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The Evolution of Covid-19 in Italy after the Spring of 2020: An Unpredicted Summer Respite Followed by a Second Wave
Author(s)
Language
English
Obiettivo Specifico
6A. Geochimica per l'ambiente e geologia medica
Status
Published
JCR Journal
JCR Journal
Peer review journal
Yes
Title of the book
Issue/vol(year)
23/17(2020)
Publisher
MDPI
Pages (printed)
8708
Issued date
2020
Abstract
The coronavirus (COVID-19) pandemic was particularly invasive in Italy during the period between March and late April 2020, then decreased in both the number of infections and in the seriousness of the illness throughout the summer of 2020. In this work, we measure the severity of the disease by the ratio of Intensive Care Units (ICU) spaces occupied by COVID-19 patients and the number of Active Cases (AC) each month from April to October 2020. We also use the ratio of the number of Deaths (D) to the number of Active Cases. What clearly emerges, from rigorous statistical analysis, is a progressive decrease in both ratios until August, indicating progressive mitigation of the disease. This is particularly evident when comparing March-April with July-August; during the summer period the two ratios became roughly 18 times lower. We test such sharp decreases against possible bias in counting active cases and we confirm their statistical significance. We then interpret such evidence in terms of the well-known seasonality of the human immune system and the virus-inactivating effect of stronger UV rays in the summer. Both ratios, however, increased again in October, as ICU/AC began to increase in September 2020. These ratios and the exponential growth of infections in October indicate that the virus-if not contained by strict measures-will lead to unsustainable challenges for the Italian health system in the winter of 2020-2021.
References
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Freeburger, D.; Hooper, I.; et al. Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on Surfaces. J. Infect. Dis.
2020, 222, 214–222. [CrossRef]
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Nutrients 2020, 12, 988. [CrossRef]
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Lakkala, K.; Webb, A.R.; et al. Solar UV Irradiance in a Changing Climate: Trends in Europe and the
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coronavirus/sars-cov-2-dashboard (accessed on 26 October 2020). (In English)
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Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat. Med. 2020, 26, 1205–1211.
[CrossRef]
27. Ministero Della Salute, Weekly Monitoring Covid-19, Report 3–9 August. 2020. Available online:
http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=
italiano&menu=notizie&p=dalministero&id=5021 (accessed on 28 October 2020). (In English)
28. Weir, E.K.; Thenappan, T.; Bhargava, M.; Chen, Y. Does vitamin D deficiency increase the severity of
COVID-19? Clin. Med. 2020, 20, e107–e108. [CrossRef]
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López-Hoyos, M.; Muñoz-Cacho, P.; Olmos, J.M.; Gutiérrez-Cuadra, M.; Ruiz-Cubillán, J.J.; et al. Vitamin D
Status in Hospitalized Patients with SARS-CoV-2 Infection. J. Clin. Endocrinol. Metab. 2020, dgaa733.
[CrossRef]
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edu/data/mortality (accessed on 26 October 2020). (In English)
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Oxford, UK, 2020; Available online: https://www.cebm.net/global-COVID-19-case-fatality-rates/ (accessed on
23 October 2020).
2. De Natale, G.; Ricciardi, V.; De Luca, G.; De Natale, D.; Di Meglio, G.; Ferragamo, A.; Marchitelli, V.;
Piccolo, A.; Scala, A.; Somma, R.; et al. The COVID-19 Infection in Italy: A Statistical Study of an Abnormally
Severe. Dis. J. Clin. Med. 2020, 9, 1564. [CrossRef] [PubMed]
3. ISTAT Report, Primi Risultati Sull’indagine di Sieroprevalenza sul Sars-Cov-2. 2020. Available online:
https://www.istat.it/it/files/2020/08/ReportPrimiRisultatiIndagineSiero.pdf (accessed on 28 October 2020).
