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American Journal of Infectious Diseases
Letters to the Editor
Retrospective Observational Study of the Environmental
Impact in SARS-CoV-2 Virus Transmission based on
Exclusion Criteria
1*Katia Margiotti, 1Marco Fabiani, 2Marina Cupellaro, 1Alvaro Mesoraca and 1,2,3Claudio Giorlandino
1ALTAMEDICA, Human Genetics Lab, Viale Liegi 45, 00198 Rome, Italy
2ALTAMEDICA, Department of Biochemistry, Viale Liegi 45, 00198 Rome, Italy
3ALTAMEDICA, Department of Prenatal Diagnosis, Fetal-Maternal Medical Centre, Viale Liegi 45, 00198 Rome, Italy
Article history
Received: 10-11-2020
Revised: 11-01-2021
Accepted: 25-01-2021
Corresponding Author:
Katia Margiotti
ALTAMEDICA, Human
Genetics Lab, Viale Liegi 45,
00198 Rome, Italy
Email: katia.margiotti@artemisia.it
Abstract: In Italy, as today October 26 the virus is circulating throughout
the country. By a new decree of the Ministry of Health of October 25,
2020, authorities in Italy have suspended most of the recreational activities,
like, cinemas, theatres, gyms and restaurants. Aim of this observational
study was to evaluate environmental risk related to SARS-CoV-2 infection.
Information questionnaire concerning the activities carried out during the
last 14 days was proposed at 256 SARS-CoV-2 positive subjects. Among
the SARS-CoV-2 positive subjects, 95% (213/226) never went to cinemas
and or theatres, 93% (211/226) never went restaurants and 92% (209/226)
never went to gyms. Our data strongly suggest that the virus infection
rarely occurred in the considered environmental system.
Keywords: SARS-CoV-2, Environmental Impact, COVID-19
Dear Editor
The first diagnosis of COVID-19 in Europe has been
confirmed in a 38-year-old Italian healthy man. Only 4
days after the onset of COVID-19, the patient was
admitted to the intensive unit care of the Policlinico San
Matteo in Pavia because of respiratory failure. After
several weeks of intubation and supportive treatment, the
patient luckily recovered and could be discharged in
good conditions. Worldwide, in less than 4 months,
spread of SARS-CoV-2 virus was inevitable, has moved
from affecting a few persons in Wuhan (Hubei province,
China) to more than 38 million people in almost every
country (Coronavirus Research Center,
https://coronavirus.jhu.edu/map.html visited on October
16th, 2020) (Zhu et al., 2020; Lu et al., 2020).
In Italy for the management of Phase 2 of the
emergency, a specific monitoring system on
epidemiological data and response capacity of regional
health services has been activated, introduced with the
decree of the Ministry of Health of April 30, 2020
(http://www.salute.gov.it/portale/nuovocoronavirus/hom
eNuovoCoronavirus.jsp?lingua=english). As today
October 26 the virus is now circulating throughout the
country. In the past recent weeks, a strong increase in
cases was observed, which brought the cumulative
incidence in only 14 days to 75 per 100 000 inhabitants
(period 28/9-11/10) versus 44,37 per 100 000 inhabitants
(period 21/9-4/10). In the same period, the number of
symptomatic cases almost doubled 15,189 symptomatic
cases in the period 28/9-11/10 versus 8,198 symptomatic
cases in the period 21/9-4/10. In order to block the
spreading of the virus, by a new decree of the Ministry
of Health of October 25, 2020, authorities in Italy have
suspended most of the recreational activity, like,
cinemas, theatres, gyms and restaurants.
