Covid, close-up on the situation in Italy on infections, hospitalizations and vaccinations

The latest weekly monitoring by the ISS and the Ministry of Health a few days ago provides one rosy photography of the Italian epidemiological situation. The national Rt index fell to 0.63, well below the threshold of 1, the incidence of cases (essential parameter for the classification of regions in colors) a 9 for every 100 thousand inhabitants compared to 11 a dozen days ago. And also the burden for the national health system is currently minimal: 3% occupancy in intensive care (the critical threshold is 30%) e always 3% in the medical area (with a threshold of 40%). As of July 5th the numbers say they are respectively 191 seriously ill patients e 1.337 those hospitalized. The current positives, at least the official ones, are just over 43 thousand. In constant decline for several weeks now. Deaths are also on the declineAccording to more updated data, 177 people died in the week ending 5 July, about 25 per day. Last week they had been 202 and scrolling through the previous weeks 268, 432, 477, 821, 1,069. In certain moments of the epidemic we have had 800 deaths in a single day.

However the decline in infections has sharply reduced in the last two weeks. Already the ISS monitoring, and the rapid sample investigations on the sequencing, showed that the proportion of cases of Delta variant infection was increasing. The various outbreaks in many parts of Italy, as indeed in at least a dozen European countries that are witnessing a linear rise for now (even the WHO has sounded the alarm for a difficult autumn again), they could undoubtedly be at the basis of this progressive slowdown, which is in all probability destined to score one case resumption. As the British case shows, however, the relationship between infections, hospitalizations (also increasing, but much more contained than the population that is becoming infected) and deaths has greatly weakened thanks to the protective shield of vaccines: less than one in 50 infected ends up in hospital, while in January it happened to one in ten. For this reason, the country will reopen all activities on 19 July anyway. But he is in quite a different condition from ours and the one taken by the former mayor of London is a largely political decision: Boris Johnson’s message is that everyone has the chance to get vaccinated – 85% had one dose and two thirds both – and therefore this is the right time, given the success of vaccines, to reopen and get used to living with Sars-CoV-2 despite a boom in cases and other deaths.

In Italy we proceed abundantly above 500 thousand injections a day and the current picture is 54.3 million vaccines administered: 39.2% of the population over the age of 12 completed the vaccination cycle, over 55% received at least one dose. The extraordinary commissioner Figliuolo has repeatedly reassured the regions that adequate supplies will arrive during the summer to maintain this pace: we will see if in some territories, against the logic that instead it would take very fast vaccinations, appointments will have to be postponed. To date, 60.9 million doses have been delivered and 54.3 have been used, with the case differences related to the obvious underutilization of AstraZeneca and Johnson & Johnson and substantial dependence on Pfizer and to a much lesser extent Moderna.

Indeed, we must insist and do more. Recover those for example 2.5 million people over 60 which for various reasons has not yet been seen by local health systems. I am at risk both now and in the fall. In particular, 1,458,624 people are waiting for a vaccine in the 60-69 age group, equal to 19.31%. In the 70-79 year range they are 781,499 equal to 12.98%. In the over 80 group there are 345,390, equal to 7.58%. Too many: we cannot afford them. They are people who risk their lives or end up in hospital, if not immediately within a few weeks and especially in the fall, when they will be more likely to meet an infected on their way. Then it is necessary shorten the timing of recalls, avoid hesitation, too many holiday calculations and waste of time. To be able to show up for the autumn appointment with at least 85% of the fully vaccinated population: that, in fact, is the new threshold calculated on the basis of the replication index of the Delta variant, 40-60% more contagious than the Alpha, still the predominant strain for a little while. The full cycle works against the Delta, particularly against severe cases, so there aren’t too many concerns from that point of view.

The concern is precisely to vaccinate, to run faster to contain the consequences on hospitals: physicist Roberto Battiston, full professor at the University of Trento and responsible for Agenas data on the pandemic in the Italian regions, explained to the Corriere della Sera that we must arrive at88% of the vaccinated population. Other experts identify the threshold at 80%, against the old one of 60% estimated on the first strain of the virus and the following ones. In short, the more the replication rate rises, the more the population needs to be vaccinated to slow down and then stop the propagation. It is difficult to reach that figure by the end of September, in time to be completely protected for the autumn season: for this reason many have returned to talk about vaccination obligation. Given that we will not be able to talk about new closures, and certainly not as rigid as those of the past few months, one of the possible ways will be to prevent the unvaccinated from a series of activities that will only require the completion of the vaccination cycle. Otherwise, what is the point of getting vaccinated and then having to submit to the same measures as those who, on the other hand, irresponsibly don’t care?

The first signs of the reversal of the trend in the decline in infections, uninterrupted since the spring, had indeed arrived in recent weeks. Delta is no surprise. In the past, the decline was just over 5,7% – but in 7 regions and two provinces the numbers were growing – against 31.2 in the week of 21-27 June, with a comparable number of swabs. Since April, the trend has not fallen below 10% and it is likely that it has substantially interrupted. Precisely because of the Delta variant, destined to become dominant during August and replace the Alpha. On the other hand, the decreases in hospitalizations in the medical area and in intensive care continued with significant percentages. It remains to be understood how this growth in cases will develop during the summer and early autumn, to what extent the partial protection of vaccines will be able to break the link between infections, hospitalizations and deaths also in Italy and how much other elements instead (such as the outdoor life, the conditions of high temperatures and insolation and the maintenance of the masks indoors and in group conditions) will be able to provide us with a few more precious weeks by September.