ORIGINAL ARTICLE   

Minerva Respiratory Medicine 2023 March;62(1):9-24

DOI: 10.23736/S2784-8477.22.02003-4

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

A local outbreak as mirror-like scenario for COVID-19 worldwide progression. Clinical presentation to the Emergency Department during one of the first sub-regional outbreak in Italy. A lesson to learn

Chiara PRATICÒ ¹ ✉, Ilaria RICCI IAMINO ¹, Pierluigi VIALE ², Federica FOGACCI ³, Anna L. TINUPER ^{1, 4}, Federico M. VERARDI ¹, Sara TEDESCHI ², Claudia MORSELLI ¹, Valeria PALMONARI ¹, Simone CAVINI ¹, Andrea TAMPIERI ¹, Rodolfo FERRARI ¹

¹ Emergency Department, Santa Maria della scaletta, New Civil Hospital, AUSL Imola, Imola, Bologna, Italy; ² Infectious Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Bologna, Bologna, Italy; ³ Department of Medicine and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; ⁴ Emergency Medicine Graduate School, Alma Mater Studiorum, University of Bologna, Bologna, Italy

BACKGROUND: One of the most precocious Italian COVID-19 outbreaks began in February 2020 in Medicina, a small town in the province of Bologna. We compared the characteristics of different cohorts, to identify potential predictive factors for outcome: patients of Medicina outbreak versus those of the surrounding district (Imola), and before or after the local medical intervention.
METHODS: Between March the 3^rd and April the 9^th, 2020 167 adults with COVID-19 were admitted to the Emergency Department (ED) (78 from Medicina cluster, 89 from Imola district). Data at ED presentation were collected; hospitalized patients were followed until death or discharge.
RESULTS: Medicina and Imola cohorts were similar in age, main comorbidities, clinical presentation, laboratory tests, arterial blood gas analysis (ABG), death and acute respiratory distress syndrome (ARDS) rates. Age, hypertension, diabetes, chronic obstructive pulmonary disease, dyspnea, body temperature, quickSOFA Score, elevated C-reactive protein (CRP), creatinine, urea, Δ A-a O2, respiratory rate and FiO2 were associated with death and ARDS. Elevated Glasgow Coma Scale, diastolic blood pressure, oxygen peripheral saturation, P/F and pH were associated with patient survival and protective from ARDS. After the intervention in Medicina district, patients presenting at ED were younger and with long-lasting symptoms; CRP values were significantly lower, ABG and respiratory clinical parameters were less severely impaired. These differences did not affect the outcome.
CONCLUSIONS: Since the results of our study are consistent with worldwide evidences, we suggest that the early insight of a small local SARS-CoV-2 outbreak can be representative and predictive of the subsequent course of the virus in wider areas. This must be kept in mind to manage next epidemic waves.

KEY WORDS: COVID-19; SARS-CoV-2; Disease outbreaks; Respiratory distress syndrome