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

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 SARSCoV-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.

Automated summary

Before February 20, 2020, over 500 cases of COVID-19 were detected in Lombardy, with SARS-CoV-2 already circulating in at least 222 municipalities. The mean serial interval was 6.6 days, and the basic reproduction number ranged from 2.6 to 3.3 across different provinces in Lombardy. A decrease in the net reproduction number was observed following the detection of the first case.