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Pietro Senaldi
Yesterday began the national vaccination campaign against Covid-19. At this moment it involves a few thousand Italians, all workers of the health and social health system. The goal is to prevent contagion spread to hospitals, infecting the weakest segments of the population and ensuring the stability of the health system, which in recent months has often been in danger when doctors and nurses have been affected by the virus. The next step is the vaccination of the guests of the nursing homes and their employees, who were the main scene of the massacre, especially during the first wave of the epidemic. The vaccine it’s not mandatorybut it is highly recommended for healthcare professionals, even if at least 20% of them are reluctant to take it. In this first phase, the Regions, to which the State will distribute the doses according to the health population, will contact those who have the right to serum. The goal of prophylaxis is achievement of herd immunity, which is obtained when around 90% of the population has come into contact with the virus, whose circulation, therefore, is naturally limited, until its progressive elimination. Yesterday’s vaccinations are just the first step in a process that will likely last all of next year. The government plans to vaccinate 10 million Italians by Easter, and then continue to immunize half the population during the summer. Once the serum has been distributed in hospitals and nursing homes, and without prejudice to the indication of additional risk categories, such as the forces of order or school personnel, it is essential to draw up a ranking that indicates the precedence among the population in the right to administration, to avoid a flood of prophylaxis and the violation of the right to health of the most vulnerable. To put it bluntly, each of us will have a number that will indicate our right of precedence to access the Covid vaccine. It will be assigned to us basically based on our degree of fragility with respect to the disease and our ability to contract it. One of the greatest elements of fragility is advanced age, but this will not be the only criterion from which the ranking will be made, and many times it will not even be the main one. To propose a method capable of deciding our destiny will be a man and his staff, Giovanni corrao, Professor of Medical Statistics at the Bicocca University of Milan. “My job is to analyze data and evidence from the real world,” explains the scientist, contacted by Free. “We observe what happened to us, how the patients were treated, the effectiveness of the drugs used, the therapies and we try to learn from our recent past, highlighting the mistakes that have been made so as not to repeat them.” Corrao met with the government and the leaders of the Regions last week, obtaining the green light for the creation of the great anti-Covid algorithm, the statistical and mathematical formula that will determine the ranking of access to prophylaxis, analyzing and comparing the records of health of all. Italians. The procedure arises from an intuition of the professor, who presented a proposal for an operating protocol to the Ministry of Health, with which the methodological details were also discussed, also involving experts from the Regions, who will provide the therapeutic and diagnostic data essential for the study . .
Professor Corrao, it’s a huge job: how long do you plan to take?
We already started this week and I hope to finish the job in fifteen days ”.
Who works there?
“Three years ago, here at the University of Milano Bicocca, a group of young researchers and I established an interuniversity center that involved 25 universities in the country, Health Research and Pharmacoepidemiology, a multidisciplinary group of medical statisticians, epidemiologists, data scientist and Italian clinicians “.
What data will you use?
“The data is what each regional service collects to reimburse the health services provided. By putting together the service offered and the patient’s identification code, we can reconstruct the entire health history of each individual: we know what diseases they have had and their risk coefficient with respect to a possible Covid infection “.
Isn’t there a privacy issue?
“No, because those who analyze the health data do not know the person’s identification code.”
What is the starting point for your calculation?
The algorithm that determines the ranking is based on the identification of the clinical profile of all the patients who in the last ten months have developed severe forms of Covid, which have forced them to be hospitalized in intensive care or have even caused their death. We determine the weight that each frailty factor, from age to previous pathologies, has had in determining the worsening of respiratory function or even death ».
Do you also give importance to the medications that are used to treat?
“The drugs that the individual used routinely before contracting Covid are part of the individual’s medical history and have the appropriate weight in the algorithm.”
Let’s get to the heart of the study: how will you use the health data of Italians to build the ranking?
«It is the classic application of the concept of personalized medicine. The algorithm that will assign each of us a score that will indicate the degree of precedence in access to prophylaxis is based on a combination of weightings and correlations between lifestyle, general health situation, age, chronic diseases. There are about forty items, each of which will be associated with a value depending on the individual analyzed, which will allow us to draw an exhaustive clinical picture from which the subjective risk of death in the event of contraction of Covid will result ”.
