Italy warned of severe rebound of COVID-19

Easing of lockdown measures might lead to rise in coronavirus cases, UK researchers say

The easing of lockdown measures in Italy may lead to more people contracting COVID-19 than during the first wave of novel coronavirus in some regions of the country, according to new modeling from researchers in the United Kingdom.

After a nearly two-month lockdown due to the novel coronavirus, Italy began relaxing restrictions on Monday, with around 4 million workers being allowed to return to work in select sectors.

People can now travel within their regions, while bars and restaurants have reopened for takeaway orders. The retail stores are expected to reopen later this month.

The relaxations have brought some relief to the people, especially businessmen, who have endured the longest-running restrictions on movement and operations in Europe since the pandemic began.

But this move toward normalcy could be short-lived, according to researchers at the Imperial College London. They warn that a second and more severe wave of infections could hit Italy, a nation that has already experienced the third-highest death toll due to COVID-19 in the world, behind the United States and the UK.

"The impact of COVID-19 on Italy has been tragic but the response taken to limit the impact of the disease has been successful and disease control has been substantively achieved," said Samir Bhatt, a senior lecturer at Imperial's School of Public Health.

"Unfortunately, continued social distancing and other measures are required to prevent this success from being rapidly reversed, and our work provides a warning against underestimating the importance of such sacrifice."

Bhatt led a study that used Italian mobility data to forecast outcomes for novel coronavirus transmission.

The mobility data captures the number of people leaving their homes and the time they spend at places, including grocery stores, pharmacies, parks, transit stations, retail outlets, recreation centers, homes and workplaces.

The authors concluded that in the absence of additional interventions, even a 20 percent return to pre-lockdown mobility could lead to a resurgence in the number of deaths far greater than those experienced in the current wave, in several regions.

The Imperial College London team's projections for Piedmont and Lombardy, the most populous and worst-hit regions in Italy, are particularly concerning.

To reflect this, the researchers used the attack rate, which is calculated as the estimated number of infections divided by the number of people at risk for the illness. The researchers estimate that the current attack rate in the Piedmont region is 7.8 percent, and the team predicts that a 20 percent return to pre-lockdown mobility will see the attack rate in the region rise to 19.6 percent.

In Lombardy, where more than 13,000 people have died due to COVID-19, the attack rate is currently at 13.3 percent, and it could rise to 13.8 percent with a 20 percent return of mobility.

A 40 percent return to pre-lockdown mobility could lead to even higher attack rates according to the projections, with Piedmont rising to 54.8 percent.

"Even small changes in mobility will most likely lead to a resurgence of deaths and the occurrence of a second wave which may be even greater than what Italy has already experienced," said Michaela Vollmer, a research associate at Imperial's Faculty of Medicine who contributed to the study.

Seth Flaxman, a senior lecturer in statistics at the Imperial College London who worked on the modeling, urged Italian authorities to closely monitor transmission and mobility in the next few weeks and months, and stressed the importance of testing and contact tracing.

"Without effective community surveillance, even a partial return to pre-lockdown levels of mobility could lead to a resurgence in the epidemic, with deaths starting to increase once again in the months ahead," Flaxman said.