Supporting Activities for Epidemiological Surveillance and Contact Tracing in Enna, Catania and Palermo in Sicily, Italy

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Project location: ITALY, Sicily
Project start date: April 2020 - Project end date: December 2020
Project number: 2020-028
Beneficiary: Medici Senza Frontiere Italia

MSF has been working in Italy since 1999. In particular, in Sicily Médecins Sans Frontières (MSF) continued to provide psychological and medical assistance to migrants and refugees in Italy, including specialized care for victims of torture. During the past years, MSF also ran a clinic in Catania for patients requiring care after discharge from hospitals in Sicily. MSF psychologists also supported asylum seekers in reception centers in the province of Trapani, handing over activities at the end of the year as planned. In Palermo, they provided support and orientation to more than 800 people to access national health services. MSF also distributed relief items such as blankets and tents to migrants and refugees living in informal settlements, in particular in Rome and around Italy’s northern borders.  

Their presence within the region gives MSF the chance to plan a brand-new intervention against the Covid-19 pandemic faster and effectively.

Sicily is the 4th most populated region in Italy. The health system is divided into 9 health provinces ("aziende sanitarie provinciali" - ASP), one for each province. The ASP services integrate private health facilities, the main one located in Palermo and Enna.  According to the regional epidemiological observatory the analysis of the number of cases should consider:

  • 30.419 people reported themselves to health system after arriving in Sicily in March but many more arrived from the North of Italy in March at the beginning of the lockdown. These people have not been tested nor tracked.
  • Elderly people centers (RSA – Residenze sanitarie assistenziali and other kind of centers) are the most hit by the disease and in some provinces like Enna more than half of the cases reported are there.
  • Lack of chemical reagents and poor laboratory capacity does not allow a proper data collection (33.787 test to date). Health authorities report 3 weeks delay to receive the results of the tests. In other words, the number of positive cases is supposed to be much higher.

In response to the Covid-19 emergency, the Nando and Elsa Peretti Foundation has awarded a grant to MSF to support its covid-19 emergency response in Sicily, and in particular to cover human resources costs related to 1 epidemiologist, 1 Medical doctor per the telecovid activity, and 2 nurses for three months. 

MSF’s coronavirus response in Sicily is based on activities of surveillance and contact tracing, and in particular:

1) Telecovid – remote surveillance and patient follow up

2) Support of epidemiological surveillance to the 3 identified provincial departments (Enna, Catania, Palermo) for:

  • Data collection and encoding in the database
  • Contact tracing
  • Data analysis through statistics and epidemiological models
  • Coordination with a regional observatory for a consistent approach

3) Health promotion and outreach: support to local NGOs.

During the explo an urgent need to focus on most vulnerable situation was raised by the local NGOs and infectious diseases ward director in Palermo main hospital. The main target suggested are:

  • Highly-densed population of urban poor areas. This reality is mainly in Palermo and includes migrants as well as Italians.
  • Prisons. Prisons are overcrowded and no special measures have been adopted to prevent the spread of Covid infection. No systematic testing and isolation were started, and patients are treated only if have symptoms. Police personnel affected to the prisons are also exposed since DPI distributed are not enough. 
  • Migrants working in agriculture. MSF worked in this reality in the past years and the problems of exploitation and lack of access to health care has not improved since then. This is especially true in Vittoria area (Ragusa province) where authorities have no data on how many workers are there and no actor is present. Some doctors are trying to organize a volunteer mobile clinic to do active screening/detection of cases (depending of availability of testing tools) in the area but they have little or no experience on health promotion.   
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