First COVID-19 wave in the province of Bergamo, Italy: epidemiological and clinical characteristics, outcome and management of the first hospitalized patients

Northern Italy was the first European country affected by the spread of the SARS-CoV-2, with the epicenter in the province of Bergamo. This study aims to analyze the characteristics of patients who experienced more severe symptoms during the first wave of COVID-19 pandemic. We retrospectively collected epidemiological and clinical data on patients with laboratory-confirmed wild-type SARS-CoV-2 infection who were admitted to the "ASST Bergamo Ovest" hospital between February 21 and May 31, 2020. A total of seven hundred twenty-three inpatients met the eligible criteria and were included in the study cohort. Among the inpatients who survived, the average hospital length of stay was more than two weeks, with some lasting up to three months. Among the 281 non-survivors, death occurred in 50% within five days. Survivors were those whose first aid operators recorded higher oxygen saturation levels at home. The request for first aid assistance came more than one week after symptom onset, within three days in 10% of cases. In similar future scenarios, based on our data, if we aim to enhance the survival rate, we need to improve the territorial healthcare assistance and admit to hospitals only those patients who are at risk of severe illness requiring specialized and urgent interventions within two, three, or, at most, five days from the onset of symptoms. This implies that the crucial factor is, has been, and will be the ability of a healthcare system to react promptly in its entirety within a few days.