The association between first and second wave COVID-19 mortality in Italy

Background The relation between the magnitude of successive waves of the COVID-19 outbreak within the same communities could be useful in predicting the scope of new outbreaks. Methods We investigated the extent to which COVID-19 mortality in Italy during the second wave was related to first wave mortality within the same provinces. We compared data on province-specific COVID-19 2020 mortality in two time periods, corresponding to the first wave (February 24-June 30, 2020) and to the second wave (September 1-December 31, 2020), using cubic spline regression. Results For provinces with the lowest crude mortality rate in the first wave (February-June), i.e. < 22 cases/100,000/month, mortality in the second wave (September-December) was positively associated with mortality during the first wave. In provinces with mortality greater than 22/100,000/month during the first wave, higher mortality in the first wave was associated with a lower second wave mortality. Results were similar when the analysis was censored at October 2020, before the implementation of region-specific measures against the outbreak. Neither vaccination nor variant spread had any role during the study period. Conclusions These findings indicate that provinces with the most severe initial COVID-19 outbreaks, as assessed through mortality data, faced milder second waves.

Automated summary

The study found that the mortality rate during the second wave of COVID-19 was related to the mortality rate during the first wave in the same provinces. Provinces with lower mortality rates in the first wave experienced higher mortality rates in the second wave, while provinces with higher mortality rates in the first wave had lower mortality rates in the second wave.