The aim of our retrospective observational study was
to evaluate environmental risk for infection spreading
related with the above-mentioned recreational activities
(cinemas, theatres, gyms and restaurants) and as
additional information we asked about the use of public
transportation. Exclusions criteria related to
environmental risk on the virus transmission could be
essential in terms of decision making and economic,
social and political distresses will be decreased. In the
present study, we interrogated 256 SARS-CoV-2
positive subjects, that gave complete informed consent
and answered to an information questionnaire
concerning the activities carried out during the last 14
days. Evidence suggests that SARS-CoV-2 positivity can
be detected in people 1-3 days before their symptom
Katia Margiotti et al. / American Journal of Infectious Diseases 2021, 17 (1): 1.4
DOI: 10.3844/ajidsp.2021.1.4
2
onset, with the highest viral loads observed around the
day of symptom onset, followed by a gradual decline
over time. The duration of SARS-CoV-2 positivity
generally appears to be 14 days for asymptomatic
persons and even more for patients with mild to
moderate disease (He et al., 2020; Woodruff et al.,
2020; Wölfel et al., 2020; Zhou et al., 2020). 5100
subject who voluntarily contacted the Altamedica
diagnostic centre in Rome (COVID authorized
diagnostic regional centre) from mid-September until
24th of October 2020 were enrolled, were collected and
analysed by the antigen test (STANDARD F COVID19
Ag FIA, SD Biosensor, Suwon, South Korea). Among
the 5100 analysed subject, 5% (256/5100) resulted
SARS-CoV-2 virus infected, all with minimal or no
symptoms, while 95% (4844/5100) has no positive
results for the antigen test. Among the 256 SARS-CoV-2
positive subjects 30 declined to answer to the
information questionnaire. The sample studied are
shown in Table 1. Among the SARS-CoV-2 positive
subjects, 45% (102/226) never travel by public
transportation, 95% (213/226) never went to cinemas
and or theatres, 93% (211/226) never went restaurants
and 92% (209/226) never went to gyms (Fig. 1 and 2).
Our data has shown that the infection possibly
contracted during recreational activity could affect a
very small percentage of SARS-CoV-2 positive
subjects in our population study. Despite this is an
exclusion and not an inclusion criteria study, related
with the environmental risk we cannot exclude an
effect on the epidemic spread related with the public
transportation, since 54% of our SARS-CoV-2 positive
subject reported to use public transportation assiduously
and/or occasionally (Zheng et al., 2020).
Authorities in the new decree of the Ministry of
Health of October 25, 2020 have limited restaurant,
closed gym and others recreational activity, but they
must be aware that according to the results obtained in
this study 93-95% of the 226 SARS-CoV-2 positive
subjects, never went to restaurant/gym or cinema.
Although larger population studies are ongoing to better
determine the accuracy of our consideration, data
strongly suggest that the virus infection rarely occurred
in the considered environmental system.
Fig. 1: From mid-September 2020, 5100 subjects were analyzed in the Altamedica laboratories, of which 4844 were negative and
256 were positive for antigen test directed towards the SAR-CoV-2 virus. Among positive subjects 93% claimed to have
never attended recreational activity, such us restaurants or gyms, 14 days before contracting the virus
CONSORT diagram
Analysed cases (n = 5100)
SARS-CoV-2 negative
subjects (n = 4844)
SARS-CoV-2 positive
subjects (n = 256)
Excluded (n = 30)
Declined to participate
SARS-CoV-2 positive
subjects 226
Public transporation
CINEMA/THEATRE
Assiduously
39 (17%)
Occasional
83 (37%)
Never 102
(45%)
Not
remember
Assiduously
0
Occasional
13 (6%)
Never 213
(94%)
Not
remember
Katia Margiotti et al. / American Journal of Infectious Diseases 2021, 17 (1): 1.4
DOI: 10.3844/ajidsp.2021.1.4
3
Fig. 2: From mid-September 2020, 5100 subjects were analyzed in the Altamedica laboratories, of which 4844 were negative and
256 were positive for antigen test directed towards the SAR-CoV-2 virus. Among positive subjects 95% claimed to have
never attended recreational activity, such us cinemas or theatres 14 days before contracting the virus
Table 1: Patient characteristics of the COVID-19 group.
Characteristics COVID-19 group
Age, years 33.5 (12.5-72.4)
Male sex 99 (44%)
Female sex 127 (56%)
Authors Contributions
Katia Margiotti: Provided insights on data analysis
drafting the manuscript.
Marco Fabiani: Provided insights on data analysis
and revised the manuscript.
Marina Cupellaro: Performed the laboratory
analysis.
Alvaro Mesoraca: Participated in conceiving the
study and revised the manuscript.
Claudio Giorlandino: Conceived the study drafted
and revised the manuscript.
Ethics Approval and Consent to Participate
The study was approved by the local ethical
committee of Artemisia SPA and all participating
patients given them written consent.
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CONSORT diagram
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Excluded (n = 30)
Declined to participate
SARS-CoV-2 positive
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GYM
Assiduously
0
Occasional
12 (5%)
Never 211
(93%)
Not
remember
Assiduously
11 (5%)
Occasional
6 (3%)
Never 209
(92%)
Not
remember
Katia Margiotti et al. / American Journal of Infectious Diseases 2021, 17 (1): 1.4
DOI: 10.3844/ajidsp.2021.1.4
4
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