Impact of tiered restrictions on human activities and the epidemiology of the second wave of COVID-19 in Italy

Mattia Manica, Giorgio Guzzetta, Flavia Riccardo, Antonio Valenti, Piero Poletti, Valentina Marziano, Filippo Trentini, Xanthi Andrianou, Alberto Mateo-Urdiales, Martina del Manso, Massimo Fabiani, Maria Fenicia Vescio, Matteo Spuri, Daniele Petrone, Antonino Bella, Sergio Iavicoli, Marco Ajelli, Silvio Brusaferro, Patrizio Pezzotti and Stefano Merler ()
Additional contact information
Mattia Manica: Bruno Kessler Foundation
Giorgio Guzzetta: Bruno Kessler Foundation
Flavia Riccardo: Istituto Superiore di Sanità
Antonio Valenti: Italian Workers’ Compensation Authority (INAIL)
Piero Poletti: Bruno Kessler Foundation
Valentina Marziano: Bruno Kessler Foundation
Filippo Trentini: Bruno Kessler Foundation
Xanthi Andrianou: Istituto Superiore di Sanità
Alberto Mateo-Urdiales: Istituto Superiore di Sanità
Martina del Manso: Istituto Superiore di Sanità
Massimo Fabiani: Istituto Superiore di Sanità
Maria Fenicia Vescio: Istituto Superiore di Sanità
Matteo Spuri: Istituto Superiore di Sanità
Daniele Petrone: Istituto Superiore di Sanità
Antonino Bella: Istituto Superiore di Sanità
Sergio Iavicoli: Italian Workers’ Compensation Authority (INAIL)
Marco Ajelli: Indiana University School of Public Health
Silvio Brusaferro: Istituto Superiore di Sanità
Patrizio Pezzotti: Istituto Superiore di Sanità
Stefano Merler: Bruno Kessler Foundation

Nature Communications, 2021, vol. 12, issue 1, 1-9

Abstract: Abstract To counter the second COVID-19 wave in autumn 2020, the Italian government introduced a system of physical distancing measures organized in progressively restrictive tiers (coded as yellow, orange, and red) imposed on a regional basis according to real-time epidemiological risk assessments. We leverage the data from the Italian COVID-19 integrated surveillance system and publicly available mobility data to evaluate the impact of the three-tiered regional restriction system on human activities, SARS-CoV-2 transmissibility and hospitalization burden in Italy. The individuals’ attendance to locations outside the residential settings was progressively reduced with tiers, but less than during the national lockdown against the first COVID-19 wave in the spring. The reproduction number R(t) decreased below the epidemic threshold in 85 out of 107 provinces after the introduction of the tier system, reaching average values of about 0.95-1.02 in the yellow tier, 0.80-0.93 in the orange tier and 0.74-0.83 in the red tier. We estimate that the reduced transmissibility resulted in averting about 36% of the hospitalizations between November 6 and November 25, 2020. These results are instrumental to inform public health efforts aimed at preventing future resurgence of cases.

Date: 2021
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DOI: 10.1038/s41467-021-24832-z

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