Yes, surveillance should include all positives, including asymptomatic ones. Just before the CTS meeting on changes to the daily Covid 19 bulletin, the Istituto Superiore di Sanità has published its Faq (the answers to frequently asked questions), in which it reiterates that “the importance of monitoring cases through surveillance should not be confused with the criteria by which indications for cases and contacts”.
The CTS is already reflecting on possibility to make the monitoring weekly of the Ministry of Health on new positives, hospitalized and victims. The Regions, given the obvious impossibility of tracing due to the high number of infected people due to the rapid spread of the Omicron variant, they would like to consider only the symptomatic cases, remove the end-of-quarantine pad for those with no symptoms and review the rules for elementary schools. The European Center for Disease Control also suggests considering only symptomatic positivity and not asymptomatic positivity cases. This would greatly reduce the daily count because symptomatic positives are 30% of the current positives.
According to the Istituto Superiore di Sanità, however, it is necessary to count the positives and not only the symptomatic cases (respiratory symptoms, high fever, altered taste and smell) because “the SARS-CoV-2 infection it gives a variegated and evolving symptomatology also due to the appearance of new viral variants which often interact in different ways with our organism. This makes it very difficult to clinically recognize a symptomatic SARS-CoV-2 infection in the absence of laboratory confirmation. ”
Furthermore, “experience has shown that most infections, particularly in vaccinated subjects, proceed asymptomatically or with very nuanced symptoms. Not monitoring these cases would limit our ability to identify emerging variants, their characteristics and we could not know the clinical status that follows the infection in the different populations (eg by age, vaccination status, comorbidities). Furthermore, it would not make it possible to monitor the progress of the circulation of the virus over time and, consequently, the risks of a detrimental impact on the ability to maintain adequate levels of health care even for diseases other than COVID-19 ».
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