key: cord-265785-mcru4j6g
authors: Indolfi, Ciro; Spaccarotella, Carmen
title: The Outbreak of COVID-19 in Italy: Fighting the Pandemic
date: 2020-04-01
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.03.012
sha: 
doc_id: 265785
cord_uid: mcru4j6g

nan

The Outbreak of COVID-19 in Italy has caused a never-seen-before disaster in terms of hospitalizations and deaths.

On January 9, 2020, the Chinese Center for Disease Control and Prevention reported that a new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2), had been identified as the causative agent of coronavirus disease-2019 , and the genomic sequence was made public.

Italy was the first European nation to be affected by COVID-19 with 143,626 confirmed total cases and 18,279 deaths to date (1) . The pandemic has mainly been located in northern Italy (Figure 1 ), partially sparing, for the moment, the southern part of the country. Italy was not prepared for COVID-19, currently a planetary health emergency with 1, 436, 198 cases and 85,522 deaths worldwide (2) . The Italian crisis provoked by COVID-19 is the most serious event in Italian history after World War II; it is a national human, health, and economic tragedy.

COVID-19 mortality in Italy has been 9%, higher than that in China. The reasons for this high mortality are unclear. However, the infected fatality rate may actually be lower because the tests have not been widespread compared to other countries such as South Korea. Furthermore, the oldest population in Italy may have increased mortality. In fact, the median age in Italy of those who have died is w80 years (Figure 2 ). No patient <20 years of age has been hospitalized or has died. Only 1% of the deaths have been detected in patients <50 years of age.

On February 21, 2019, the first Italian patient with COVID-19 was diagnosed, a 38-year-old man hospitalized at Codogno Hospital, Lodi, in northern Italy. Also, in northern Italy, on February 21, 2020, another outbreak of viruses was discovered in Vò Euganeo (Padua) and, in the Veneto region, the first death was reported, a 78-year-old man in a hospital in Padua. He was the first of a long series of deaths. The mortality rate in the Lombardy region alone, with a total of 10,022 deaths, is greater than the number of deaths in China (3,342 total deaths).

Social containment, early and rapid throughout a nation, is the most effective measure for controlling the spread of COVID-19; this social containment perhaps was delayed in Italy ( Figure 3) . Italy was the first nation in Europe affected by COVID-19 and was therefore caught unprepared. The rapid spread of COVID-19 and the dangerousness of the disease, very different from the normal seasonal influenza, were perhaps initially underestimated. Today, the entire nation is on lockdown, and cities and towns have become isolated, as seen in Figure 3 (4).

Healthcare workers in Italy paid a very high price with more than 11,000 confirmed cases, 100 clinicians killed by COVID-19 and many with burnout syndrome.

The epidemic in Italy has also found territorial medicine to be unprepared, which has not been able 

It has been previously reported that the quality of the universal Italian health system and healthy behaviors have contributed in the past to the country's favorable overall health (7). In a race against time in an unprecedented health national health emergency, with an organizational effort never seen before in Italy, hundreds of doctors and nurses (many then SARS-CoV-2 positive) are fighting this horrible disease. The advantage of the Italian health system is that all citizens may have access to medical therapies.

However, in recent years, health policy has profoundly changed in Italy. The number of beds has been reduced, and regional autonomy has accentuated inequalities in the quality of services on the national territory. There has been recent concern in the cardiology community about the possible negative effect of COVID-19 in Italy -2 0 2 0 : ---Italy, as it has done in the past, will improve its health and economic systems after this tragedy.

Probably nothing will be like before, and this catastrophe will be a great opportunity to further improve an efficient and effective national universal health system. 

Critical case utilization for the COVID-19 outbreak in

At the epicenter of the Covid-19 pandemic and humanitarian crises in Italy: changing perspectives on preparation and mitigation

COVID-19 and Italy: what next?

Italy Collaborators. Italy's Health Performance, 1990-2017: Findings From the Global Burden of Disease Study