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LitCovid-sentences  

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Id Subject Object Predicate Lexical cue
T1 0-33 Sentence denotes The Italian Outbreak of COVID-19:
T2 34-72 Sentence denotes Conditions, Contributors, and Concerns
T3 74-359 Sentence denotes In late December 2019, several cases of interstitial pneumonia of unknown origin were reported in Wuhan, China, and on January 9, 2020, a novel coronavirus was identified as the causative infective agent, named 2019 novel coronavirus (2019-nCoV); the disease was termed COVID-19 .1 , 2
T4 360-452 Sentence denotes Figure Potential reasons for the outbreak of COVID-19 in Italy and its regional differences.
T5 453-719 Sentence denotes Since then, the contagion has spread exponentially through China, South Korea, and many other countries, and the presence of asymptomatic cases together with the ease of modern travel allowed the virus to reach every continent, with the sole exception of Antarctica.
T6 720-792 Sentence denotes On March 11, the World Health Organization declared a state of pandemic.
T7 793-974 Sentence denotes Herein, we discuss possible factors that may contribute to the differences in Italy’s COVID-19 outbreak compared with other countries and the differences among regions within Italy.
T8 975-1089 Sentence denotes Italy was one of the first European countries that dealt with COVID-19, with first cases detected in January 2020.
T9 1090-1274 Sentence denotes In mid-February, cases of community spread were detected in the region of Lombardy, and the outbreak soon involved all of northern Italy, eventually appearing elsewhere in the country.
T10 1275-1359 Sentence denotes At first, the fatality rates in Italy and China were comparable, approximating 2.3%.
T11 1360-1541 Sentence denotes However, over the past weeks, the Italian situation has worsened, with mortality rates reaching as high as 8% to 12%, and with the total number of deaths surpassing those in China.3
T12 1542-1725 Sentence denotes As a consequence, and similar to Chinese emergency policy, restrictive measures were then adopted in Italy, including general lockdown, measures shown to check the contagion in Wuhan.
T13 1726-1974 Sentence denotes The grave situation in Italy raises 2 salient questions: “Why have there been so many cases and deaths?” and “Why are there these differences among regions?” There are no answers to these questions, but we offer the following speculations (Figure).
T14 1976-2021 Sentence denotes Why Have There Been So Many Cases and Deaths?
T15 2022-2024 Sentence denotes 1.
T16 2025-2359 Sentence denotes A first point of discussion is that in other countries, including South Korea, a wider sample of the population was tested, whereas in Italy and especially in the north, diagnostic tests were mainly reserved for symptomatic cases seen in the emergency department or symptomatic cases at home with recent contact with a confirmed case.
T17 2360-2523 Sentence denotes Therefore, the actual number of positive patients could be even 10-fold higher than the estimated number, thus considerably reducing the percentage of fatal cases.
T18 2524-2611 Sentence denotes However, this assumption cannot be confirmed until extended population testing is done.
T19 2612-2614 Sentence denotes 2.
T20 2615-2685 Sentence denotes Epidemiological and demographic differences should also be considered.
T21 2686-2780 Sentence denotes For instance, mortality rates have been higher in the elderly as well as in men than in women.
T22 2781-2890 Sentence denotes This could be because men are more frequent smokers and have more cardiovascular comorbidities than do women.
T23 2891-2978 Sentence denotes In both China and South Korea, life expectancy is lower than that in Western countries.
T24 2979-3129 Sentence denotes In South Korea, most infected patients are young, nonsmoking women, who, generally and in the absence of COVID-19, have a lower overall risk of death.
T25 3130-3305 Sentence denotes This argument may partially explain the differences between Italy on the one hand and South Korea or China, on the other, but not with the rest of Europe or the United States.
T26 3306-3480 Sentence denotes An additional hypothesis is that Italian grandparents spend more time with their young grandchildren, the latter possibly representing asymptomatic carriers of the infection.
T27 3481-3550 Sentence denotes Further epidemiological research is needed with regard to this issue.
T28 3551-3553 Sentence denotes 3.
T29 3554-3752 Sentence denotes A relevant issue is that the Italian health system, which experienced financial cuts in the past years, was poorly positioned and resourced to deal with the emergency imposed by the COVID-19 crisis.
T30 3753-3924 Sentence denotes The lack of an appropriate number of intensive care units, managed care organization, and lifesaving devices such as ventilators may have compromised the care of patients.
