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      The Europe second wave of COVID-19 infection and the Italy “strange” situation

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          Abstract

          At the end of February 2020 COVID-19 infection appeared in Italy, with consequent diffusion, in few weeks, in almost all the Europe. Despite that human-to-human is the recognized main virus transmission way, several authors supposed pollution-to-human mechanisms to justify the appearance of contagious in Italy. However, these works often suffered of a lack of analysis of possible overlapping of different variables, other than only environmental ones.

          After a decreasing of detected cases in summer, Europe faced with the appearance of a COVID-19 second wave. In this context the Italy situation appeared to be “strange”. Indeed, compared with the other selected Countries (France, Germany, UK, and Spain), the Italian infection cases resulted to be lower, in the same analysed period. This work is devoted to find a possible justification of the unexpected situation found in Italy. A comparison of the imposed restrictions in the considered Countries allows to highlight that some policies result more effective to limit the virus spread. This clearly shows that the imposed constraints and the people capacities to receipt them are fundamental parameters that must be always accounted in the determination of the virus expansion. The lesson provided by Italy should be achieved by other member states where the COVID-19 sanitary crisis results to be worse. It is evident that the re-opening of ordinary activities involving people interactions, in Autumn, may contribute to promote a larger SARS-CoV-2 diffusion also in Italy.

          Author strongly highlights that pollution-to-human transmission mechanisms cannot be proposed whiteout considering the complexity of human-to-human interactions, that can be modified by imposed restrictions. It is fundamental to understand that a more precise acknowledge of the variables that should be considered in model predictions, instead of a need of more precise point prediction, will contribute to increase the reliability and the comprehension of the virus diffusion mechanisms, that is fundamental to face this pandemic period.

          Highlights

          • Italy was the first EU Country to suffer severe effects of SARS-CoV-2 diffusion during COVID-19 first wave.

          • During second wave Italy seems to be less affected by pandemic in comparison to other EU Countries.

          • The restrictions imposed in the selected Countries and the corresponding trend of COVID-19 diseases are discussed.

          • Results suggest that the complexity of human-to-human interactions should be always accounted in any model about virus spread.

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          COVID-19 and Italy: what next?

          Summary The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
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            The effect of human mobility and control measures on the COVID-19 epidemic in China

            The ongoing COVID-19 outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions have been undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We use real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation on transmission in cities across China and ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. Following the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.
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              The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study

              Summary Background In December, 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, emerged in Wuhan, China. Since then, the city of Wuhan has taken unprecedented measures in response to the outbreak, including extended school and workplace closures. We aimed to estimate the effects of physical distancing measures on the progression of the COVID-19 epidemic, hoping to provide some insights for the rest of the world. Methods To examine how changes in population mixing have affected outbreak progression in Wuhan, we used synthetic location-specific contact patterns in Wuhan and adapted these in the presence of school closures, extended workplace closures, and a reduction in mixing in the general community. Using these matrices and the latest estimates of the epidemiological parameters of the Wuhan outbreak, we simulated the ongoing trajectory of an outbreak in Wuhan using an age-structured susceptible-exposed-infected-removed (SEIR) model for several physical distancing measures. We fitted the latest estimates of epidemic parameters from a transmission model to data on local and internationally exported cases from Wuhan in an age-structured epidemic framework and investigated the age distribution of cases. We also simulated lifting of the control measures by allowing people to return to work in a phased-in way and looked at the effects of returning to work at different stages of the underlying outbreak (at the beginning of March or April). Findings Our projections show that physical distancing measures were most effective if the staggered return to work was at the beginning of April; this reduced the median number of infections by more than 92% (IQR 66–97) and 24% (13–90) in mid-2020 and end-2020, respectively. There are benefits to sustaining these measures until April in terms of delaying and reducing the height of the peak, median epidemic size at end-2020, and affording health-care systems more time to expand and respond. However, the modelled effects of physical distancing measures vary by the duration of infectiousness and the role school children have in the epidemic. Interpretation Restrictions on activities in Wuhan, if maintained until April, would probably help to delay the epidemic peak. Our projections suggest that premature and sudden lifting of interventions could lead to an earlier secondary peak, which could be flattened by relaxing the interventions gradually. However, there are limitations to our analysis, including large uncertainties around estimates of R 0 and the duration of infectiousness. Funding Bill & Melinda Gates Foundation, National Institute for Health Research, Wellcome Trust, and Health Data Research UK.
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                Author and article information

                Journal
                Environ Res
                Environ Res
                Environmental Research
                Elsevier Inc.
                0013-9351
                1096-0953
                19 November 2020
                19 November 2020
                : 110476
                Affiliations
                [1]INSTM and Chemistry for Technologies, University of Brescia, via Branze 38, 25123 Brescia, Italy
                Article
                S0013-9351(20)31373-6 110476
                10.1016/j.envres.2020.110476
                7674970
                33221311
                d45e2413-e44c-4464-a824-1e8db86956dd
                © 2020 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 1 October 2020
                : 2 November 2020
                : 10 November 2020
                Categories
                Article

                General environmental science
                covid-19,sars-cov-2,italy,second wave,facemask,restriction measures,human-to-human interactions,air pollution,urban resilience

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