Thought of the Day - May 3 2021 - Novel Coronavirus Was Across Italy in 2019

An interesting peer-reviewed paper published late last year shows that SARS-CoV-2 was spreading in Italy six months before their first "official" case ( https://journals.sagepub.com/doi/full/10.1177/0300891620974755 )

A lung cancer screening trial took blood samples from 959 people across Italy from September 2019 through March 2020. These samples were later tested for SARS CoV-2 antibodies. Unbeknownst to them, 111 (over 10%) of the people in the study were shown to have developed antibodies to COVID-19 at some point during the trial. Most surprisingly 23 had antibodies at the beginning of the trial, thus were probably exposed in August of 2019, six months before the first cases in Italy were detected (two tourists from China) at the end of January, and the first domestic case confirmed on February 2020.

As you can see from the map (A) antibodies were found across the country, with the highest prevalence in the province of Lombardy (B) the region hardest hit in the spring of 2020.

This study highlights a number of issues:

1. Most obviously that there was a severe underestimation of the prevalence of cases. Regional and national health authorities, after an attempt to identify cases and suspects early and trace all the potential contacts, soon abandoned this strategy as unsustainable and concentrated on the identification strategy, with swabs and serology, on symptomatic cases only. Thus, a significant underestimation of overall COVID-19 cases was begun, with the consequence that an overestimation of the mortality rate was created, which is probably the case across much of the world;

2. The second concern regards the onset of the epidemic, which preceded the identification of the first case by several months. It turns out in November–December 2019, many general practitioners in Italy began reporting the appearance of severe respiratory symptoms in elderly and frail people with atypical bilateral bronchitis, which, as was the case in China, was attributed to aggressive forms of seasonal influenza and thus ignored.

In short, the conclusion of the paper is that COVID-19 is far less deadly and has been around far longer than reflected in official records.

Cheers

Cliff