Ministero della Salute

Key Points

• An analysis of the data referring to the period  August 24-30, 2020 is reported. Due to the time between exposure to the pathogen and the development of symptoms and between these and the diagnosis and subsequent notification, many of the cases reported this week are likely to have contracted the infection in the second ten days of August. Some of the cases identified by screening, however, may have contracted the infection in earlier periods.
• An increase in new cases reported in Italy for the fifth consecutive week is confirmed, with a cumulative incidence (ISS flow data) in the last 14 days (period 17/8-30/8) of 23.68 per 100,000 inhabitants, up from the period 6/7-19/7 and similar to the levels observed at the beginning of May. The majority of cases continue to be developed on our national territory (15% of the new cases diagnosed in the monitoring week are imported from abroad); in particular, a not negligible percentage of cases imported from other Regions/PAs is observed (17.6% in the current week).
• In Italy, as in Europe and globally, there has been an epidemiological transition of the SARS-CoV-2 epidemic with a sharp drop in the median age of the population contracting the infection. The median age of the cases diagnosed in the last week is 32 years, a slight increase compared to last week. Circulation now occurs more frequently in younger age groups, in the context of an advanced reopening of commercial activities (including places of aggregation) and an increased mobility. The change in transmission dynamics (with emergencies of cases and outbreaks associated with recreational activities both at home and abroad) that was assessed over the previous weeks is confirmed.
• The national transmission index (Rt) calculated on symptomatic cases and referring to the period August 13-26, 2020, is equal to 1.18 (95%CI:0.86 - 1.43). This shows that, net of asymptomatic cases identified through screening/tracking activities and cases imported from foreign countries (these categories are not mutually exclusive), there has been an increase in the number of symptomatic cases contracted locally and diagnosed in our country.
• However, the national transmission index must be interpreted with caution at this particular time of the epidemic. In fact, Rt calculated on symptomatic cases, while remaining the most reliable indicator at regional level and comparable over time for monitoring transmissibility, could slightly underestimate the actual transmission of the virus at national level. Therefore, the national Rt must always be interpreted taking into account the incidence data as well.
• Moreover, during the current week of monitoring, new cases of SARS-CoV-2 infection were diagnosed in all Regions/PPAA. During this week, 39% of new cases diagnosed in Italy were identified through screening activities and 29% through contact tracing activities. The remaining cases were identified as symptomatic (27%) or the reason for the diagnostic assessment is not reported (5%). Therefore, overall, 68% of the new cases were diagnosed thanks to intensive screening activity and case investigation with identification and monitoring of close contacts.
• Thirteen Regions/PAA reported an increase in the number of cases diagnosed, compared to the previous week (ISS flow). These cannot be attributed solely to an increase in cases imported from abroad. A high number of new cases continues to be reported in almost all the Regions/PAA and a substantially increasing trend has been observed for several weeks. This should call for caution, as it shows that the circulation of SARS-CoV-2 is becoming increasingly relevant in our country. Although an initial increase in the number of hospitalizations is reported in almost all Regions, in none of the Regions/PPAA have any signs of overloading of the health care services been identified. Furthermore, the essential and growing commitment of the territorial services (Prevention Departments) to ensure that the present outbreaks are promptly identified and investigated is confirmed.
• In the current week of monitoring, a total of 1799 active outbreaks were reported, of which 649 new (the adopted definition of outbreak foresees the identification of 2 or more positive cases linked to each other), both increasing for the fifth consecutive week (in the previous monitoring week 1374 active outbreaks were reported, of which 490 are new). This implies an increasing commitment of the territorial services in the search for contacts, as they are managing to contain the local transmission of the virus.

Conclusions

• Italy is in an epidemiological transition phase that is currently progressively worsening. Even this week there has been a widespread transmission of the virus throughout the country, causing even outbreaks of significant size and often associated with recreational activities that involve gatherings and violations of the rules of physical distancing, both in Italy and abroad.
• Therefore, there is a subsequent import of cases and further local transmission (also upon returning after holiday periods).
• The number of new cases of infection remains lower overall than in other European countries, however, there has been an increase for five consecutive weeks.
  Compliance with the prevention and quarantine measures recommended by the health authorities remains a crucial and necessary tool to fight the spread of the infection. On the other hand, the increase in diagnostic capacity must be accompanied by the strengthening of territorial services for case finding and contact management, including quarantine of close contacts and immediate isolation of secondary cases. The reduction in the time between the onset of infection and isolation remains a key element in controlling the spread of the infection.
• It is therefore necessary to maintain a high resilience of all territorial services, to continue to strengthen the population's awareness and compliance with control measures, to carry out active research and diagnostic assessment of potential cases, isolation of cases, quarantine of their close contacts. These actions are fundamental to control transmission and possibly rapidly identify and cope with epidemic upsurges.
• It is also essential to maintain a high level of attention and continue to strengthen contact tracing activities, in order to identify all potential transmission outbreaks at an early stage and continue to control the epidemic. Hence, it remains essential to maintain a high level of awareness among the general population about the worsening epidemiological situation and the importance of continuing to strictly adhere to all measures necessary to reduce the risk of transmission, such as individual hygiene, mask use and physical distancing.
• The need to comply with quarantine and other measures recommended by the health authority is reiterated, including the identification of dedicated facilities, both for people returning from countries for which quarantine is envisaged, and at the request of the health authority having been identified as close contacts of a case. Although the national territorial services have so far managed to contain local transmission of the virus, an exceptional workload is repeatedly reported, risking to jeopardise the timely management of contacts, as well as failing to ensure all other activities that are unrelated to the current emergency.
• The situation described in this report, which is mainly related to infections contracted in the second decade of August 2020, confirms the presence of important warning signs related to an increase in local transmission. At present, all data confirm that it is appropriate to maintain the prevention and control measures already adopted by the Regions/PPAA, and to be ready to take further action in the event of further deterioration.
• The population is recommended to pay particular attention to the risk of infection in crowded settings, where non-compliance with the recommended measures is observed and during periods of stay in countries or areas with higher viral circulation. In such cases, it is recommended that particular attention is responsibly paid to the behavioural regulations for the prevention of SARS-CoV-2 transmission, particularly towards the most vulnerable population groups.