Epidemiological investigations detected over 500 cases (median age: 69, IQR: 57–78) before the first COVID-19 diagnosed patient (February 20, 2020), and suggested that SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities with sustained transmission across all the Lombardy provinces. We estimated the mean serial interval to be 6.6 days (95% CrI, 0.7–19). Our estimates of the basic reproduction number range from 2.6 in Pavia (95% CI, 2.1–3.2) to 3.3 in Milan (95% CI, 2.9–3.8). A decreasing trend in the net reproduction number was observed following the detection of the first case.
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## Epidemics

# The early phase of the COVID-19 epidemic in Lombardy, Italy

Author links open overlay panelDaniloCeredaa1, MattiaManicab1, MarcelloTiraniac, FrancescaRovidade, VittorioDemichelic, MarcoAjellif, PieroPolettib, FilippoTrentinibg, GiorgioGuzzettab, ValentinaMarzianob, RaffaellaPiccarretagh, AntonioBaronei, MicheleMagonij, SilviaDeandreak, GiulioDiurnoa, MassimoLombardol, MarinoFaccinic, AngeloPanm, RaffaeleBrunoen, ElenaParianio…StefanoMerlerb2

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## Highlights

- •
  Over 500 cases (median age: 69, IQR: 57–78) declaring symptom onset before the notification of the first case (20 February 2020) were retrospectively detected.

- •
  SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities of Lombardy.

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  The estimated mean serial interval was 6.6 days (95% CrI, 0.7–19).

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  The basic reproduction number in the 12 provinces of Lombardy ranged from 2.6 (95% CI, 2.1–3.2) to 3.3 (95% CI, 2.9–3.8).

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  A decreasing trend in the net reproduction number following the detection of the epidemic and the introduction of the first restrictive measures.

## Abstract

### Background

In the night of February 20, 2020, the first epidemic of the novel coronavirus disease (COVID-19) outside Asia was uncovered by the identification of its first patient in Lombardy region, Italy. In the following weeks, Lombardy experienced a sudden increase in the number of ascertained infections and strict measures were imposed to contain the epidemic spread.

### Methods

We analyzed official records of cases occurred in Lombardy to characterize the epidemiology of SARS-CoV-2 during the early phase of the outbreak. A line list of laboratory-confirmed cases was set up and later retrospectively consolidated, using standardized interviews to ascertained cases and their close contacts. We provide estimates of the serial interval, of the basic reproduction number, and of the temporal variation of the net reproduction number of SARS-CoV-2.

### Results

Epidemiological investigations detected over 500 cases (median age: 69, IQR: 57–78) before the first COVID-19 diagnosed patient (February 20, 2020), and suggested that SARS-CoV-2 was already circulating in at least 222 out of 1506 (14.7%) municipalities with sustained transmission across all the Lombardy provinces. We estimated the mean serial interval to be 6.6 days (95% CrI, 0.7–19). Our estimates of the basic reproduction number range from 2.6 in Pavia (95% CI, 2.1–3.2) to 3.3 in Milan (95% CI, 2.9–3.8). A decreasing trend in the net reproduction number was observed following the detection of the first case.

### Conclusions

At the time of first case notification, COVID-19 was already widespread in the entire Lombardy region. This may explain the large number of critical cases experienced by this region in a very short timeframe. The slight decrease of the reproduction number observed in the early days after February 20, 2020 might be due to increased population awareness and early interventions implemented before the regional lockdown imposed on March 8, 2020.

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## Keywords

COVID-19

SARS-CoV-2

Epidemiology

Transmission dynamics

Reproduction number

Coronavirus

Lombardy outbreak

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## Cited by (0)

These authors contributed equally to this work.

These authors are joint senior authors.

© 2021 The Author(s). Published by Elsevier B.V.

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