The epidemiological framework described precedes the adoption of the restrictive measures introduced by the ministerial decree DPCM of October 24, 2020. The epidemic in Italy is deteriorating further, with the number of new cases reported almost doubled, compared to the week of October 12-18, 2020 (100,446 cases compared to 52,960 cases in the previous week). This is still generally compatible with a type 3 scenario but evolving towards a type 4 scenario. It should be noted that in some Italian Regions the transmission speed is already compatible with a type 4 scenario, with the risk of a short term hold up in health services. There is an increasing difficulty in finding complete data, due to the serious overload of territorial services, which could lead to an underestimation of transmission speed, particularly in some Regions.  Therefore, a general critical situation is confirmed on the national territory, with a significant impact in many Italian Regions/PAs.

In this week of monitoring, 11 Regions/PAs are to be considered at high risk of uncontrolled transmission of SARS-¬CoV-¬2, and 8 are classified as moderate risk, with high probability of progress to high risk in the coming month. This week, for the first time, hospital bed occupancy in the medical area was reported to have exceeded the critical threshold (40%) in some territories.

It is confirmed that a drastic reduction in physical interactions between people is needed to relieve the pressure on health services. It is essential that the population avoid all opportunities for contact with people outside their own homes that are not strictly necessary, and it is also essential to stay at home as much as possible. It should be remembered that it is compulsory to adopt strict individual behaviours and to respect the hygiene and health measures provided for, as well as the correct use of masks. The need to respect all measures recommended by the health authorities is reiterated, including quarantine measures for close contact with proven cases and isolation of the cases themselves.

The Regions/PAs are invited to carry out a continuous risk analysis, also at sub-regional level, and to consider a timely increase of mitigation measures in the most affected areas, according to the level of risk and on the basis of the guidelines provided in the document Prevention and response to Covid-¬19: strategy evolution and planning in the transition phase for the autumn-winter period, issued through a Memo by the Ministry of Health on 12/10/2020 Prot. 32732, in connection with the Ministry of Health.

Key Points

  • An analysis of the data for the period October 19-25, 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 become infected at the beginning of October. The present report is therefore an epidemiological framework prior to the adoption of the restrictive measures introduced by the ministerial decree DPCM of 24 October 2020.
  • It is confirmed that the epidemic in Italy is rapidly worsening and is still globally compatible with a type 3 scenario but evolving towards a type 4 scenario. It should be noted that in some Italian Regions the transmission speed is already compatible with a type 4 scenario, with the risk of a short term hold up in health services. Therefore, a general critical situation is confirmed on the national territory, with a significant short-term impact in many Italian Regions/PAs.
  • In this week of monitoring, 11 Regions/PAs were classified as high risk of uncontrolled transmission of SARS¬-CoV-¬2.  Of these, 5 are considered at high risk, as a precautionary measure, as they cannot be reliably assessed, because surveillance data were not complete at the time of assessment. Another 8 regions/PAs are classified as moderate risk, with a high probability of progress to high risk in the coming month.
  • This week there has been a further strong increase in cases, which brings the cumulative incidence (ISS flow data) in the last 14 days to 279.72 per 100,000 inhabitants, in the period 12/10-¬-25/10 (vs 146.18 per 100,000 inhabitants in the period 5/10-¬-18/10). In the same period, the number of symptomatic cases doubled: from 27,117 (period 5/10-¬-18/10) to 54,377 (period 12/10-¬-25/10).  The increase in cases is widespread throughout the country, with all Regions/PPAA reporting an increase in the number of diagnosed cases, compared to the previous week (MdS flow).
  • In the period 08 - 21 October 2020, the Rt calculated on symptomatic cases was equal to 1.70 (95%CI: 1.49 - 1.85). There are Rt values higher than 1.25 in most Italian Regions/Pas, with values higher than 1.5 in different Regions/PAs. For details on how to calculate and interpret the Rt reported, please refer to the detailed information available on the Higher Institute of Health website.
  • It should be noted that alerts on the resilience of territorial health services have been reported in almost all Regions/PPAA. In addition
    • There was a deterioration in the quality of data reported to the integrated surveillance system, both for timeliness (delay in reporting cases reported to the surveillance system on aggregate data coordinated by the Ministry of Health) and for completeness. This is a further critical element of resilience and may lead to an underestimation of transmission speed and risk.
    • The percentage of cases detected through contact tracing activities continued to drop (19.2%) while an increase in the percentage of cases detected for the appearance of symptoms continued to be observed (32.6%). The percentage of cases detected through screening activities remained relatively stable (28.3%) while the increase (19.9%) in the percentage of cases in which the reason for the diagnostic test was not reported is confirmed.
    • The number of cases not attributable to known transmission chains continued to increase (49,511 cases this week vs. 23,018 the previous week), exceeding 80% of new cases reported in some Regions/PAs.

This week, for the first time, the critical threshold of employment in medical areas (40%) has been reported to have been exceeded in some territories, and there is a high probability that 15 Regions/PPAA will exceed the critical thresholds of intensive care and/or medical areas in the coming month. Overall, the number of people admitted to intensive care has risen from 750 (18/10) to 1,208 (25/10); while the number of people admitted to medical areas has risen from 7,131 (18/10) to 12,006 (25/10).

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Data di pubblicazione: 5 novembre 2020, ultimo aggiornamento 20 novembre 2020

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