key: cord-0891521-udu1xg3p authors: Bertolini, Alessandro; Maiolani, Martina; Menatti, Elisabetta; Barbonetti, Claudio; Stiglich, Francesco; Valenti, Donato; Fregoni, Vittorio title: Covid19: Could other alternatives have been possible? date: 2020-06-03 journal: J Glob Antimicrob Resist DOI: 10.1016/j.jgar.2020.05.010 sha: 8137ee2b96a9ee51277b2d0726c69ae3f0c1d0a2 doc_id: 891521 cord_uid: udu1xg3p nan On February 21, 2020, at Codogno Hospital (Lodi's Province, Lombardy), Italy's Covid19 'patient one' was discovered. The diagnosis was made eluding the criteria to perform a nasopharyngeal swab for COVID-19 test. From that moment on, the COVID-19 outbreak became manifest. In the following week the cases within the Province increased exponentially and it was interpreted as a disease cluster originating from the hospital. Shortly after, it became clear that the course of disease was often subclinical and its diffusion could also be sustained by pauci-asymptomatic carriers. On March 19, during a Board in our Hospital (Sondrio's Province, Lombardy) a proposal was made to carry out a prospective observational study recruiting all the asymptomatic and in-service hospital employees in order to determine the amount of infected subjects among them by using a qualitative serological test. The cost would have been s12 plus VAT each. The Hospital General Manager approved the project on the same day; nevertheless, on March 21, he received from the Regional Government the order to block the trial because based on a non-validated diagnostic method. On March 31, the Regional Government declared itself in favor of the serologic tests. On April 1st we submitted our project to Regional Government asking permission to carry it out, but we have no feedback since then. The Coronavirus epidemic wave has so far affected 75,723 people and caused 13,272 deaths in Lombardy. At to date in our Province of 180,000 inhabitants there have been 1380 cases. The new virus [1] spread very quickly among the population totally exposed to the infection and that lacked a specific immunity. The disease showed different clinical pattern of aggressiveness, ranging from the complete absence of symptoms to ARDS. The gold standard for the diagnosis is viral RNA detection, through RT-PCR method, on nasopharyngeal swabs (80% sensitivity) [2] , that we must use for symptomatic subjects even if healthcare population. Since February 21 to date, several Italian hospital employees have tested positive to nasopharyngeal swabs performed after the onset of symptoms [3] . At least 154 Italian doctors died. The incidence of positive swabs between hospital employees is estimated 20%. They are the most exposed to the risk of infection due to the close contact with patients [4] . The lack of knowledge of the immunity condition in this at-risk population can contribute to exacerbate the infection rate within hospitals and among the general population during clinical contacts [5] . Among the diagnostic alternatives to swab, the qualitative serological test exposes the incidence of infection in subjects by detection of IgM/IgG antibodies produced against the virus. We chose qualitative NADAL 1 COVID-19 IgG/IgM Rapid Test (test cassette) REF 243001N-10, by Nal Von Minden GmbH (Germany); execution of test requires a finger-prick blood sample and provides a qualitative result (yes/no) within 15 min with a declared diagnostic sensitivity of 94.1% and specificity of 99.2%. According to our study design, we would have recruited for test 2408 asymptomatic in-service employees of our hospital. While we were waiting for the authorization, on April 9, we started an exploratory pilot study recruiting to test a more limited sample. In order not to violate government mandates, three private Entities (Italian League against Cancer, Teglio's Casa di Riposo Sant'Orsola, Casa di Riposo "Città di Tirano") offered 175 tests. In addition, hospital's Oncology Department received 50 complimentary tests from the manufacturer. To date, we have performed 149 tests in asymptomatic healthcare workers. All people tested were apyretic (<37.5 C) and free from respiratory symptoms (cough/dyspnea/nasal congestion). Among them we have found 15 positive cases: 3 cases with IgM, 3 cases with both IgM and IgG, 9 cases with IgG. Twelve out of fifteen positive cases got the chance to do nasopharyngeal swab within 24 h and eight of twelve resulted positive for SARS-Cov-2 RNA. (Table 1) . We reiterate that all these healthcare workers were regularly at work in their hospital wards at the time of test. All swab positives were placed in home isolation following national health regulations. The subjects not subjected to swab or negative have partially continued their activity. Only one decided on personal initiative to leave work for a period of time remaining in home isolation. All rapid test subjects did not develop fever or respiratory symptoms in the days and weeks following the test. In 18 negative subjects we repeated test after one month with negative results. In conclusion: the cost s12 plus VAT for each; all the healthcare workers were regularly at work in their hospital wards at the time of test. In this emergency situation, we chose how to respond rapidly to viral spread, firmly believing that to circumscribe the asymptomatic clusters is crucial. The tests gave us a rapid response with limited costs and immediate practical implications. The pandemia surfaced in a hospital and, through the hospital network, affected healthcare providers who initially had little knowledge of the virus and inadequate supplies of personal protective equipment. From hospitals, Covid19 spread to other patients and subsequently to other healthcare workers in a vicious cycle. Our experience confirms the validity of a strategy that can give rapid answers to make rapid decisions to stop this vicious cycle. We'll use our inexpensive method for outpatients who are not subject to the current government rule: chemotherapy, radiotherapy, dialysis or psychiatric patients are at risk as outpatients Funding None declared. A novel coronavirus from patients with pneumonia in China Report from the American Society for Microbiology COVID-19 International Summit Death from Covid-19 of 23 health care workers in China COVID-19: protecting health-care workers 395 Transmission of 2019-nCoV infection from an asymptomatic contact in Germany None to declare. Not required.