(In Italian)
4. Reuters. New coronavirus Losing Potency, Top Italian Doctor Says. Thomson Reuters, World News. 31 May 2020.
Available online: https://www.reuters.com/article/us-health-coronavirus-italy-virus/new-coronavirus-losingpotency-top-italian-doctor-says-idUSKBN2370OQ (accessed on 23 October 2020).
5. Vespignani, A. Il Sole 24 Ore Infodata. 2020. Available online: https://www.infodata.ilsole24ore.com/2020/05/
24/covid-19-modeling-italy-quattro-scenari-prevedere-contagio/ (accessed on 1 June 2020).
6. Vollmer, M.A.C.; Mishra, S.; Unwin, H.J.T.; Gandy, A.; Mellan, T.A.; Bradley, V.; Zhu, H.; Coupland, H.;
Hawryluk, I.; Hutchinson, M.; et al. Report 20: Using Mobility to Estimate the Transmission Intensity of
COVID-19 in Italy: A Subnational Analysis with Future Scenarios Technical Report; Imperial College COVID-19
Response Team: London, UK, 2020; Available online: https://www.imperial.ac.uk/mrc-global-infectiousdisease-analysis/covid-19/report-20-italy/ (accessed on 28 August 2020).
7. Department of Italian Civil Protection Repository. Available online: http://opendatadpc.maps.arcgis.com/
apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1 (accessed on 26 October 2020).
8. Wilson, N.; Kvalsvig, A.; Barnard, L.; Baker, M.G. Case-Fatality Risk Estimates for COVID-19 Calculated by
Using a Lag Time for Fatality. Emerg. Infect. Dis. 2020, 26, 1339–1441. [CrossRef] [PubMed]
9. Spiegel, M.R. Theory and Problems of Probability and Statistics; McGraw-Hill: New York, NY, USA, 1992;
pp. 116–117.
10. Geoghegan, J.L.; Holmes, E.C. The phylogenomics of evolving virus virulence. Nat. Rev. Genet. 2018,
19, 756–769. [CrossRef] [PubMed]
11. Song, P.; Li, W.; Xie, J.; Hou, Y.; You, C. Cytokine storm induced by sars-cov-2. Clin. Chim. Acta 2020,
509, 280–287. [CrossRef]
12. Young, B.E.; Fong, S.W.; Chan, Y.-H.; Mak, T.-M.; Ang, L.W.; Anderson, D.E.; Lee, C.Y.-P.; Amrun, S.N.;
Lee, B.; Goh, Y.S.; et al. Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection
and the inflammatory response: An observational cohort study. Lancet 2020, 396, 603–611. [CrossRef]
13. Benedetti, F.; Snyder, G.; Giovanetti, M.; Angeletti, S.; Gallo, R.; Ciccozzi, M.; Zella, D. Emerging of a
SARS-CoV-2 viral strain with a deletion in nsp1. J. Transl. Med. 2020, 18, 1–6. [CrossRef]
14. Fishman, D.N. Seasonality of infectious diseases. Annu. Rev. Public Health 2007, 28, 127–143. [CrossRef]
15. Iikuni, N.; Nakajima, A.; Inoue, E.; Tanaka, E.; Okamoto, H.; Hara, M.; Tomatsu, T.; Kamatani, N.; Yamanaka, H.
What’s in season for rheumatoid arthritis patients? Seasonal fluctuations in disease activity. Rheumatology
2007, 46, 846–848. [CrossRef]
16. Moltchanova, E.V.; Schreier, N.; Lammi, N.; Karvonen, M. Seasonal variation of diagnosis of Type 1 diabetes
mellitus in children worldwide. Diabet. Med. 2009, 26, 673–678. [CrossRef]
17. Dopico, X.C.; Evangelou, M.; Ferreira, R.C.; Guo, H.; Pekalski, M.L.; Smyth, D.J.; Cooper, N.; Burren, O.S.;
Fulford, A.J.; Hennig, B.J.; et al. Widespread seasonal gene expression reveals annual differences in human
immunity and physiology. Nat. Commun. 2015, 6, 7000. [CrossRef]
18. Scafetta, N. Distribution of the SARS-CoV-2 Pandemic and Its Monthly Forecast Based on Seasonal Climate
Patterns. Int. J. Environ. Res. Public Health 2020, 17, 3493. [CrossRef] [PubMed]
