Flu still down, but now school effect feared as emergency rooms remain under stress

Around 7.5 million Italians have ended up in bed so far because of the flu, but for the second week there has been a drop in the number of cases of contagion from respiratory viruses. The first peak had been reached before Christmas, with 980,000 cases, and now the number has dropped to 803,000 (there were 820,000 in the previous seven days), but the Istituto Superiore di Sanità (Italian National Institute of Health) urges caution and emphasises that it is important to "wait for the next bulletin," the experts point out, "to understand whether the downward trend will continue or whether the cases will rise again, and in the latter case whether they will exceed the levels reached in recent weeks. Weighing on the next few days could be the effect of the reopening of schools as well as the cold period that pushes people to stay indoors: two factors that favour contagions. In the meantime, the super-flu, fuelled by the K variant, is hitting the elderly and children hard, even causing dangerous pneumonia, increasing access to emergency rooms: from North to South, many patients are stationed on stretchers waiting for a bed in the ward and the 118 system is overworked.

There were an estimated 803,000 new cases of acute respiratory infections, including influenza, in Italy in the week from 29 December to 4 January, amounting to 14.1 cases per 1,000 patients, a slight decrease from the previous week, when it was 14.5. In total, about 7.5 million cases have been recorded since the start of surveillance. This is what emerges from the report of the RespiVirNet surveillance of the Istituto Superiore di Sanità (Iss), in which it is specified that the data reported this week, in particular those from sentinel surveillance in the community, may not reflect the real incidence and circulation of influenza viruses due to a possible reduction in the number of visits and data transmitted in conjunction with the Christmas holidays. The highest incidence is observed, as usual, in the 0-4 age group, with about 37 cases per 1,000 patients. 'The downturn in the curve that we are seeing in these weeks seems to be more evident than in previous years during the same period,' comment the experts from the Infectious Diseases Department of the Iss.-. We will have to wait for the next bulletin to understand whether the downward trend will continue or whether the cases will go back up, and in the latter case whether they will exceed the levels touched in recent weeks'. The intensity is very high in Campania, high in Sicily and Marche, medium in Veneto, Emilia Romagna, Tuscany, Lazio, Abruzzo, Apulia and Umbria while it is low in all the others. In the first week of January a 17% positivity rate for influenza was recorded in the community, while in the hospital stream it was 40.5%. Surveillance of severe and complicated forms of influenza shows a similar number of cases in the week from 22 to 28 December compared to the same week in the previous season. The most prevalent subtype among the severe forms is A(H1N1)pdm09, while the most prevalent form of influenza in the community is attributable to the A(H3N2) virus, namely the K variant. It should be noted that most cases of severe and complicated influenza concern unvaccinated persons.

Pneumonia cases are on the rise almost everywhere, while bronchiolitis (from the syncytial virus) is on the decline thanks to vaccinations. The crux, everywhere, remains the capacity of the territorial system to cope with the increased demand for care, particularly for the most fragile, such as the elderly. Because of the flu, 'we are experiencing a very significant increase in the demand for interventions by citizens to the 118 operations centres. The crisis of the territorial filter is causing a surge, especially in the period between Christmas and the beginning of the year, in requests for assistance for any type of acute situation, so that citizens are flooding the operations centres with requests, putting the 118 systems, which are obliged to respond very quickly, especially for emergencies and emergencies, in a serious 'distress' condition, i.e. in a condition of extreme performance load,' explained Mario Balzanelli, president of the Italian Society of the 118 system. The appeal is to request intervention only for serious symptoms such as respiratory difficulties. Emergency rooms all over Italy are registering a significant increase in accesses, especially of frail patients, with a worsening of the phenomenon of 'boarding', the stationing on stretchers of patients who need a bed, reported Alessandro Riccardi, national president of the Italian Society of Emergency Medicine (Simeu). At the root of this problem, Riccardi explained, 'there is a slowdown in discharges from hospitalisation linked to patients who are more difficult, more fragile. Each sick person in boarding slows down the access time of patients in the emergency room by 19 minutes and if these are 20, it means more than three hours of waiting time'.

 "It is impossible to predict when the peak of the 2026 flu and other respiratory infections will be reached". But "on the one hand the cold weather, which prompts people to spend more time indoors", and on the other "the resumption of schools" and contact between millions of people - students, school staff, and parents accompanying children - are two factors affecting the course of the winter sickness epidemic. And they are 'expected to lead to an increase in the number of sick people, "possible from next week". The paediatrician Italo Farnetani predicts this: "Making predictions on the peak is not possible," the expert clarifies, "because the trend in the entire population depends on various elements, such as the infectious load and the number of pathogens in circulation - and there is no reason to believe that this year will be substantially different from previous years, on this front - but also the weather conditions. And this is a factor that makes a difference, not because the cold makes people sick as such, but because cold temperatures, such as those of these days, encourage people to stay indoors more, where the transmission of infectious agents and contagion is easier and quicker. Applying these principles to the current situation, it is easy to foresee that a surge in contacts will also correspond to a substantial increase in the number of sick people, from the week beginning 12 January'. These days, recalls Farnetani, 'children and young people have returned to school. And so twenty million people, including students and those accompanying them, teachers and school staff, will meet with the possibility of exchanging infectious agents. One only has to think of the crowding at the entrances and exits of schools to understand how the opportunities for contact multiply. In this context, between school and work, every single person encounters many others, in a number that varies throughout the day. But mathematically it is a high daily number. Then there are the climatic conditions: the worsening weather and the dropping temperatures induce people to spend less and less time outdoors".