The association between first and second wave COVID-19 mortality in Italy

BMC Public Health. 2021 Nov 11;21(1):2069. doi: 10.1186/s12889-021-12126-4.

Abstract

Background: The relation between the magnitude of successive waves of the COVID-19 outbreak within the same communities could be useful in predicting the scope of new outbreaks.

Methods: We investigated the extent to which COVID-19 mortality in Italy during the second wave was related to first wave mortality within the same provinces. We compared data on province-specific COVID-19 2020 mortality in two time periods, corresponding to the first wave (February 24-June 30, 2020) and to the second wave (September 1-December 31, 2020), using cubic spline regression.

Results: For provinces with the lowest crude mortality rate in the first wave (February-June), i.e. < 22 cases/100,000/month, mortality in the second wave (September-December) was positively associated with mortality during the first wave. In provinces with mortality greater than 22/100,000/month during the first wave, higher mortality in the first wave was associated with a lower second wave mortality. Results were similar when the analysis was censored at October 2020, before the implementation of region-specific measures against the outbreak. Neither vaccination nor variant spread had any role during the study period.

Conclusions: These findings indicate that provinces with the most severe initial COVID-19 outbreaks, as assessed through mortality data, faced milder second waves.

Keywords: COVID-19; Epidemiology; Mortality; Public health; SARS-CoV-2; Waves.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19*
  • Disease Outbreaks
  • Humans
  • Italy / epidemiology
  • SARS-CoV-2
  • Vaccination