T31 3925-4230 Sentence denotes The paucity of personal protective equipment throughout the country caused a spread of the contagion among medical staff and consequently patients.4 Furthermore, the lack of renovation in health care facilities with inappropriate air ducts could have facilitated virus circulation in compromised patients.
T32 4231-4233 Sentence denotes 4.
T33 4234-4396 Sentence denotes The Chinese “disaster response plan” allowed the construction of 2 dedicated hospitals in only 10 days, whereas Italy was unprepared to face emergency conditions.
T34 4397-4399 Sentence denotes 5.
T35 4400-4604 Sentence denotes The Chinese experience emphasized not just the quarantine of asymptomatic and mildly symptomatic cases but also follow-up of possible contacts and of the infectious status so as to attenuate viral spread.
T36 4605-4762 Sentence denotes Finally, virus mutation and the appearance of more virulent genotypes may contribute to geographic differences in morbidity and mortality caused by COVID-19.
T37 4763-4912 Sentence denotes Different genotypes for 2019-nCoV exist, and it is thus intriguing whether genotypes determine the infectivity of and mortality caused by 2019-nCoV.5
T38 4914-4960 Sentence denotes Why Are There These Differences Among Regions?
T39 4961-5119 Sentence denotes Substantial differences occur throughout Italy, with the north of the country, predominantly Lombardy, exhibiting the highest rates of spread and mortality.1.
T40 5120-5412 Sentence denotes One possible explanation is that the above-mentioned Italian regions represent a central driver of the Italian economy, being the headquarters of several major industries; individuals from other regions and other countries who are involved with such industries may spread the virus elsewhere.
T41 5413-5580 Sentence denotes Nevertheless, other Italian cities that are overcrowded because of business and tourism, such as Rome, have not experienced the same prevalence and spread of COVID-19.
T42 5581-5724 Sentence denotes A supposition could be that the northern experience led to severe restrictive measures throughout the country, thereby containing the outbreak.
T43 5725-5727 Sentence denotes 2.
T44 5728-5818 Sentence denotes Climate conditions may also be relevant to the differences reported among Italian regions.
T45 5819-6034 Sentence denotes Higher temperature and humidity may block virus diffusion and reduce its persistence in the air and on the objects.6 This explanation has been given to the unequal distribution of the contagion among the continents.
T46 6035-6174 Sentence denotes In Italy, however, differences in climate among regions are less than what exists between Italy and other parts of the world such as China.
T47 6175-6177 Sentence denotes 3.
T48 6178-6280 Sentence denotes More recently, there is increasing attention on the possible role of air pollution in virus diffusion.
T49 6281-6564 Sentence denotes The correlation between the air pollution index and increased fatality was previously hypothesized for the severe acute respiratory syndrome caused by a virus member of the Coronaviridae family; subsequent evidence supported this hypothesis for the severe acute respiratory syndrome.
T50 6565-6754 Sentence denotes In particular, atmospheric particulate seems to act as a carrier of the virus, facilitating its diffusion and dissemination and allowing its survival in active form for hours and even days.
T51 6755-6906 Sentence denotes Indeed, air pollution imposes an increased vulnerability of the population to respiratory syndromes, even in the absence of microbial causative agents.
T52 6907-7139 Sentence denotes A recently published position paper of the Italian Society of Environmental Medicine in collaboration with 2 Italian universities compared COVID-19 case distribution (updated to March 3) and air pollution levels in the past 20 days.
T53 7140-7376 Sentence denotes Interestingly, northern Italy had both the most polluted area and the highest number of cases of COVID-19, thereby supporting the possibility that the degree of air pollution may contribute to regional differences in cases of COVID-19.7
T54 7377-7511 Sentence denotes In sum, there is no single explanation that accounts for the severity and catastrophic consequences of the COVID-19 outbreak in Italy.
T55 7512-7660 Sentence denotes Intense and sustained effort is needed to optimize strategies that prevent the spread of infection and to devise targeted therapies for the disease.
T56 7661-7793 Sentence denotes In the meantime, severe restrictive measures and strict social distancing are crucial to contain the contagion among the population.
T57 7794-7994 Sentence denotes Hospitals should be provided with appropriate personal protective equipment, ventilators, and further intensive care unit equipment to preserve the medical staff and to optimize care for all patients.
T58 7996-8011 Sentence denotes Acknowledgments
T59 8012-8090 Sentence denotes Drs Del Buono and Iannaccone contributed equally as first author to this work.
T60 8091-8121 Sentence denotes Potential Competing Interests:
T61 8122-8164 Sentence denotes The authors report no competing interests.