Although cases of COVID-19 were documented in other countries a little earlier than the first Italian cases, Italy was the first European country to be severely affected by the pandemic
The first cases of COVID-19 in Italy were diagnosed on 30 January 2020; these were two Chinese tourists who were visiting Rome. Other isolated cases – all arriving or returning from China – had already been reported in France (24 January) and Germany (27 January). At that time, isolated cases or small outbreaks, all related to people who had recently been to China, had been reported in most European countries.
On 20 February 2020, in a climate of growing concern, in which – however – the real risk still seemed ‘far away’ (the World Health Organization would only declare a Sars-CoV-2 ‘pandemic’ on 11 March), the Italian public and the world of healthcare were shaken by the news. The first Italian case (‘Patient 1’) was a 38-year-old man admitted to Codogno Hospital (in a village of 15,000 inhabitants in the province of Lodi, Lombardy, Northern Italy) with severe pneumonia and the need for ventilatory support in the intensive care unit. He was defined as Patient 1 because he was considered the first to fall ill with COVID-19 on Italian soil, having not made trips abroad previously.
Over the next 24 hours, another 16 patients between Lombardy and Veneto tested positive for Sars-CoV-2; all of whom had not travelled to China recently. This was the start of the outbreaks of COVID-19 in Italy. As of 1 March 2020, Italy had 3089 confirmed cases and 109 deaths, most of them in the northern regions, and was, by far, the European country most affected by COVID-19, second only to China and South Korea.
It was almost impossible to understand what was happening in Italy: we were the first western country hit by a large-scale spread of Sars-CoV-2, where the virus seemed to have arrived extremely suddenly and disruptively, thereby seriously impacting on the response capacity of the public health service.
Epidemiologists in regions of northern Italy were on the hunt for ‘Patient 0’; that is the person who – after returning from other countries already affected by COVID-19 – had infected Patient 1 and spread the virus between Lombardy and Veneto.
Over time, however, it became clear that there was no Patient 0 because Patient 1 was evidently not the first Italian case. In retrospect, the common opinion, and also the official position of the Italian Ministry of Health, was that the Sars-CoV-2 virus had already been circulating in Italy for at least a few weeks prior causing, for the most part, less acute (and therefore more difficult to identify) cases, together with sporadic cases of interstitial pneumonia (which is also associated with other infections such as influenza) that would go undiagnosed.
Which new strategies were adopted?
‘Red zones’ and lockdown
As early as 21 February, the Italian Prime Minister had ordered the creation of ‘red zones’ for the municipalities of Lombardy and Veneto, which were the most affected. Knowing that the situation was no longer contained at a local level, a national lockdown was decreed from 4 March, with the closure of schools of all levels, universities, and non-essential production sites and a lockdown on free movement.
Suspension of non-urgent clinical services
- the spread of Sars-CoV-2 infection in hospitals was limited (at least in many regions), and;
- resources (medical and healthcare personnel) to support the services that were under most stress were freed up.
At the time of writing, 35,154 people have died as a result of COVID-19 in Italy, which is one of the highest mortality rates per million inhabitants in the world. We have had to pay a very high price in terms of human life, not to mention accompanying psychological impacts and economic repercussions. But the health service and civil society endured, perhaps unexpectedly according to some observers, so much so that The New York Times conceded: “…when Italy was the stuff of COVID nightmares, Trump and Biden, and much of Europe, mocked it as a shorthand for uncontrolled contagion. Now the pariah has become a model – however imperfect – of viral containment as the US and Europe struggle.”
Now the situation here has improved, many families are taking vacation at the sea or in the mountains. But we are keeping our guard up, the memories of the days of March and April still etched in the minds of the population and the healthcare workers at the forefront of care. We sincerely hope a second wave of COVID-19 will not come, but if it does, we hope to be able to face this fully prepared.
Filippo Fassio MD
Allergy and Clinical Immunology Unit, Azienda USL Toscana Centro, Italy