key: cord-0684971-e2nl766y authors: Turriziani, Ombretta; Sciandra, Ilaria; Mazzuti, Laura; Di Carlo, Daniele; Bitossi, Camilla; Calabretto, Marianna; Guerrizio, Giuliana; Oliveto, Giuseppe; Riveros Cabral, Rodolfo J.; Viscido, Agnese; Falasca, Francesca; Gentile, Massimo; Pietropaolo, Valeria; Rodio, Donatella M.; Carattoli, Alessandra; Antonelli, Guido title: SARS‐CoV‐2 diagnostics in the virology laboratory of a University Hospital in Rome during the lockdown period date: 2020-08-02 journal: J Med Virol DOI: 10.1002/jmv.26332 sha: 375de6683b44e5cdefc9ac67da89dc56f417f8ac doc_id: 684971 cord_uid: e2nl766y Italy was one of the most affected nations by coronavirus disease 2019 outside China. The infections, initially limited to Northern Italy, spread to all other Italian regions. This study aims to provide a snapshot of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) epidemiology based on a single‐center laboratory experience in Rome. The study retrospectively included 6565 subjects tested for SARS‐CoV‐2 at the Laboratory of Virology of Sapienza University Hospital in Rome from 6 March to 4 May. A total of 9995 clinical specimens were analyzed, including nasopharyngeal swabs, bronchoalveolar lavage fluids, gargle lavages, stools, pleural fluids, and cerebrospinal fluids. Positivity to SARS‐CoV‐2 was detected in 8% (527/6565) of individuals, increased with age, and was higher in male patients (P < .001). The number of new confirmed cases reached a peak on 18 March and then decreased. The virus was detected in respiratory samples, in stool and in pleural fluids, while none of gargle lavage or cerebrospinal fluid samples gave a positive result. This analysis allowed to gather comprehensive information on SARS‐CoV‐2 epidemiology in our area, highlighting positivity variations over time and in different sex and age group and the need for a continuous surveillance of the infection, mostly because the pandemic evolution remains unknown. A novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing human disease named coronavirus disease , was first identified in Wuhan, China. 1 In early January 2020, this novel member of enveloped RNA coronavirus was detected in samples of bronchoalveolar lavage (BAL) fluid from a patient in Wuhan and subsequently confirmed by the Chinese Centre for Disease Control and Prevention as the cause of pneumonia cases of unknown origins emerged in December. 1, 2 Despite the effort to stop the transmission of COVID-19, the infection spread throughout mainland China, and in January 2020, cases were reported in Thailand, Japan, and South Korea. 3, 4 On 11 March 2020 the infection reached the necessary epidemiological criteria to be declared a pandemic by the WHO, having spread to at least 114 countries worldwide. 5 The first Italian case of COVID-19 has been assessed in Lombardy region on 20 February 2020. From that moment public health measures have been taken to contain the epidemic, initially located in some restricted areas, and extended by the government to all the Italian peninsula from 11 March 2020. 6, 7 The territory was heterogeneously affected by the SARS-CoV-2 outbreak. Northern regions have experienced the highest burden, in contrast with the south and the islands where virus spread has been contained. 8 In fact, the Rome province showed, on the 4 May, a total of 4.948 positive cases compared to the 20.254 of Milan province on a national total of 211.938 positive cases. 9 In this scenario this paper aims to take a snapshot of the epidemiological characteristics of the population resulted positive for SARS-CoV-2 at Sapienza University Hospital "Policlinico Umberto I" in Rome starting from 6 March until 4 May. This study includes all individuals (n = 6565) who have been tested 2.1 | Statistical analysis χ 2 Test was used to analyze the differences in positivity between groups. The positivity trend over time was analyzed using the χ 2 test for trend. Mann-Whitney U test was used to compare age between groups. Statistical tests were conducted two-sided at a significance level of 0.05 using GraphPad Prism version 7.00 for Windows (GraphPad Software, La Jolla, CA). The number of positive individuals was significantly different stratifying patients for both sex and age ( Figure 3 ). In particular, the positivity rate increased with age (P < .00001) and was higher in male patients compared to females (P < .00001). For all age groups the percentage of positive male individuals was always higher than in females, with a significant difference for the 41 to 50 (P < .05) and 51 to 60 years (P < .001) groups. Age is by now recognized as the strongest predictor of mortality and this association is firmly supported by our data. Multiple hypotheses have been suggested to explain this correlation. As known, older patients are more vulnerable due to underlying age-related diseases. Moreover, aging is characterized by inflamm-aging and immune senescence, which are defined respectively as a condition of chronic subclinical systemic inflammation and an impairment of the acquired immune system. All these clinical conditions appear to be involved in the worsening of COVID-19 infection outcomes in elderly people, especially in males. 26 In our study only the 27.7% of subjects was younger than 40 years. Then it is not possible to rule out that a substantial number of asymptomatic cases remained underdiagnosed, especially among young people under 40. [27] [28] [29] Nowadays, the proportion of subclinical infections is unknown and should be derived from future serological studies. 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The data that support the findings of this study are available from the corresponding author upon reasonable request. http://orcid.org/0000-0001-6400-9168Alessandra Carattoli https://orcid.org/0000-0002-6120-6526Guido Antonelli http://orcid.org/0000-0002-2533-2939