Thread by @fcoin

This is the English translation of a letter from Sergio Romagnani Emeritus Professor of Clinical Immunology and Internal Medicine to the Italian Newspaper Corriere Fiorentino 1/x
corrierefiorentino.corriere.it/firenze/notizi…

In this letter, Romagnani explains why massive testing of both symtomatic and asymptomatic cases is vital in order to reduce the spread of Covid-19. In fact, according to a study conducted in Vò (Italy) 1. the vast majority of people who become infected, between 50 and 75%

are completely asymptomatic, but still represent a formidable source of contagion(2) the isolation of asymptomatic cases is essential to control the spread of the virus (3)This is paritcularly important for categories such as doctors and nurses who, being exposed to the virus 3/x

frequently develop an asymptomatic infection.Testing asymptomatic cases thus reduces the risk of creating communities of high viral density which also increases the severity of the course of the disease. Political authorities often argue that extending testing to the majority 4/x

of the population even when they are symptom-free is costly, in fact it is no longer done in the UK. BUT-though costly, it saves lives, it reduces the costs&risks of intensive care, & it is vital to contain the rapid spread of the virus, thus saving the economy from recession 5/x

Dear Director, since the prediction made in my previous letter on February 25th was correct, because Lombardy is having difficulties getting the necessary number of intensive care beds to save patients suffering from pneumonia with respiratory insufficiency as a result of the 6/x

the Covid-19 infection, & I hope that the Region of Tuscany has in the meantime has increased its numbers, I take the liberty to submit to the general attention and in particular to the Regional Health authorities another point that in my opinion deserves 7/x

to be taken into account.
I refer to the results of the epidemiological study carried out in the Veneto region of Vò under the direction of Dr. Andrea Crisanti, Director of the Chair of the Diagnostic Unit of Microbiology and Virology at the University of Padua. 8/x

I would like to point out that Dr. Crisanti immediately after graduating in Medicine attended my Immunology laboratory for a period of six months in 1981, and then he moved to the United Kingdom becoming an internationally renowned virologist and recently returned to Italy 9/x

where he was appointed "for clear fame" as Professor of Microbiology at the University of Padua. Having read in the Corriere della Sera of March 14 of his study in Vò I have therefore decided to contact him personally to get the summary of the results of this study 10/x

in Vò I have decided to contact him to get the summary of the results of this study. When we spoke, he started with a sentence that was very moving for me: "the short period in your laboratory was fundamental for my training and made me understand that research was my way". 11/x

Then he described the results of his study. In this study all the inhabitants of the town of Vò were tested for COVID-19 & it was shown that the vast majority of ppl who become infected, between 50 and 75%, are completely asymptomatic, but still represent a formidable source 12/x

of contagion. In Vò, in fact, with the isolation of infected people, the total number of sick people fell from 88 to 7 (at least 10 times less) within 7-10 days. What is even more interesting and partly surprising, was that the isolation of the infected 13/x

people, the total number of sick people fell from 88 to 7 (at least 10 times less) within 7-10 days. What is even more interesting and partly surprising, was that the isolation of the infected (symptomatic or not symptomatic) was not only able to protect other people 14/x

from the contagion, but also to protect from the serious evolution of the disease in the infected subjects because the rate of recovery in the infected patients, if isolated, was in 60% of cases equal to only 8 days. These data provide 2 very important pieces of information 15/x

1) the percentage of infected people, even if asymptomatic, in the population is very high & represents the majority of cases especially, but not only, among young people;
2) the isolation of asymptomatic people is essential to be able to control the spread of the virus and 16/x

the severity of the disease. In the light of these extraordinary data, it is clear that current virus containment policies need to be reviewed. Indeed, it is absolutely essential to stop the spread of the virus by identifying as many asymptomatic individuals as possible 17/x

w/are an important source of the disease and to identify them as early as possible.On the basis of the data obtained in Vò, a "massive active surveillance"has already begun throughout the Veneto region, i.e. it has been decided in that region to test all workers most exposed 18/x

to the infection (doctors, nurses, police forces, workers forced by their type of work to have many inter-personal contacts), even if asymptomatic, a process financed by an industrialist from Veneto whose name is unknown, in order to find all infected individuals 19/x

even if asymptomatic, and then isolate them as was done in the pilot study of Vò. The first consideration arising from this experience is that the current national & also our region's way of dealing with the problem of Covid-19 infection (testing only symptomatic individuals)

is the opposite of what should be done. In fact, now that the virus circulates widely, it is no longer so important to swab symptomatic people. All those with fever, cough and respiratory symptoms should still be placed in isolation or transported to hospital and treated 21/x

appropriately for their symptoms and all those who have been exposed to these subjects should still be in isolation.
What seems crucial now in the battle against the virus is to try to find people who are asymptomatic but are already infected and who are more likely 22/x

to be infected because no one is infected.
But what seems crucial now in the battle against the virus is to try to find asymptomatic but already infected people, who are more likely to be infected because nobody fears them or isolates them. This is particularly true for 23/x

categories such as doctors and nurses who, being exposed to the virus, frequently develop an asymptomatic infection and continue to spread the infection among themselves and their patients. In fact, in many regions, both Italian and international, 24/x

it is being decided to stop testing doctors and nurses unless they develop symptoms. But in light of the results of Vò's study, this decision can be extremely dangerous; hospitals risk becoming areas with a high prevalence of infected people where no affection is isolated. 25/x

The risk of infection for patients and between colleagues risks becoming very high and there is also the risk of creating communities of high viral density which, according to Vò's study, also increase the severity of the course of the disease.
It is therefore absolutely 26/x

essential to extend the tests to the majority of the population, in particular to the categories at risk (i.e. exposed to multiple contacts), and therefore isolate positive subjects and their contacts, even if asymptomatic, as early as possible. 27/x

In particular, it is absolutely necessary to test all those who have a high probability of transmitting the virus, especially if they live in closed communities with multiple and close contacts. Finally, it is very important 28/x

that all those at risk wear masks, not so much to protect themselves from infection, but rather to protect others from themselves, even when they are symptom-free.
It could be objected that the costs of a high number of tests, as well as the technical difficulties arising 29/x

from them have been the reasons given to advise against this strategy so far at the level of national health policy and therefore also of the Tuscany region, choosing to carry out the test only to people who are highly suspicious because of their symptoms. 30/x

so far at the level of national health policy and therefore also of the Tuscany region, choosing to carry out the test only to people who are highly suspicious because of their symptoms. But the costs, evaluated in terms of lives saved 31/x

of much lower numbers of people requiring the costs and risks of intensive care, and also in economic terms, would ultimately be enormously lower than those related to the execution of a much higher number of tests than currently performed. 32/x

Moreover, similar results are coming in recent days from the use of such a strategy in S.Korea. My letter is intended to be a strong recommendation to the Tuscan Region's health service to examine the problem.
Sergio Romagnani Emeritus Prof. Clinical Immunology Uni of Florence