Monitoring of potential new critical infections for any respiratory viral disease, in particular for Covid-19. The precise tracking of people with few symptoms and asymptomatic symptoms decisive to prevent a new outbreak of the epidemic. In many Italian hematologies, nasopharyngeal swabs and serological tests are being done periodically for patients and healthcare professionals: a useful and desirable approach. For not all regions have had and have the same rules, while for us professionals uniformity of criteria would be necessary. The World Health Organization and many scientific studies highlight the important role in the spread of infection by asymptomatics and, in this context, the particular fragility of patients with cancer, much more at risk than the rest of the population, must be considered.
Conflicting opinions on tests for SARS-CoV-2
Over the past two months, numerous (often conflicting) opinions have been exposed on which laboratory tests are most suitable for identifying early SARS-Cov-2 infection and then tracing contacts. The methods are basically two: the search for the virus in the nasopharyngeal swab or the search for antiviral antibodies in the blood. The sensitivity of the two different methods and their positivity occurs at different times of the infection: first the swab is positive and then, during the second week, the antibodies that remain longer. In addition, a positive swab indicates an active infection, while being positive for the serological test means having developed the antibodies and this can indicate an active infection, but also a recent or already cured one. So the serological test is not useful for diagnosing early infections, better the nasopharyngeal swab which, to accurately trace the virus, should always be done for those with mild symptoms. Which did not happen in our country.
Strategies for autumn
Recently a study conducted at the National Cancer Institute has shown the effectiveness of a rapid and simple serological test, with results in 12 minutes (not all tests see the same things and for now each Region does it by itself) in identifying doctors and positive though asymptomatic nurses. To fully resume the activity of hospitals and hematology departments that treat patients with cancer and particularly delicate, because immunosuppressed, healthcare workers must also be monitored to ensure that there are no infectious subjects. Although in hospitals (particularly in the hematology and transplant divisions) the attention to the use of personal protective equipment such as masks or gloves is very high, an operator at work unaware of being positive still remains a potential danger for patients, colleagues and his family. In the initial phase of the epidemic, many infections occurred in the hospital: effective strategies are needed for next autumn, when Covid-19 will return with the flu and bacterial infections of the respiratory tract. We need a single direction at national level that chooses the most appropriate test to identify asymptomatic infections and that determines how often to do it to all healthcare professionals.
Paolo Corradini president of the Italian Society of Hematology, director of the Division of Hematology at the National Cancer Institute of Milan and professor of Hematology at the University of Milan
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