{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:47:55Z","timestamp":1760147275741,"version":"build-2065373602"},"reference-count":16,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Studies on SARS-CoV-2 conducted in confined settings for prolonged times allow researchers to assess how the coronavirus spreads. San Patrignano (SP), Italy, is the largest European drug rehabilitation facility. Methods: Between 15 October and 31 December 2020, all SP residents were tested for SARS-CoV-2. We analyzed the relationships between individual characteristics and being SARS-CoV-2-positive. Three selected predictive models were used to calculate the number of expected hospitalizations. For each model, we summed the estimated individual risks to obtain the expected number of hospitalizations in our sample, and we tested whether the observed and expected numbers differed. Results: Of 807 residents, 529 (65.6%) were SARS-CoV-2-positive. Of these 323 (61.1%) were symptomatic. A strong relationship was found between being positive and living connections (p-value &lt; 0.001). No statistically significant relationship was found with age, sex, smoking history, or comorbidities. Although 9 to 17 hospitalizations were expected, no hospitalizations were observed (p-value &lt; 0.001). No one died of COVID-19. Conclusions: The peculiar characteristics of SP residents or the SP environment might at least partially explain the null hospitalization rates. Despite the extreme uniqueness of our population and despite the protected environment and all precautions that were taken, the fact that the virus was able to circulate and infect a large portion of the population highlights the fundamental role of social interactions in the spread of the disease.<\/jats:p>","DOI":"10.3390\/ijerph20032136","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T03:23:49Z","timestamp":1674617029000},"page":"2136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["SARS-CoV-2 Infection in San Patrignano, the Largest European Drug Rehabilitation Community"],"prefix":"10.3390","volume":"20","author":[{"given":"Isabella","family":"Sala","sequence":"first","affiliation":[{"name":"Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy"},{"name":"Department of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9963-1624","authenticated-orcid":false,"given":"Carlotta Micaela","family":"Jarach","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Bagnardi","sequence":"additional","affiliation":[{"name":"Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-3564","authenticated-orcid":false,"given":"Maria Sofia","family":"Cattaruzza","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy"},{"name":"Societ\u00e0 Italiana di Tabaccologia (SITAB), 00136 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Morri","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, AUSL della Romagna, 47924 Rimini, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Ottogalli","sequence":"additional","affiliation":[{"name":"San Patrignano Medical Center, 47853 Coriano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Zag\u00e0","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Tabaccologia (SITAB), 00136 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8967-0400","authenticated-orcid":false,"given":"Silvano","family":"Gallus","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Boschini","sequence":"additional","affiliation":[{"name":"San Patrignano Medical Center, 47853 Coriano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"m1632","DOI":"10.1136\/bmj.m1632","article-title":"What the Diamond Princess taught the world about covid-19","volume":"369","author":"Baraniuk","year":"2020","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2766","DOI":"10.1111\/jgs.17434","article-title":"A systematic review of long-term care facility characteristics associated with COVID-19 outcomes","volume":"69","author":"Konetzka","year":"2021","journal-title":"J. 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