Factors influencing the sharp increase in COVID-19 in Northern Italy.

Factors possibly influencing the sharp increase in COVID-19 in Northern Italy. Jefferson T, Spencer EA, Heneghan C.


Published on June 27, 2020

Reference Goumenou M, Sarigiannis D, Tsatsakis A, et al. COVID‑19 in Northern Italy: An integrative overview of factors possibly influencing the sharp increase of the outbreak (Review). Mol Med Rep. 2020;22(1):20‐32. doi:10.3892/mmr.2020.11079
Study type
Country Italy
Setting Community
Funding Details Unfunded
Transmission mode Meteorological, Pollutant borne
Exposures Social, density, environmental

Bottom Line

Administrative organisation issues, human bias, and bureaucracy in relevance to the epidemic are key factors in the extreme outbreak in Northern Italy.

Evidence Summary

The authors assessed comparatively variables which could have triggered the explosive beginning of the epidemic in northern Italy. They reached a conclusion based on socio-political variables after having considered a wide range of factors. The overwhelming of the health system was an important factor according to them. This is a logical non sequitur given that it does not account for the exponential growth of cases but may have impacted on the number of deaths. They identify pollution as the truly different variable between Northern Italy, Greece and Germany.

What did they do?

The authors describe the start of the pandemic in Northern Italy and follow its evolution through to the 10th of April. They took into account several variables, some of them linked, such age structure, population density, health status, the prevalence of comorbidities, hypertension (including ACE levels), diabetes, genetic predisposition, physical activity levels, social and family customs, interspecies transmission (dog to man) and privacy (openness about one’s health) and air quality, health system saturation and administrative organisation.

The authors compared the variables with Greece and Germany, both countries with a lower death toll.

Study reliability

The authors’ logic is difficult to follow at times. 


Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Unclear Unclear Yes Yes No

What else should I consider?

This was a review across a range of potential factors influencing the development of the pandemic in Northern Italy. The hypotheses are not proven by the data presented. It does not allow conclusions to be drawn confidently for other settings.

The timeline shows the first measures taken against the COVID-19 pandemic on the 30th of January with the closure of direct flights from China.

Source: Molecular Medicine Reports, 22, 20-32. https://doi.org/10.3892/mmr.2020.11079

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Elizabeth Spencer

Dr Elizabeth Spencer; MMedSci, PhD. Epidemiologist, Nuffield Department for Primary Care Health Sciences, University of Oxford.

Tom Jefferson

Tom Jefferson, epidemiologist.