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30 April 2020 The Minister of Health, Roberto Speranza, has signed the ministerial decree defining the criteria relating to health risk monitoring activities for the evolution of the epidemiological situation. The ministry announced it. "In the current state of the epidemic - reads the text - the consolidation of a new phase, characterized by initiatives to loosen the lockdown and their progressive extension, can only take place where close monitoring of the progress of virus transmission is ensured on the national territory. Other prerequisites are the degree of preparation and maintenance of the health system, to ensure the identification and management of contacts, monitoring of quarantinates, adequate and timely execution of swabs for the diagnostic assessment of cases, the link between primary and hospitalization assistance, as well as the constant and timely supply of the necessary information flows, to be carried out through the insertion of data in routine information systems or created ad hoc for the emergency in progress ".

Three types of indicators
For this "some indicators have been designed with threshold and alert values ​​which must be monitored, through nationally coordinated surveillance systems, in order to obtain aggregate national, regional and local data". These are three types of indicators: on monitoring capacity, on diagnostic assessment, investigation and management of contacts, and those relating to transmission stability and the maintenance of health services. With respect to the diagnostic assessment, the percentage of positive swabs will be evaluated excluding as far as possible all the screening and "re-testing" activities of the same subjects, overall and by macro-setting (territorial, PS / Hospital, other) per month , the time between the start date of symptoms and the diagnosis date and the time between the start date of symptoms and the date of isolation, but also the number, type of professional figures and time / person dedicated in each territorial service to contact-tracing and withdrawal / sending activities to reference and monitoring laboratories for close contacts and quarantined and isolated cases respectively.

Maintenance of health services
The most delicate part is that of transmission stability and the maintenance of health services: the number of cases reported to the Civil Protection in the last 14 days will be evaluated, the RT index calculated on the basis of the integrated ISS surveillance (we will use two indicators, based on symptoms starting date and hospitalization date), the number of cases reported to Covid-net sentinel surveillance per week (optional), but also the number of accesses in the Emergency Room with ICD-9 classification compatible with syndromic frameworks attributable in Covid-19, and above all the occupancy rate of the total ICU beds and of those in the ordinary hospitalization regime. The transition phase of the Covid-19 epidemic, writes the ministry, "aims to protect the population, with particular attention to vulnerable sections of the population, and to maintain a limited number of cases of infection and in any case within values ​​that make it manageable by the country's health services. "

Risk assessment
The document also identifies alert values ​​that must lead to a joint national and regional risk assessment, to decide whether the conditions are such as to require a review of the measures taken / to be adopted and possibly also of the management phase. epidemic. Threshold values ​​are defined in a timely manner for some indicators while a comparative evaluation will be carried out with the data of the previous 7 days collected in the context of the integrated national surveillance, the historical of which will therefore constitute the epidemiological reference value. Bearing in mind that "the health threat is constituted by the uncontrolled and unmanageable transmission of Sars-CoV-2, and the risk related to the probability of infection / transmission in Italy and the impact, or the severity of the pathology with particular attention to that observed in subjects over 50 years of age ", with specific algorithms relating to probability and impact with the reference indicators indicated.

Joint action with the regions
A moderate / high / very high risk classification will lead to a joint re-evaluation and validation with the Region concerned which will lead to the integration of the information to be considered with any further assessments carried out by the same on the basis of calculated process and result indicators for their services. If a high / very high risk is confirmed, that is, a moderate but not manageable risk with the containment measures in place, they will be reevaluated in concert with the Region. interested. "

Attention to contacts
Finally, "in order to be carried out effectively, research and contact management must include an adequate number of human resources, such as health and public health workers, administrative staff and, where possible, other staff already present in the Veterinary services of the Prevention Departments, to be involved according to local needs Based on ECDC estimates, in order to guarantee this essential activity in an optimal way, not less than 1 person per 10,000 inhabitants should be made available in the various local divisions, including the activities epidemiological investigation, tracking of contacts, monitoring of quarantenates, execution of swabs, preferably to be performed in centralized structures (drive in or similar), connection with primary assistance, timely insertion of data in the various information systems It is necessary to provide appropriate staff training and guarantee by the D the Prevention and Healthcare Departments, maintaining the levels of supply of the remaining ordinary services (e.g. screening, vaccinations) ".