The increase in age of cases diagnosed during the week of monitoring shows an increase in the transmission of the virus from the youngest to the oldest age groups, especially within families. It is therefore recommended that all appropriate precautions are also taken within the family/household.

Key Points

  • An analysis of the data for the period 31 August – 6 September 2020 is provided below. Due to the time between exposure to the pathogen and the development of symptoms and between these and the diagnosis and subsequent notification, many of the cases reported this week are likely to have contracted the infection in the third decade of August. Some of the cases identified by screening, however, may have contracted the infection in earlier periods.
  • An increase in the new cases reported in Italy for the sixth consecutive week is confirmed, with a cumulative incidence (ISS flow data) in the last 14 days (period 24/8-6/9) of 27.89 per 100,000 inhabitants, up from the period 6/7-19/7. The majority of cases continue to be developed on the national territory (15% of new cases diagnosed in the monitoring week are imported from abroad); in particular, a not negligible percentage of cases imported from other Regions/PAs is observed (11.1% in the current week, a decrease compared to the previous week).
  • In Italy, as in Europe, an epidemiological transition of the SARS-CoV-2 epidemic occurred during the summer, with a sharp drop in the median age of the population contracting the infection. However, in the last two weeks, the median age of the diagnosed cases is increasing again and is now about 35 years. Particularly, people over 50 years of age were around 28% of cases diagnosed in the period 24/8-6/9; these were just over 20% in the previous two weeks. Although circulation in the summer period has occurred more frequently in younger age groups, within a context of an advanced reopening of commercial activities (including places of aggregation) and increased mobility, there are now signs of greater transmission of the virus over the national territory, in the home/family environment, with a circulation that is also affecting older people. The dynamics of transmission remain extremely fluid: the effects of outbreaks associated with recreational activities, already observed in the previous weeks, both on the national territory and abroad, continue to be observed, with a further increase in transmission in the family/household environment during the current week.
  • Starting from June, probably due to the reopening on May 4 -18, and June 3, a slight but constant increase in the national transmission index (Rt) was noticed at national level, which exceeded the threshold of 1, around  August 16, 2020. In the period August 20 – September 2, 2020 the Rt calculated on symptomatic cases is equal to 1.14 (95%CI:0.71 – 1.53). For details on the methods of calculation and interpretation of the Rt reported, please refer to the detailed information available on the website of the Higher Institute of Health.
  • However, the national transmission index must be interpreted with caution at this time of the epidemic. In fact, a Rt calculated on symptomatic cases, while remaining the most reliable indicator at regional level and comparable over time for monitoring transmissibility, could slightly underestimate the real transmission of the virus at national level. Therefore, the national Rt must always be interpreted considering the incidence data.
  • Moreover, during this monitoring week new cases of SARS-CoV-2 infection were diagnosed in all Regions/PPAA. During this week of monitoring, 37% of the new cases diagnosed in Italy were identified through screening activities and 31% through contact tracing activities. The remaining cases were identified as symptomatic (27%) or the reason for the diagnostic assessment is not reported (5%). Therefore, overall, 68% of the new cases were diagnosed thanks to intensive screening activity and case investigation, with identification and monitoring of close contacts.
  • The virus is now circulating throughout the country. Ten Regions/PPAA reported an increase in the number of cases diagnosed, compared to the previous week (ISS flow), which cannot be attributed solely to an increase in cases imported from abroad. A high number of new cases continue to be reported in almost all the regions/PAA and there has been a substantial upward trend for several weeks. Outbreaks are reported in almost all provinces, reflecting a circulation of the virus throughout Italy. This should call for caution, as it shows that the circulation of SARS-CoV-2 in the country is increasing.
  • Compared to the previous two weeks of monitoring (from August 17 to 30, 2020), there has been an increase in the occupancy rate of dedicated beds, in both the medical and intensive care areas in almost all Regions. At national level, the employment rate in the medical area has increased from 1 to 2%, while the employment rate in intensive care has increased from 2% to 3%, with values above 5% for some regions. Although no signs of overburdening of the health care services have yet been identified, the observed trend could be reflected in increased efforts, in the short term. The important and growing commitment of the territorial services (Prevention Departments), to ensure that outbreaks are promptly identified and investigated is also confirmed.
  • During the week of monitoring, a total of 2280 active outbreaks was reported, of which 691 were new outbreaks (the adopted definition of outbreak foresees the identification of 2 or more positive cases linked to each other). Both types have been increasing for the sixth consecutive week (in the previous week of monitoring, 1799 active outbreaks were reported, of which 649 new). This implies an increasing commitment of the territorial services in the search for contacts, managing to contain the local transmission of the virus.

Conclusions

  • In Italy there is currently a slow and progressive worsening of the SARS-Cov-2 epidemic, although lower than in other countries of the same geographical area. Also, this week has seen a widespread transmission of the virus throughout the national territory, causing significant outbreaks that have often been associated with recreational activities involving gatherings and violations of the rules of physical distancing, both on the national territory and abroad.
  • This is also leading to local transmission from the younger to the more fragile or elderly population, especially within families, and the situation is also reflected in a greater involvement of hospital services. Citizens are therefore recommended to take all appropriate precautions within their family/household.
  • Overall, even though the number of new cases of infection remains lower than in other European countries, it has been increasing for six consecutive weeks. Compliance with the prevention and quarantine measures recommended by the health authorities remains a crucial and unavoidable element in fighting the spread of the infection. On the other hand, the increase in diagnostic capacity must be accompanied by the strengthening of territorial services for case finding and contact management, including quarantine of close contacts and immediate isolation of secondary cases. Reducing the time passing between the onset of the infection and proper isolation remains a key element in controlling the spread of the infection.
  • It is therefore necessary to maintain a high level of resilience within territorial services, to continue to strengthen the population’s awareness and compliance with control measures, to carry out active research and diagnostic assessment of potential cases, isolation of cases, quarantine of their close contacts. These actions are fundamental to control transmission, and possibly rapidly identify and cope with epidemic upsurges.
  • It is also essential to maintain a high level of attention, continuing to strengthen contact tracing activities, to identify all potential transmission outbreaks early, and continue to control the epidemic. Therefore, it is essential to maintain a high level of awareness among the general population about the worsening epidemiological situation, together with the importance of strictly complying to all measures necessary to reduce the risk of transmission, such as individual hygiene, mask use and physical distancing.
  • The need to comply with quarantine and other measures recommended by the health authorities is reiterated, both for travellers returning from countries requiring quarantine and having been identified as close contacts in a case, following a request from the health authority.
  • The situation described in this report, mainly related to infections contracted in the third decade of August 2020, confirms the presence of important warning signs linked to an increase in local transmission. At the moment, data confirm that it is appropriate to maintain the prevention and control measures already adopted by the Regions/PAA, and to be ready for the activation of additional interventions, in the event of a further worsening of the situation.
  • The population is recommended to pay particular attention to the risk of infection in crowded settings where non-compliance with the recommended measures is detected, and during periods of stay in countries or areas with higher viral circulation. In such cases, it is recommended that particular attention is responsibly paid to the behavioural norms for the prevention of SARS-CoV-2 transmission, particularly towards the most vulnerable population groups.

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