mandatory to adopt rigorous individual behaviors and to respect the sanitary measures in force regarding the spacing and correct use of the masks. We reiterate the need to comply with the measures recommended by the health authorities, including quarantine measures for close contacts in established cases and the isolation of the cases themselves ”.

Finally, in the report “the Regions / HAPPs are invited to carry out a continuous risk analysis at the subregional level. It is necessary to maintain and / or strengthen mitigation measures based on the level of risk identified as indicated in the document “Prevention and response to COVID-19: evolution of the strategy and planning in the transition phase for the autumn-winter period “sent by Circular of the Ministry of Health of 12/10/2020 Prot. 32732”.

Luciano Fassari

December 30, 2020
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