Tag: eccesso di mortalità

Effect of timing of implementation of the lockdown on the number of deaths for COVID-19 in four European countries

Publication date: 20/10/2020 – E&P Code: repo.epiprev.it/1984
Authors: Raffaele Palladino1,2,3, Jordy Bollon4, Luca Ragazzoni4,5, Francesco Barone-Adesi4,5

Abstract: Background: Lockdown in France, Italy, Spain and United Kingdom, the four European countries which have been impacted the most by the COVID-19 emergency, was enforced 13 to 16 days after the one in Hubei, when normalizing for the time when the outbreak hit 50 cases in all countries. This prompts the question on how many deaths for COVID-19 could have been avoided during the early phase of the pandemic, had containment measures in European countries aligned in timing with those adopted in China.
Methods: We modeled the daily number of COVID-19 deaths in France, Italy, Spain, United Kingdom and we estimated the effect of the national lockdown implementing an interrupted time series analysis. Then, we created four separate counterfactual scenario by predicting the daily number of deaths that would have been observed in the four countries if the lockdown had been implemented at the same time as in Hubei. Finally, we estimated the relative change in the number of total deaths in the counterfactual scenario, compared to the observed one.
Results: If an early lockdown had been implemented, the death toll would have been 2461, 6769, 6792 and 4071, corresponding to a 92% (95%CI: 86% to 95%), 81% (95%CI: 77% to 84%), 78% (95%CI: 62% to 86%) and 90% (95%CI: 88% to 92%) relative reduction, as compared with observed data.
Conclusions: We found that a more rapid and homogeneous response would have avoided a substantial number of deaths. Our results underline the need of strengthening public health emergency preparedness at national and global level.

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A municipality-level Analysis of Excess Mortality in Italy in the period January-April 2020

Publication date: 10/07/2020 – E&P Code: repo.epiprev.it/1911
Authors: Annibale Biggeri1, Dolores Catelan1, Mario Braga2, Corrado Lagazio3, Fabio BarboneSottomesso alla peer review sulla rivista Epidemiologia&Prevenzione

Abstract: The first confirmed cases of Covid-19 in WHO European region was reported at the end of January 2020, and from that moment the epidemic has been speeding up and rapidly spreading across Europe. The health, social and economic consequences of the pandemic are difficult to evaluate since there are many scientific uncertainties and unknowns. Several authors discussed the preventable methodologic errors that have arisen in reporting on the COVID-19 crisis. The use of excess mortality for all causes has been advocated as a less biased measure of impact. The main focus of this paper is on statistical methods for the identification of spatial clusters of excess mortality, directly or indirectly caused by Covid-19. In particular, we analyzed mortality for all causes at municipality level in Italy 2015-2020 and compared excesses observed January-April 2020 with the corresponding period in the previous 5 years. Mortality data were made available by the Ministry of Internal Affairs Italian National Resident Population Demographic Archive and Italian Central Statistical Institute (ISTAT). We obtained for each municipality the posterior predictive distribution under a hierarchical null. We calculated the one-sided tail probabilities over the posterior predictive distribution using the observed death counts. Post processing of posterior predictive probabilities is conducted to account for multiplicity. Excess death counts are obtained using the posterior relative risk using as reference the municipality-specific expected count – the mean of the posterior predictive distribution – and the observed 2020 death counts. Attributable Community Rate is also calculated using the population denominators. Full Bayesian models implemented via MCMC simulations were conducted. The scientific community has been debating on the extent of the consequences of the pandemic in Italy or, in other terms, on how many deaths were caused by the virus well above the seasonal mortality. Our study is not intended to answer this question, but to provide a methodological approach to analyze epidemic data accounting for the spatial and temporal uncertainty.

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Sorveglianza della mortalità durante la pandemia COVID-19 in regione Emilia-Romagna

Publication date: 23/06/2020 – E&P Code: repo.epiprev.it/1878
Authors: Bartolini Letizia1, Chiara Di Girolamo1, Nicola Caranci1, Maria Luisa Moro1

,Abstract: La pandemia legata alla diffusione del virus SARS-CoV-2 ha determinato un impatto sanitario dalle dimensioni inizialmente difficili da definire. Tra le prime attività di monitoraggio in vari ambiti geografici italiani vi è stata l’analisi della mortalità generale e tra i casi notificati come positivi nel sistema di sorveglianza del COVID-19. Con l’obiettivo di analizzare l’ordine di grandezza, in termini assoluti e in riferimento all’atteso del quinquennio 2015-2019, si sono descritti i decessi avvenuti nel periodo 1° gennaio-15 maggio nell’intera regione Emilia-Romagna. Tramite le registrazioni che alimentano l’anagrafe delle persone assistite e la registrazione delle notifiche, si è potuto rilevare un eccesso della mortalità del 24% (uomini: 29%, donne: 19%) rispetto ai valori medi dello stesso periodo del quinquennio precedente. Mentre fino a febbraio 2020 la mortalità era stata inferiore all’atteso, è seguito un sensibile aumento fino ad un massimo nella settimana 18-24 marzo (+113%). Tale eccesso è stato più accentuato nelle provincie occidentali (+491% nella provincia di Piacenza) e sensibilmente minore nella provincia di Ferrara e in Romagna, ad eccezione di Rimini, che ha avuto un impatto di intensità intermedia e spostato in avanti, come avvenuto a Reggio Emilia e a Modena. A Bologna la massima intensità si è registrata ancora più avanti nel tempo (aprile inoltrato).

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Excess deaths and hospital admissions for COVID-19 due to a late implementation of the lockdown in Italy

Publication date: 05/06/2020 – E&P Code: repo.epiprev.it/1735
Authors: Raffaele Palladino1,2, Jordy Bollon3, Luca Ragazzoni3,4, Francesco Barone-Adesi3,4

Abstract: Background: In Italy, the COVID-19 pandemic led to the implementation of containment measures to the highest level, with a national lockdown enforced on March 9th, 2020. Despite this, by the time the epidemic curve started to flatten the health system already exceeded its capacity in different areas of the country, raising concerns that the public health response was indeed delayed. Aim of this study was to evaluate the health effects of late implementation of the lockdown in Italy.
Methods: Using national data on daily number of COVID-19 cases we first estimated the effect of the lockdown, employing an interrupted time series analysis. Second, we evaluated the effect of an early lockdown on the trend of new cases, creating a counterfactual scenario where the intervention was implemented one week in advance. We then predicted the corresponding number of intensive care unit (ICU) admissions, non-ICU admissions, and deaths. Finally, we compared the number of hospital admissions and deaths under the actual and counterfactual scenarios.
Results: an early implementation of the lockdown would have avoided about 126,000 COVID-19 cases, 54,700 non-ICU admissions, 15,600 ICU admissions, and 12,800 deaths. On the relative scale, this corresponds to a reduction of 60% (95%CI: 55% to 64%), 52% (95%CI: 46% to 57%), 48% (95%CI: 42% to 53%), and 44% (95%CI: 38% to 50%), respectively.
Conclusions: We found that the late implementation of the lockdown in Italy was responsible for a substantial proportion of hospital admissions and deaths associated with the COVID-19 pandemic. Understanding the factors contributing to a delayed response is necessary to strengthen public health preparedness in case of a second wave of infections.

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