On several aspects of COVID-19 yet to be defined: the second wave

Since the end of September 2020, the COVID-19 pandemic in Italy has registered a new increase in infections, uniform among all regions, defining the beginning of the second wave. The contagion curve began to rise after summer with the easing of the restrictions and the reopening of the social system. Then, in the last days of November 2020 it reached a peak in patients tested positive for Sars-Cov-2. This article compares the data of adult patients (>18 years old) who have been evaluated at the Emergency Department of the Umberto I Polyclinic Hospital in Rome, Italy, in March 2020 (first pandemic wave) with those of October 2020 (second pandemic wave). The study design follows the previous one in March. The typical patient who presented to the Emergency Department for COVID-19 has not changed from March to October: it is a sixty-year-old male. The main symptoms have partly changed (in the second wave, fever is less frequent 74% vs. 91% and dyspnea is more frequent 53% vs. 41%) and some secondary symptoms have appeared increasing in percentage (fatigue and diarrhea). Regarding pre-existing conditions, there are no differences. Patients are no longer hy- poxic at the entrance to the Emergency Department but have more frequently undergone oxygen therapy before entering the hospital. A better organization of the hospital made it possible to hospitalize them early and carry out CPAP or NIV directly in the ward and not in the ED. At 14 days follow-up, the number of discharged patients significantly decreased in October compared to March, and the number of deaths also decreased. Between the first and second pandemic waves, the hospital response was changed according to the new assistance needs of the Roman population: the availability of COVID-19 beds increased; there was a faster transfer of the patient to the appropriate ward; there has been a modification in the therapies that followed the developments of the world scientific literature. Local medicine has also worked in “dif- ferent” ways: the possibility for patients to be tested for Sars-Cov-2 has been extended and home therapies started earlier and according to global guidelines. Consequently, the patient arrived at the hospital earlier and was discharged under a higher protection regime. This whole organization has had a positive effect on the outcomes of the disease in general, but not on the mortality rate. The information gathered leads us to believe that the public is more aware of the danger of the SARS-Cov-2 virus, and that the hospital is more prepared to face this pandemic.