January 1, 2021, a new year begins in Italy in the name of Covid. The daily bulletin marks 22,210 cases and 462 deaths, figures in decline. The country is in the descending phase of the most dramatic and intense Sars-CoV-2 epidemic wave ever touched and is preparing to enter the heart of the long-awaited anti-Covid vaccination campaign. The first medical testimonials were immunized on V-Day (27 December 2020) with the first EU approved shield product, Pfizer / BioNTech’s Comirnaty *. And in January, not only the numbers of post-Christmas infections will grow, but also those of the elderly and white coats who are starting to be vaccinated. Thus pass the first days of a year that started with the sprint of a concrete weapon against the virus and today is nearing completion in the name of a new threat: the Omicron variant.
The pandemic is still here, and the numbers say it once again: while the United Kingdom and France break through the ceiling of 200 thousand infections and the EU is alarmed by the rise of Omicron, Italy is also experiencing its surge, surpassing the 125 thousand cases, the highest figure ever; the deaths have started to rise above 100, but remain much lower than those recorded in the same period last year, such as hospitalizations and especially intensive care. In between there were 12 months between turns in therapy, and closures / openings driven by the roller coaster of the epidemic. Rewinding the tape, January is dominated by the debate on vaccines: on the 7th the regulatory bodies give the green light to that of Moderna for the over 18s – the second to collect the ok in the EU – and Italy immediately shows itself to be spotty. leopard in the vaccination campaign. There is a hunger for shield injections in the world and at first the flow of doses is not constant.
The governors themselves end up in the crosshairs of the controversies, the pharmaceutical companies themselves and in particular the then extraordinary Commissioner for the coronavirus emergency, Domenico Arcuri (replaced in March by General Francesco Paolo Figliuolo). Lombardy is also struggling with the booking system, a region that has paid a very high toll to the pandemic (after the initial stalemate it will reach the top for administered doses). After those in mRna, on January 29 the green light also arrives for the first anti-Covid vaccine with an adenoviral vector, the one produced by AstraZeneca. The choice is to use it to expand immunization to other categories: after doctors and the elderly, law enforcement and teachers.
This vaccine was eagerly awaited and announced in large quantities. In reality, the case immediately breaks out: deliveries to the EU are not as expected and a dispute arises with the company. Then the deaths of a soldier and a teacher, both Sicilians, which occurred after the vaccination (later the 18-year-old Camilla Canepa in Liguria will also lose her life). And with the increasing numbers of immunized, reports of atypical thrombosis associated with low platelet levels begin to emerge in more countries, which will later be discovered to be a very rare side effect of the vaccine, as certified by the EMA.
The AstraZeneca vaccine (the only one sold in the first phase at cost price) does not have an easy time, between temporary suspensions as a precaution decided by various countries, including Italy, France, Germany, and indications that will change several times: initially recommended by Aifa only under the age of 55, then extended up to the age of 65 and then administered only over the age of 60, for maximum caution. However, it will remain the most widespread for months in low-middle-income areas. In this scenario, the European green light for the single-dose vaccine, with an adenoviral vector, by Johnson & Johnson arrives on 11 March. This vaccine will also deal with reports of rare thrombosis and ad hoc indications on the age groups to which it should be administered.
If 2021 is the year of vaccines, April is the month of the debate on the obligation to give the shield injection, which is triggered for health professionals. The effect of the provision is that in the following months the suspensions of the staff who remain in no vax positions arrive. Overall coverage on the general population front grows, but at a slower rate as it decreases with age. The government decides to speed up, and in mid-June it launches the Green Pass defining its release procedures, in advance of the EU. And while in May the green light for the Pfizer vaccine had also arrived for 12-15 year olds, after the summer there is already talk of a third dose: Italy will begin at the end of September to administer them to healthcare professionals, the elderly and the frail. In October, however, there are still about 8 million unvaccinated (today they are 9.4 million including 5-11 year olds discovered, for whom vaccinations have recently started). It happens despite the fact that the green certificate – which can also be obtained with a negative swab – is required to access an ever-increasing number of activities, from gyms to restaurants.
The no vax and no Green pass demonstrations enliven the Italian squares for weeks and it becomes clear that there is a hard core of vaccination resistant that will be difficult to erode. The figure is worrying because in the meantime, in November, Europe returns to the epicenter of the pandemic. The infections begin to rise again: it is the fourth wave. Italy focuses on the booster and the Minister of Health Roberto Speranza announces that from 22 November the audience of recipients will be expanded to all over 40 (later the age threshold will drop again).
As the curve begins to rise also in Italy, the government raises the bar and tries to run for cover with measures ranging from the obligation extended to new categories (from teachers to law enforcement) to the super Green pass (only vaccinated and cured ) to secure Christmas. The Holidays, however, bring with them the explosion of infections, of the demand for tampons – which generates the tilt of the system – and of asymptomatic people in quarantine. To avoid paralysis, a new round of measures that increase the scope of the super green pass, cut the quarantines for multi-vaccinated people and reduce the need for tests.
2021 is also the year of therapies. In March, monoclonal antibodies against Covid-19 made their debut in Italy, to be used very early in those at risk of severe forms. And if the idea of the plasma of the recovered disappears, in the wake of the uninspiring data of several studies, different drugs explored in the hardest emergency phase are confirmed, and used in a structured way in hospitalized patients (from the old anti-inflammatory drug anti-arthritis dexamethasone such as tocilizumab).
But the promise with which the year ends – apart from the green light for the vaccine for children aged 5-11, which arrived from the EMA on 25 November and from Aifa on 1 December – is that of antiviral pills, which can be used. in the first days after diagnosis. The data show potential in reducing the risk of hospitalization and death. There are two drugs in the running: that of Merck (MSD outside the US and Canada), for which the final data have corrected the initially emerging efficacy downwards, and that of Pfizer.
The front of therapies continues to enrich itself and also that of vaccines, with the approval in December in the EU of the first anti-Covid protein vaccine, that of Novavax. But the list of variants of concern of the Sars-CoV-2 coronavirus is also enriched: after months in which Delta had reigned supreme, the new Omicron – reported for the first time by South Africa and baptized with the Greek letter on 26 November from the WHO – already promises to steal the show. The variant, experts say, shows a certain capacity for immune escape: the data on the reinfection of the recovered and on the two doses of the vaccine are not encouraging, but those on the boosters seem to show a notable reinforcement of protection. But according to some studies, the associated disease appears to be characterized by less severity. While information on this is still being collected, and it is not yet known whether an ad hoc vaccine will be needed, the new variant has already shown signs of high transmissibility. Omicron runs around the world and is already dominant in several European countries.