[The COVID-19 Epidemic: the experience in the Social and Health Care Center of the Mantua District (Lombardy Region, Northern Italy)]

Objectives: to describe the course of COVID-19 epidemic in the hospitals of the ASST of Mantua (Lombrady Region, Northern Italy) from February 2020 to April 2021.

Design: observational study.

Setting and participants: data from hospital discharging chart of all patients admitted to the hospitals of ASST were collected from 26.02.2020 to 30.04.2021 with COVID-19 diagnosis. Data from Emergency Rooms for patients evaluated but not admitted to departments were also collected.

Main outcome measures: the data from hospital discharging were crossed for diagnosis with data from laboratory. The department were classified into 'low intensity' and 'middle/high intensity'. The comparison was according to the different periods of epidemic.

Results: patients admitted to the hospitals were 2,738: 510 died (17.3%) and 1,736 patients were evaluated in the Emergency Rooms but not admitted to departments. Among these patients, 166 died (9.6%). The prevailing age class were >=65 years, with a trend to reduction in the third wave. The proportion of admission in middle/high intensity departments was significantly higher in the second wave than in the first. N. 510 deaths by 2,738 (17.3%) were observed, with significant reduction in the second and third waves in the low intensity departments (from 21.9% to 14.3% and 12.7%) (p<0.001), while mortality was substantially unchanged in the middle/high intensity departments (28.0%, 29.6%, and 28.3%). The mortality for patients with >=65 years was 26.7%. Females showed lower mortality (OR 0.690; CI95% 0.560-0.840) and lower incidence of admissions in middle/high intensity departments (OR 0.556; CI95% 0.459-0.673) in the three waves. Finally, including also the patients not admitted, the general mortality was 15.1%.

Conclusions: a worse outcome by mortality and severity of disease was observed for male gender compared to female and for older age classes. Moreover, a significant improvement of outcomes in the second and third waves, compared to the first, was pointed out.