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HEALTH

Italy to step up test-and-trace and sequencing as concern grows about Delta virus variant

The Italian health ministry on Friday told local authorities to increase their coronavirus variant sequencing and tracing efforts, as new data confirmed that the Delta strain is spreading in Italy.

Italy to step up test-and-trace and sequencing as concern grows about Delta virus variant
Photo: Marco Bertorello/AFP

The ministry sent out the instruction in a circular after the Higher Health Institute (ISS) released new figures on Friday showing that the number of infections in Italy caused by the Delta and Kappa variants have increased by 16.8 percent in June.

“From our epidemiological surveillance, a rapidly evolving picture emerges that confirms that also in our country, as in the rest of Europe, the Delta variant of the virus is becoming prevalent,” said Anna Teresa Palamara, director of ISS’s infectious diseases department.

READ ALSO: Italian health experts warn about Delta variant as vaccine progress slows

According to ISS data published on Friday, the SARS-CoV-2 variant prevalent in Italy was found to be the Alpha variant (B.1.1.7), responsible for 74.9 of cases. This is now also the most prevalent globally.

Cases associated with Kappa and Delta variants (B.1.617.1/2) “are few overall in January to June”, the ISS report added. But it stated that the frequency and spread of these reports has “rapidly” increased across the country.

The new ISS figure  still lower than those from independent analysis of data from the virus-variant tracking database Gisaid, which estimated on Thursday that Delta now accounts for as much as 32 percent of recently confirmed new cases.

Several regions have already reported clusters of the Delta variant, though the amount of test result sequencing and analysis carried out by local health authorities in Italy varies and is often low.

Each region currently volunteers to do a certain number genetic sequencing of positive swabs, which means that Italy has less data available about the spread of variants than countries where sequencing is more widespread and systematic, such as the UK or Denmark.

The region of Puglia on Friday confirmed it would begin sending 60 test results per week for further analysis following the health ministry’s instruction.

Italian authorities had largely dismissed the risks posed by Delta in Italy until recently, describing its presence as “rare” in the country in the official data monitoring report released on June 11th.

Health officials had said at the end of May that they believed vaccinations would be enough to mitigate the risks.

But Italy’s government is now re-evaluating its approach following criticism of its response so far in a report published on Thursday by independent health watchdog GIMBE.

“A ‘wait-and-see’ strategy on managing the Delta variant is unacceptable,” wrote GIMBE head Dr. Nino Cartabellotta.

MAP: Where is the Delta variant spreading in Italy?

Photo: Marco Bertorello/AFP

The report described Italy’s current levels of full vaccination coverage as “worrying” considering “the lower effectiveness of a single dose against this variant “.

At the moment, just over a quarter of the Italian population is fully vaccinated against Covid-19, compared to 46% in the United Kingdom.

The report pointed out that some 2.5 million people aged over 60 in Italy have not yet received the first dose of a vaccine.

The foundation urged the government to “properly implement” measures recommended by the ECDC in its report published earlier this week: “enhance sequencing and contact tracing, implement screening strategies for those arriving from abroad, and accelerate the administration of the second dose in over 60s”.

Cartabellotta said: “You can’t control the Covid pandemic only with vaccines, masks and distancing. Today the Delta variant requires tracing and sequencing”.

Amid rising concern about the impact of the variant, which is thought to increase the risk of hospitalisation, Italian health authorities on Monday imposed new travel restrictions on arrivals from the UK – almost a month after other EU countries including France and Germany did the same.

Despite concerns about the spread of Delta, Italian health authorities on Friday also confirmed that all regions of Italy would be allowed to ease the health measures further from Monday, June 28th, as the number of infections recorded remained low this week.

READ ALSO: Italy to drop outdoor mask-wearing rule from June 28th

The last region still classed as a ‘yellow’ zone, Valle d’Aosta, will join the rest of the country in the low-risk ‘white’ tier, meaning most rules can be relaxed.

“With the decree I just signed, all of Italy will be ‘white’ starting from Monday. It is an encouraging result, but we still need caution and prudence,” Speranza
wrote on Facebook.

Referring to the spread of more transmissible variants of the coronavirus, the minister added: “the battle has not yet been won.”

Member comments

  1. My question is, if delta is more widespread in Italy than previously thought, and is most likely increasing, why are hospitalizations and deaths consistently going down? I keep hearing the delta is more dangerous and scary and everything but why aren’t deaths going up?

    1. The UK shows that you can have an extremely high case rate of people infected with the Delta variant, but maintain a very low death rate. This is because the age groups mostly being infected now are far younger, fitter people than those most affected at the beginning of the pandemic. Young people will generally be out and about more, both at work and socially and so have a greater chance of catching the highly-transmissible Delta variant, particularly if they have yet to be vaccinated.

      Younger people may become infected, but in most cases will recover without the need for hospitalisation and with very few deaths. Vaccination commenced with the very old and very frail and has worked its way down the age groups, which means older people with co-morbidities who are more at risk of hospitalisation and death are far less likely to become infected, as they are now fully-vaccinated.

      The Delta variant is more transmissible, but not apparently more dangerous. It demonstrates the massive importance of pushing on at speed with the vaccination programme, that’s for sure.

      1. So, in other words it’s a non-issue. Covid was dangerous for the people who are now protected. Why are we using delta to continue with restrictions? Remember the regular old flu when people lived like normal in the before times? Yeah that was as, if not more, dangerous to young people as covid is. We need to be basing our decisions not on if covid is eradicated but on how many people are actually dying from it because it isn’t like there are no repercussions from restrictions. Being masked and isolated is not good for the immune system at all for one thing, let alone everybody’s mental health. It’s over folks. Time to go back to normal.

        1. I don’t think for one minute that it’s a non-issue just because deaths are fewer. Many younger people report long-lasting serious symptoms after having Covid (the so-called ‘Long Covid’), and there seems to be little to no treatment for these. Flu isn’t more dangerous to young healthy people and never has been – when we get winter flu surges, the hospitals are full of the elderly frail, not 20 to 40-year-olds. In addition, other countries are still in the midst of the worst of the pandemic.

          For Italy at least, we’ve opened up again and mask use won’t be necessary outside from Monday. I don’t think there’s any need for people to be isolated if they don’t want to be. Covid’s definitely not over and it never will be, sadly (it will always be with us) – but we will have to live with it.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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