19. Carleton, T.; Meng, K.C. Causal empirical estimates suggest COVID-19 transmission rates are highly seasonal.
medRxiv 2020. [CrossRef]
20. Cannell, J.J.; Vieth, R.; Umhau, J.C.; Holick, M.F.; Grant, W.B.; Madronich, S.; Garland, C.F.; Giovannucci, E.
Epidemic influenza and vitamin D. Epidemiol. Infect. 2006, 134, 1129–1140. [CrossRef] [PubMed]
21. Moozhipurath, R.K.; Kraft, L.; Skiera, B. Evidence of protective role of Ultraviolet-B (UVB) radiation in
reducing COVID-19 deaths. Sci. Rep. 2020, 10, 17705. [CrossRef]
22. Ratnesar-Shumate, S.; Williams, G.; Green, B.; Krause, M.; Holland, B.; Wood, S.; Bohannon, J.; Boydston, J.;
Freeburger, D.; Hooper, I.; et al. Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on Surfaces. J. Infect. Dis.
2020, 222, 214–222. [CrossRef]
23. Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Evidence
that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.
Nutrients 2020, 12, 988. [CrossRef]
24. Fountoulakis, I.; Diémoz, H.; Siani, A.-M.; Laschewski, G.; Filippa, G.; Arola, A.; Bais, A.F.; De Backer, H.;
Lakkala, K.; Webb, A.R.; et al. Solar UV Irradiance in a Changing Climate: Trends in Europe and the
Significance of Spectral Monitoring in Italy. Environments 2020, 7, 1. [CrossRef]
25. ISS COVID-19 Integrated Surveillance Data in Italy. 2020. Available online: https://www.epicentro.iss.it/en/
coronavirus/sars-cov-2-dashboard (accessed on 26 October 2020). (In English)
26. Davies, N.G.; Klepac, P.; Liu, Y.; Prem, K.; Jit, M.; CMMID COVID-19 Working Group; Eggo, R.M.
Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat. Med. 2020, 26, 1205–1211.
[CrossRef]
27. Ministero Della Salute, Weekly Monitoring Covid-19, Report 3–9 August. 2020. Available online:
http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=
italiano&menu=notizie&p=dalministero&id=5021 (accessed on 28 October 2020). (In English)
28. Weir, E.K.; Thenappan, T.; Bhargava, M.; Chen, Y. Does vitamin D deficiency increase the severity of
COVID-19? Clin. Med. 2020, 20, e107–e108. [CrossRef]
29. Hernández, J.L.; Nan, D.; Fernandez-Ayala, M.; García-Unzueta, M.; Hernández-Hernández, M.A.;
López-Hoyos, M.; Muñoz-Cacho, P.; Olmos, J.M.; Gutiérrez-Cuadra, M.; Ruiz-Cubillán, J.J.; et al. Vitamin D
Status in Hospitalized Patients with SARS-CoV-2 Infection. J. Clin. Endocrinol. Metab. 2020, dgaa733.
[CrossRef]
30. INFN, Gruppo di Lavoro CovidStat INFN. 2020. Available online: https://covid19.infn.it/mappa_nazionale/
htmlFiles/complexDashboard_2020-10-25.html?theme=classic (accessed on 26 October 2020). (In Italian).
31. John Hopking University, Corona Virus Resource Centre. 2020. Available online: https://coronavirus.jhu.
edu/data/mortality (accessed on 26 October 2020). (In English)
32. Ficetola, G.F.; Rubolini, D. Climate affects global patterns of COVID-19 early outbreak dynamics. medRxiv 2020.
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