Felice, C

Grossi, U

Zanus, G

English

Grossi Ugo

Zanus Giacomo

Felice Carla

Archivio istituzionale della ricerca - Università di Padova

Letter to the EditorCoronavirus disease 2019 in Italy: The Veneto modelUgo Grossi MD, PhD1,2 , Giacomo Zanus MD1 and Carla Felice MD, PhD11Regional Hospital Treviso, University of Padua, Italy and 2Centre for Neuroscience, Surgery and Trauma, Barts and the London School of Medicine & Dentistry,Queen Mary University of London, London, United KingdomTo the Editor—In a Viewpoint article in the Journal of theAmerican Medical Association (JAMA) regarding the thirdnovel coronavirus (SARS-CoV2) outbreak in Wuhan, China, inDecember 2019, Drs Wu and McGoogan presented the key find-ings in a large case series of 72,314 infected individuals, refiningthe estimates in China to severe disease in 14% of cases and acase-fatality rate of 2.3%.1 Among the total case records, only889 (1%) were classified as asymptomatic (ie, lacking typicalsymptoms including fever, dry cough, and fatigue), >5 timeslower than those observed in Italy.2 After February 21, 2020,Italy became the hardest-hit country, with the highest death tollof 17,127 (>5 times as much as China) and 135,586 confirmedcases on April 7, 2020.Recent evidence shows that 86% of all infections were undocu-mented prior to the Wuhan shutdown on January 23, 2020, repre-senting the infection source for 79% of documented cases.3 It hasnow become evident that the percentage of mild or asymptomaticcases in developed societies, such as China and Italy, prior to majorrestrictions or control, was much higher than previously recog-nized. Although challenging without strict containment measures,Fig. 1. Timeline of number of tests for SARS-COV-2 per million people (dotted lines) and case fatality rate (solid lines) in Lombardia (blue) and Veneto (red).Source: Italian Civil Protection and Ministry of Health.Author for correspondence: Ugo Grossi, E-mail: ugo.grossi@qmul.ac.ukCite this article: Grossi U, Zanus G, and Felice C. (2021). Coronavirus disease 2019 inItaly: The Veneto model. Infection Control & Hospital Epidemiology, 42: 236–237, https://doi.org/10.1017/ice.2020.225© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved. This is anOpen Access article, distributed under the terms of the Creative Commons Attribution licence(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Infection Control & Hospital Epidemiology (2021), 42, 236–249doi:10.1017/ice.2020.225https://doi.org/10.1017/ice.2020.225 Published online by Cambridge University Pressidentification of these subjects may slow the spread of SARS-CoV2.The cases of Veneto and Lombardia, contemporaneously affectedneighboring regions in Italy, provide 2 telling examples withstrikingly different endings. As of April 15, 2020, a total of 44,107tests per million people have been performed in Veneto, which isdouble the number of tests conducted in Lombardia (Fig. 1).Indeed, in contrast to the neighboring region, Veneto adopted alarge-scale population screening model at the beginning of the out-break, allowinghome isolation for a larger number ofmild (or asymp-tomatic) cases (85% vs 60% of active cases according to the lastestimates).4 This strategymay have avoided overwhelming the healthsystem, with a consequent positive impact on the case fatality rate inVeneto, which is currently almost 3 times lower than that inLombardia.In fact, in line with previous modeling predictions,5 Lombardiadid run out of intensive care beds at the end ofMarch, resulting in theneed to transfer critical patients to other Italian regions or Europeancountries. Furthermore, between one-half and one-third of the dailynational deaths are still being recorded in this region at this time.At a time when Italy is facing its biggest challenge since WorldWar II, the ‘Veneto model’ indicates that early mass screeningfor SARS-CoV-2 can make a positive difference, and it should berecommended to other countries responding to the COVID-19pandemic.Acknowledgments. None.Financial support. No financial support was provided relevant to this article.Conflicts of interest.All authors report no conflicts of interest relevant to thisarticle.References1. Wu Z, McGoogan JM. Characteristics of and important lessons from thecoronavirus disease 2019 (COVID-19) outbreak in China: summary of areport of 72,314 cases from the Chinese Center for Disease Control andPrevention. JAMA 2020;323:1239–1242.2. Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy.JAMA 2020;323:1335.3. Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates therapid dissemination of novel coronavirus (SARS-CoV2). Science 2020;368:489–493.4. Coronavirus in Italia, i dati e la mappa [in Italian]. Lab 24 website. https://lab24.ilsole24ore.com/coronavirus/. Accessed April 15, 2020.5. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020;395:1225–1228.Battle with COVID-19 in Iran: What lessons can be learned fromthe implementation of response strategies so far?Mehrdad Amir-Behghadami MSc1,2,3 , Ali Janati PhD1,2 and Masoumeh Gholizadeh PhD1,21Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences,Tabriz, Iran, 2Iranian Center of Excellence in Health Management (IceHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences,Tabriz, Iran and 3Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, IranTo the Editor—The novel coronavirus disease (COVID-19), withhuman-to-human transmission and severe human infection, hasbeen escalating rapidly since lateDecember 2019.1 Disease symptomscan range from mild flu-like cases to severe cases with life-threaten-ing pneumonia.2,3 The global condition is evolving dynamically,and on January 30, 2020, the World Health Organization (WHO)announced that COVID-19 is a “public-health emergency ofinternational concern.” During the coronavirus pandemic, theauthorities of the Iranian Ministry of Health and MedicalEducation (MOHME) reported the first cases of coronavirus onFebruary 19, 2020 in Qom.4 As of March 6, 2020, according toMOHME, 27,017 cases of COVID-19 have been identified in thecountry, 2,077 ofwhomhave died and 9,625 of whomhave recoveredso far. Following the widespread outbreak of SARS-CoV-2 in China,the MOHME launched a campaign in early February 2020 includingmonitoring and examining all incoming travelers from China andquarantine of Iranian students residing in China.Currently, no licensed vaccine for specific antiviral preventionand treatment is available for COVID-19.5 Therefore, the mosteffective measures are to eliminate the source of infection, tocut off the transmission route and to protect the susceptible.6Prevention and control became the most urgent task in Iran duringthe early days of the sudden outbreak of the SARS-CoV-2 virus.7,8In this regard, the government has invested large amounts ofhuman capital and material resources. Regarding the origin ofthe infection, people who are in close contact with patients maybecome new patients or new sources of infection. For this reason,the first action after the media provided public education onCOVID-19 disease was to establish a Corona National AntivirusHeadquarters chaired by the President of Iran and headed bythe MOHME. With the establishment of the headquarters, manyactions were taken, such as canceling public events and Fridayprayers; closing schools, universities, shopping centers andbazaars, as well as holy shrines; and banning festival celebrations.Economic measures were also taken to assist families andbusinesses. With the intersectoral collaboration, the headquartersis trying to control the outbreak of SARS-CoV-2. The Ministry ofRoads and Urban Development initiated the necessary steps forpublic transport, and the Ministry of Industry, Mine, and TradeAuthor for correspondence: Mr. Mehrdad Amir-Behghadami, Iranian Center ofExcellence in Health Management, School of Management and Medical Informatics,Tabriz University of Medical Sciences, University Rd, Golbad, EAZN 5165665811,Tabriz, East Azerbaijan, Iran. E-mail: Behghadami.m@gmail.com.Cite this article:Amir-BehghadamiM, Janati A, and GholizadehM. (2021). Battle withCOVID-19 in Iran: What lessons can be learned from the implementation of responsestrategies so far?. Infection Control & Hospital Epidemiology, 42: 237–239, https://doi.org/10.1017/ice.2020.231© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved. This is anOpen Access article, distributed under the terms of the Creative Commons Attribution licence(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Infection Control & Hospital Epidemiology 237https://doi.org/10.1017/ice.2020.225 Published online by Cambridge University Press

