Excess Mortality on Italian Small Islands during the SARS-CoV-2 Pandemic: An Ecological Study

Abstract

Small islands have been considered at an advantage when dealing with infectious diseases, including COVID-19, but the evidence is still lacking. Crude mortality rates (CMRs) and excess mortality rates (EMRs) were calculated for 35 municipalities on the Italian small islands for 2020 and 2021, and the corresponding estimates were compared to those of the parent provinces and the national estimates. Notification rates for COVID-19 were retrieved, but detailed data at the municipality level were not available. A relatively low CMR (1.069 per 100 per year, 95% confidence interval [95% CI] 0.983–1.164) was identified in 2020, compared to 1.180, 95% CI 1.098–1.269 for 2021. EMRs of small islands ranged between −25.6% and +15.6% in 2020, and between −13.0% and +20.9% in 2021, with an average gain of +0.3% (95% CI −5.3 to +5.8) for the entirety of the assessed timeframe, and no substantial differences between 2020 and 2021 (pooled estimates of −4.1%, 95% CI −12.3 to 4.1 vs. 4.6%, 95% CI −3.1 to 12.4; p = 0.143). When dealing with COVID-19 notification rates, during the first wave, parent provinces of Italian small islands exhibited substantially lower estimates than those at the national level. Even though subsequent stages of the pandemic (i.e., second, third, and fourth waves) saw a drastic increase in the number of confirmed cases and CMR, estimates from small islands remained generally lower than those from parent provinces and the national level. In regression analysis, notification rates and mortality in the parent provinces were the main effectors of EMRs in the small islands (β = 0.469 and β = 22.768, p < 0.001 and p = 0.007, respectively). Contrarily, the management of incident cases in hospital infrastructures and ICUs was characterized as a negative predictor for EMR (β = −11.208, p = 0.008, and −59.700, p = 0.003, respectively). In summary, the study suggests a potential role of small geographical and population size in strengthening the effect of restrictive measures toward countering the spread and mortality rate of COVID-19.

Infodemiology of RSV in Italy (2017–2022): An Alternative Option for the Surveillance of Incident Cases in Pediatric Age?

“…Fifth, it should be stressed that the early stages of the SARS-CoV-2 pandemic mostly occurred unnoticed to the Italian general population: as recently pointed out by some studies [ 97 , 98 , 99 , 100 ], well before the official diagnosis of first cases of COVID-19 (i.e., 21 February 2020), Italy reasonably experienced a certain circulation of this pathogen. The clinical characteristics of milder cases may have therefore led to a transient surge in both searches for topics correlated with respiratory disorders and to ILI notification rates, that then were conversely affected by the implementation of lockdown measures [ 99 , 101 , 102 , 103 ].…”

Management and Prevention of Traveler’s Diarrhea: A Cross-Sectional Study on Knowledge, Attitudes, and Practices in Italian Occupational Physicians (2019 and 2022)

“…In this study, around 1/4 of all respondents were actively involved in pre-travel consultation of overseas workers in the year before the collection of the survey, and this share has substantially decreased in 2022 compared to 2021 (15.6% vs. 32.1%). These figures can be easily explained as a consequence of the SARS-CoV-2 pandemic, including the implementation of an extensive travel ban that clearly affected work-related travel [34,65], but stress the improperly low implementation of this potentially useful intervention. In fact, our study specifically targeted TD, a mostly benign condition, but through pre-travel consultations, more insidious issues can be properly targeted, including the enactment of mandatory vaccinations (ranging from yellow fever to the requirements for meningococcus and SARS-CoV-2 immunizations) [13,66,67], the tailoring of malaria prophylaxis according to international guidelines and baseline clinical conditions of the traveler where needed [13,67], and providing basic recommendations for travels in areas characterized by increased health risks.…”

“…At the time, the group had approximately 2000 unique members, but no information could be obtained regarding the actual share of members actively participating in the group. Following the inception of the SARS-CoV-2 pandemic and its severe impact on the daily duties of OP [32,33], including the temporary suspension of work-related overseas travels [33,34], between 15 July and 15 August 2022, we performed a second round of delivery in five closed discussion groups whose admission was limited to licensed Italian medical professionals. In total, the groups had 10,293 unique members, but again no information could be obtained regarding how many of them were active participants, nor on how many of the participants were qualified as OP and/or were actively working as OP at the time of the survey.…”

Respiratory Syncytial Virus Infections in Recipients of Bone Marrow Transplants: A Systematic Review and Meta-Analysis

“…Similarly, it should be considered that, because of the poor outcome of SARS-CoV-2 infection in BMT recipients [133], preventive measures and standard operating procedures implemented by transplant centers have been extensively improved. As non-pharmaceutical interventions (i.e., actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of respiratory illnesses) [134][135][136] have been shown to be particularly effective in limiting the occurrence of all respiratory illnesses [137], the results collected before 2020 could only be somewhat representative of the ongoing risk for RSV infections in BMT centers. In fact, only the study of Samad et al [99] included data from the pandemic settings, but the recruitment of new cases was interrupted by February 2020, making it limited as a representation of post-pandemic settings.…”