Covid-19 weekly monitoring, report of September 7-13

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    Key Points: 

    • An analysis of the data for the period 7-13 September 2020 is provided below. 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 between the end of August and the beginning of September. 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 seventh consecutive week is confirmed, with a cumulative incidence (ISS flow data) in the last 14 days (period 31/8-13/9) of 29.63 per 100 000 inhabitants. Most cases (81.9%) continue to be contracted on our national territory, with a decrease in cases imported from abroad (10.8% of new cases diagnosed in the week of monitoring). In 7.3% of cases the information is not specified. The percentage of cases imported from other Regions/PAs has been decreasing for a fortnight (5.5% in the current week).
    • During the summer, in Italy, as in the rest of Europe, there was an epidemiological transition of the SARS-CoV-2 epidemic, with an increased circulation of the virus in a context of advanced reopening of commercial activities (including meeting places) and increased intra- and international mobility of the younger population.
    • For three weeks now, however, there has been a further epidemiological change. Last week’s signs of increased transmission in the home with virus circulation even among older people are confirmed. The median age of the cases diagnosed is still increasing (41 years in the monitoring week) and 35% of the new cases diagnosed in the monitoring week are older than 50 years.
    • Transmission dynamics remain extremely fluid: outbreaks associated with recreational activities continue to be observed (unchanged compared to last monitoring week) with a further increase in transmission in the family/domestic environment (73.6% of all active outbreaks in the monitoring week for which the context of probable exposure is specified).
    • Starting from June, probably due to the reopening on May 4 and 18 and June 3, a slight but steady increase in the national transmission index (Rt) was noted at national level, which exceeded the threshold of 1 around 16 August 2020. In the period 27 August to 9 September 2020, the Rt calculated on symptomatic cases was 0.92 (95% CI: 0.79 – 1.17), below 1 on average after two weeks. For details on the calculation and interpretation of the Rt reported, please refer to the detailed information available on the website of the Higher Institute for Health.
    • 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 also considering incidence data.
    • Moreover, in this week of monitoring, new cases of SARSCoV-2 infection were diagnosed in all Regions/PPAA. During the current week of monitoring, 30.0% of new cases diagnosed in Italy were identified through screening activities and 35.2% through contact tracing activities. The remaining cases were identified as symptomatic (28.7%), or the reason for the diagnostic assessment is not reported (6.1%). Therefore, overall, 65.2% of the new cases were diagnosed thanks to intensive screening and case investigation, with identification and monitoring of close contacts.
    • The virus now circulates throughout the country. Ten Regions/PPAA reported an increase in the number of diagnosed cases, compared to the previous week (ISS flow), which cannot be attributed solely to an increase in cases imported from foreign states and/or other regions. In almost all the Regions/PAA a high number of new cases continues to be reported and a substantially increasing trend has been observed for several weeks. Outbreaks are reported in almost all provinces, (101/107) and all Regions/PAs reported at least one new outbreak in the monitoring week. This should call for caution as it shows that the circulation of SARS-CoV-2 is increasingly important in the country. Compared to the period August 17-30, 2020, in almost all Regions there is an increase in the occupancy rate of dedicated beds, in both medical and intensive care areas. At national level, the employment rate in the medical area has increased from 2% to 4%, while the employment rate in intensive care has increased from 1% to 2%, with values above 5% for some Regions. Although no signs of overburdening of health care services have yet been identified, the observed trend could be reflected in increased efforts. Moreover, the important and growing commitment of the territorial services (Prevention Departments) is confirmed, ensuring that the current outbreaks are promptly identified and investigated.
    • In the current week of monitoring a total of 2397 active outbreaks were reported, of which 698 new cases (the adopted definition of outbreak foresees the identification of 2 or more related positive cases), both increasing for the seventh consecutive week (in the previous week of monitoring, 2280 active outbreaks were reported, of which 691 are new). This implies an increasing commitment of the territorial services in the search for contacts, having so far managed to contain the local transmission of the virus.

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