Epidemiological characteristics of COVID-19 cases and estimates of the reproductive numbers 1 month into the epidemic, Italy, 28 January to 31 March 2020

Author:

Riccardo Flavia12ORCID,Ajelli Marco3451,Andrianou Xanthi D62ORCID,Bella Antonino2,Del Manso Martina72ORCID,Fabiani Massimo2,Bellino Stefania2,Boros Stefano2,Urdiales Alberto Mateo72ORCID,Marziano Valentina5,Rota Maria Cristina2,Filia Antonietta2,D'Ancona Fortunato2,Siddu Andrea2,Punzo Ornella2,Trentini Filippo5,Guzzetta Giorgio5,Poletti Piero5,Stefanelli Paola2,Castrucci Maria Rita2,Ciervo Alessandra2,Di Benedetto Corrado2,Tallon Marco2,Piccioli Andrea2,Brusaferro Silvio2,Rezza Giovanni2,Merler Stefano5,Pezzotti Patrizio2,

Affiliation:

1. These authors contributed equally

2. Istituto Superiore di Sanità, Rome, Italy

3. Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, United States

4. Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, United States

5. Bruno Kessler Foundation, Trento, Italy

6. Cyprus University of Technology, Limassol, Cyprus

7. European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Abstract

Background On 20 February 2020, a locally acquired coronavirus disease (COVID-19) case was detected in Lombardy, Italy. This was the first signal of ongoing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the country. The number of cases in Italy increased rapidly and the country became the first in Europe to experience a SARS-CoV-2 outbreak. Aim Our aim was to describe the epidemiology and transmission dynamics of the first COVID-19 cases in Italy amid ongoing control measures. Methods We analysed all RT-PCR-confirmed COVID-19 cases reported to the national integrated surveillance system until 31 March 2020. We provide a descriptive epidemiological summary and estimate the basic and net reproductive numbers by region. Results Of the 98,716 cases of COVID-19 analysed, 9,512 were healthcare workers. Of the 10,943 reported COVID-19-associated deaths (crude case fatality ratio: 11.1%) 49.5% occurred in cases older than 80 years. Male sex and age were independent risk factors for COVID-19 death. Estimates of R0 varied between 2.50 (95% confidence interval (CI): 2.18–2.83) in Tuscany and 3.00 (95% CI: 2.68–3.33) in Lazio. The net reproduction number Rt in northern regions started decreasing immediately after the first detection. Conclusion The COVID-19 outbreak in Italy showed a clustering onset similar to the one in Wuhan, China. R0 at 2.96 in Lombardy combined with delayed detection explains the high case load and rapid geographical spread. Overall, Rt in Italian regions showed early signs of decrease, with large diversity in incidence, supporting the importance of combined non-pharmacological control measures.

Publisher

European Centre for Disease Control and Prevention (ECDC)

Subject

Virology,Public Health, Environmental and Occupational Health,Epidemiology

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