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Covid-19: preparedness, decentralisation, and the hunt for patient zero

BMJ 2020; 368 doi: (Published 28 February 2020) Cite this as: BMJ 2020;368:bmj.m799

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  1. Fabrizio Carinci, adjunct professor of biostatistics
  1. Department of Statistical Sciences, University of Bologna, Italy
  1. fabrizio.carinci{at}

Lessons from the Italian outbreak

The outbreak of covid-19 in Italy officially started on 31 January 2020, after two Chinese visitors staying at a central hotel in Rome tested positive for the new coronavirus SARS-CoV-2. They had landed at Milan Malpensa airport on a flight from Wuhan on 23 January.1

On 21 February, after a few days of increasing concern, a 38 year old man was admitted to the hospital in Codogno, Lombardy, and was confirmed as the first Italian citizen with covid-19 (“patient 1”). After tracing his movements and contacts, the regional authorities found a cluster of other cases, but none of them was identified as the origin of the infection (“patient 0”).2 In less than one week, the number of cases in Italy increased beyond expectations, putting the Italian health service under considerable strain. Cases were found in several bordering regions and autonomous provinces of northern Italy.

This chain of events shows how preparedness and containment can be hampered in decentralised countries such as Italy. On 24 February, the Italian prime minister threatened to take back powers …

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