Coronavirus, the indicators used to define colors and risk areas

Starting on Friday, November 6, Italy will be divided into three zones based on the criticality of the pandemic in the different regions, which will be represented with red, orange and yellow zones. The allocation of colors, which has already caused controversy, was defined based on monitoring data from the Higher Institute of Health. But what are the indicators used for evaluation?

Coronavirus, the colors of the regions and the three scenarios

During today’s press conference, the president of the Higher Institute of Health (Iss), Silvio Ironbrush, explains in detail how the division by color works: ” The new Dpcm It is part of a path shared by the Regions, the Ministry of Health and CTS, which is inspired by international models and is outlined in a three-phase 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 is running 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 in depth of the indicators that have been brought to the ministry ordinance yesterday.

“In the last week, the scenario has classified Italy with some regions with high risk and others 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 indications ”.

“It is a press conference where we do not have updated data, the control room produces them in base weekly, it 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 phase of transition, we must intervene to control the spread “of the virus” to return it to a more controlled speed and to be able to face the next months, “he said.

“The flow of information that is identified through indicators is generated in the general health services”, the data “comes from the ASL, assembled by the regions, then sent in part to the Institute and in part to the ministry. Then, they are assembled as a synthesis and are evaluated according to a risk division in the specific regional context. It 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.

Coronavirus, the 21 indicators used

Not only matters Rt, the contagion rate 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 major categories, ”as the president of the Higher Institute explained today to the Ministry of Health Health Silvio Brusaferro, there is a note from the General Directorate of Sanitary Prevention and the General Directorate of Sanitary Planning of the Ministry of Health of April 30.

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 explains, there are three categories: process indicators on the monitoring capacity, process indicators on the diagnostic diagnostic capacity, investigation and contact management, and finally result indicators related to the stability of the transmission and the stability of health services. . This is what they are:

1. Number of symptomatic cases reported per month indicating the date of symptomatic onset / total number of symptomatic cases reported to the surveillance system in the same period.
2. Number of cases reported per month with a history of hospitalization (in rooms other than IT) indicating the date of admission / total cases with a history of hospitalization (in rooms other than IT) notified to the surveillance system in the same period.
3. Number of cases notified per month with a history of transfer / admission to the ICU, indicating the date of transfer or admission to Tl / total cases with a history of transfer / admission to the ICU reported to the surveillance system in 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 and healthcare facilities that respond to the weekly checklist with at least one criticality found
7. Percentage of positive swabs excluding, as far as possible, all detection activities and “retesting” 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 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 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 the 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 the total ICU beds (code 49) for patients with Covid-19.
21. Occupancy rate of the total beds in the medical area for COVID-19 patients.