How do you decide what value to attribute to the various pathologies that contribute to determining death from Covid?
“We compared the medical history of people who died or hospitalized in intensive care due to coronavirus infection with that of people who did not contract the infection. From the difference between the medical records, we obtain the risk coefficient for each individual case ”.
What are the cocktail ingredients behind the algorithm and how will they be mixed?
“The elements are varied, from arrhythmia to previous heart attack, from lymphatic leukemia to diabetes, from obesity to hypertension. Depending on the clinical condition of the patient, each of them will have a score, say from zero to ten.
What role will old age play?
«Age is a factor of fragility in itself. In addition, it is very likely that older citizens are sicker than young people because many diseases manifest themselves over the years. But, comparing the clinical situation of two individuals, it could very well be that a thirty-year-old person is, according to the algorithm, more fragile than one of eighty. It won’t happen often, but it will. “
How is it possible?
“Take the case of a type 2 diabetic, a disease with which obesity is often correlated, which necessarily brings with it breathing difficulties. Or we think of autoimmune diseases not correlated with age, such as type 1 diabetes, many rheumatological diseases or multiple sclerosis. Citizens affected by these diseases, if they are affected by Covid, have a risk of death that can be even greater than that of an eighty year old in good condition and who may carry out physical activity ”.
How old has age started to become an important weight in the risk of death from Covid?
“There is no decisive age, it is a continuous line of increasing risk. We begin to degenerate from the moment we are born. It would be like saying that smoking is bad: from the first cigarette … ».
Professor, work starts this week: how?
“We will work for three days in the Lombardy Region, the pilot region. Let’s start from here because there is more statistical data on Covid but I have carte blanche from the ministry, only a signature of the president of the Region that makes the databases available and you can start anywhere ”.
What could happen to a Lombard citizen in four or five weeks?
“We propose that when we have assigned a score to each Lombard, Governor Fontana, based on the amount of vaccines that the state will have made available to him, write to those in the most fragile conditions offering to be vaccinated; a bit like what happens today with those over 60 who are invited to be screened for the early diagnosis of colon cancer.
Do you have an idea of the results that will be obtained?
“Yup. We know that the virus has a high tropism towards cardiovascular pathologies, linked to the damage they cause to the body more than to the drugs used to treat them. The same happens with hypertension, because after many years of high pressure it can cause damage to cardiovascular function. These subjects are at great risk even if they are relatively young. “
Is cancer also a major worsening of risk?
“Yes, because cancer is a degenerative disease that causes a general weakening of the body and because the drugs to treat it are usually immunosuppressive.”
Is it correct to start with the health personnel and, perhaps, also with the police?
“I’m not a gadget man. Certain decisions do not belong to me. However, if we consider that the vaccine, in addition to protecting ourselves, also serves to protect others, it seems logical to me that we start with the categories most in contact with fragile citizens.
Why do so many people resist getting vaccinated?
“An unmotivated fear has spread. Vaccines are one of the most important inventions of humanity and cannot be questioned by sanity.
But vaccination can cause contraindications …
“Like any substance that enters the body that the body does not know about, the vaccine also carries the least risk of a bad reaction. As it will be administered to hundreds of millions of people, it is conceivable that there are very rare cases of adverse effects. But this also happens with the drugs we use every day; just that, unlike other drugs, the vaccine not only helps us but also those around us.
Professor, you are a statistical doctor: because if the contagion index is below 1, are we still in danger instead of going towards the progressive extinction of the epidemic?
“I think because the value of RT is underestimated. The coronavirus acts in a subtle way, many times without generating any symptoms in those affected. However, the Rt index is calculated only in symptomatic patients. Consider, for example, that out of a hundred confirmed cases in Lombardy, 80 were identified because they manifested the classic symptoms of the disease. Identifying the asymptomatic is not easy and that means that we cannot have a correct perception of the actual infection rate ”.
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