Spread and Dynamics of the COVID-19 Epidemic in Italy: Effects of Emergency Containment Measures

Proc Natl Acad Sci U S A. 2020 May 12;117(19):10484-10491. doi: 10.1073/pnas.2004978117. Epub 2020 Apr 23.

Abstract

The spread of coronavirus disease 2019 (COVID-19) in Italy prompted drastic measures for transmission containment. We examine the effects of these interventions, based on modeling of the unfolding epidemic. We test modeling options of the spatially explicit type, suggested by the wave of infections spreading from the initial foci to the rest of Italy. We estimate parameters of a metacommunity Susceptible-Exposed-Infected-Recovered (SEIR)-like transmission model that includes a network of 107 provinces connected by mobility at high resolution, and the critical contribution of presymptomatic and asymptomatic transmission. We estimate a generalized reproduction number ([Formula: see text] = 3.60 [3.49 to 3.84]), the spectral radius of a suitable next-generation matrix that measures the potential spread in the absence of containment interventions. The model includes the implementation of progressive restrictions after the first case confirmed in Italy (February 21, 2020) and runs until March 25, 2020. We account for uncertainty in epidemiological reporting, and time dependence of human mobility matrices and awareness-dependent exposure probabilities. We draw scenarios of different containment measures and their impact. Results suggest that the sequence of restrictions posed to mobility and human-to-human interactions have reduced transmission by 45% (42 to 49%). Averted hospitalizations are measured by running scenarios obtained by selectively relaxing the imposed restrictions and total about 200,000 individuals (as of March 25, 2020). Although a number of assumptions need to be reexamined, like age structure in social mixing patterns and in the distribution of mobility, hospitalization, and fatality, we conclude that verifiable evidence exists to support the planning of emergency measures.

Keywords: SARS-CoV-2; SEIR models; disease outbreak scenarios; social contact restrictions; spatially explicit epidemiology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Basic Reproduction Number
  • Betacoronavirus
  • Communicable Disease Control / methods*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission
  • Hospitalization / statistics & numerical data
  • Humans
  • Italy / epidemiology
  • Models, Theoretical
  • Pandemics / prevention & control*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2