Retrospective analysis of the Italian exit strategy from COVID-19 lockdown

After the national lockdown imposed on March 11, 2020, the Italian government has gradually resumed the suspended economic and social activities since May 4, while maintaining the closure of schools until September 14. We use a model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to estimate the health impact of different exit strategies. The strategy adopted in Italy kept the reproduction number R-t at values close to one until the end of September, with marginal regional differences. Based on the estimated postlockdown transmissibility, reopening of workplaces in selected industrial activities might have had a minor impact on the transmissibility. Reopening educational levels in May up to secondary schools might have influenced SARS-CoV-2 transmissibility only marginally; however, including high schools might have resulted in a marked increase of the disease burden. Earlier reopening would have resulted in disproportionately higher hospitalization incidence. Given community contacts in September, we project a large second wave associated with school reopening in the fall.

Automated summary

After the national lockdown in Italy on March 11, 2020, economic and social activities gradually resumed from May 4 while schools remained closed until September 14. The government's strategy in keeping the reproduction number close to one had a marginal impact on transmission, with reopening of workplaces and educational levels affecting the disease burden differently. It is projected that school reopening in September may lead to a large second wave of COVID-19.