Coronavirus disease 2019 in Italy: the Veneto Model

Queen Mary Research Online

Letter to the EditorCoronavirus disease 2019 in Italy: The Veneto modelUgo Grossi MD, PhD1,2 , Giacomo Zanus MD1 and Carla Felice MD, PhD11Regional Hospital Treviso, University of Padua, Italy and 2Centre for Neuroscience, Surgery and Trauma, Barts and the London School of Medicine & Dentistry,Queen Mary University of London, London, United KingdomTo the Editor—In a Viewpoint article in the Journal of theAmerican Medical Association (JAMA) regarding the thirdnovel coronavirus (SARS-CoV2) outbreak in Wuhan, China, inDecember 2019, Drs Wu and McGoogan presented the key find-ings in a large case series of 72,314 infected individuals, refiningthe estimates in China to severe disease in 14% of cases and acase-fatality rate of 2.3%.1 Among the total case records, only889 (1%) were classified as asymptomatic (ie, lacking typicalsymptoms including fever, dry cough, and fatigue), >5 timeslower than those observed in Italy.2 After February 21, 2020,Italy became the hardest-hit country, with the highest death tollof 17,127 (>5 times as much as China) and 135,586 confirmedcases on April 7, 2020.Recent evidence shows that 86% of all infections were undocu-mented prior to the Wuhan shutdown on January 23, 2020, repre-senting the infection source for 79% of documented cases.3 It hasnow become evident that the percentage of mild or asymptomaticcases in developed societies, such as China and Italy, prior to majorrestrictions or control, was much higher than previously recog-nized. Although challenging without strict containment measures,Fig. 1. Timeline of number of tests for SARS-COV-2 per million people (dotted lines) and case fatality rate (solid lines) in Lombardia (blue) and Veneto (red).Source: Italian Civil Protection and Ministry of Health.Author for correspondence: Ugo Grossi, E-mail: ugo.grossi@qmul.ac.ukCite this article: Grossi U, Zanus G, and Felice C. (2020). Coronavirus disease 2019 inItaly: The Veneto model. Infection Control & Hospital Epidemiology, https://doi.org/10.1017/ice.2020.225© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved. This is anOpen Access article, distributed under the terms of the Creative Commons Attribution licence(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Infection Control & Hospital Epidemiology (2020), 1–2doi:10.1017/ice.2020.225identification of these subjects may slow the spread of SARS-CoV2.The cases of Veneto and Lombardia, contemporaneously affectedneighboring regions in Italy, provide 2 telling examples withstrikingly different endings. As of April 15, 2020, a total of 44,107tests per million people have been performed in Veneto, which isdouble the number of tests conducted in Lombardia (Fig. 1).Indeed, in contrast to the neighboring region, Veneto adopted alarge-scale population screening model at the beginning of theoutbreak, allowing home isolation for a larger number of mild (orasymptomatic) cases (85% vs 60% of active cases according to thelast estimates).4 This strategy may have avoided overwhelming thehealth system, with a consequent positive impact on the case fatalityrate in Veneto, which is currently almost 3 times lower than that inLombardia.In fact, in line with previous modeling predictions,5 Lombardiadid run out of intensive care beds at the end of March, resulting inthe need to transfer critical patients to other Italian regions orEuropean countries. Furthermore, between one-half and one-thirdof the daily national deaths are still being recorded in this region atthis time.At a time when Italy is facing its biggest challenge since WorldWar II, the ‘Veneto model’ indicates that early mass screeningfor SARS-CoV-2 can make a positive difference, and it should berecommended to other countries responding to the COVID-19pandemic.Acknowledgments. None.Financial support. No financial support was provided relevant to this article.Conflicts of interest. All authors report no conflicts of interest relevant to thisarticle.References1. Wu Z, McGoogan JM. Characteristics of and important lessons from thecoronavirus disease 2019 (COVID-19) outbreak in China: summary of areport of 72,314 cases from the Chinese Center for Disease Control andPrevention. JAMA 2020;323:1239–1242.2. Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy.JAMA 2020;323:1335.3. Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates therapid dissemination of novel coronavirus (SARS-CoV2). Science 2020;368:489–493.4. Coronavirus in Italia, i dati e la mappa [in Italian]. Lab 24 website. https://lab24.ilsole24ore.com/coronavirus/. Accessed April 15, 2020.5. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020;395:1225–1228.2 Ugo Grossi et al

Coronavirus disease 2019 in Italy: The Veneto model.

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Coronavirus disease 2019 in Italy: The Veneto model.

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