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. 2021 Jun:197:111097.
doi: 10.1016/j.envres.2021.111097. Epub 2021 Apr 1.

SARS-CoV-2 infection incidence during the first and second COVID-19 waves in Italy

Marco Vinceti  1 , Tommaso Filippini  2 , Kenneth J Rothman  3 , Silvia Di Federico  2 , Nicola Orsini  4
Affiliations

SARS-CoV-2 infection incidence during the first and second COVID-19 waves in Italy

Marco Vinceti et al. Environ Res. 2021 Jun.

Abstract

We assessed the relation between COVID-19 waves in Italy, which was severely affected during the pandemic. We evaluated the hypothesis that a larger impact from the first wave (February-May 2020) predicts a smaller peak during the second wave (September-October 2020), in the absence of local changes in public health interventions and area-specific differences in time trends of environmental parameters. Based on publicly available data on province-specific SARS-CoV-2 infections and both crude and multivariable cubic spline regression models, we found that for provinces with the lowest incidence rates in the first wave, the incidence in the second wave increased roughly in proportion with the incidence in the first wave until an incidence of about 500-600 cases/100,000 in the first wave. Above that value, provinces with higher incidences in the first wave experienced lower incidences in the second wave. It appears that a comparatively high cumulative incidence of infection, even if far below theoretical thresholds required for herd immunity, may provide noticeable protection during the second wave. We speculate that, if real, the mechanism for this pattern could be depletion of most susceptible individuals and of superspreaders in the first wave. A population learning effect regarding cautious behavior could have also contributed. Since no area-specific variation of the national policy against the SARS-CoV-2 outbreak was allowed until early November 2020, neither individual behaviors nor established or purported environmental risk factors of COVID-19, such as air pollution and meteorological factors, are likely to have confounded the inverse trends we observed in infection incidence over time.

Keywords: COVID-19; Epidemiology; Immunity; Outbreak; Public health; SARS-CoV-2; Seroprevalence; Wave.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Incidence of officially diagnosed SARS-CoV-2 infections in the Italian provinces in the two COVID-19 waves.
Fig. 2
Fig. 2
Population-weighted cubic spline regression analysis of the relation between first and second wave incidence of SARS-CoV-2 infection in the Italian provinces based on susceptible population (removing subjects with a previous positive swab test up to August 31, 2020). Shadow area, forecasted interval of the mean incidence point estimate; circles, province-specific values weighted for population size.
See this image and copyright information in PMC

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