![]() This choice is a trade-off between available data and having at least 20 pre-treatment time periods to estimate the counterfactual scenario. As the potential date for the beginning of the coronavirus in Italy, we use 21st January. ![]() The method adopted is the trajectory balancing method, recently developed by Hazlett and Xu ( 2018). In this paper, we make unconventional use of this evaluation approach as we consider as policy change the possible diffusion of coronavirus in Piacenza earlier than 21st February 2020. ( 2020)) Footnote 3, to our knowledge, no study used counterfactual methods to estimate when coronavirus spread in Europe. Although many scholars used counterfactual approaches to investigate research questions linked to COVID-19 (see, among others, Bayat et al. Counterfactual approaches are usually adopted to estimate the impact of a specific policy change on an outcome of interest. To this aim, we must estimate a valid counterfactual scenario using as control group municipalities with similar characteristics to Piacenza, but which are less likely to have been affected by the virus before 21st February 2020. Therefore, we need to compare Piacenza with a scenario where the virus did not hit until 21st February 2020. We analyze official daily data on the number of deaths made available by the Italian National Institute of Statistics (Istat) Footnote 1 for 7,904 municipalities for the period 1st January - 31st August 2020 Footnote 2. In light of anecdotal evidence, in the main analysis, we focus on Piacenza as a case study, while we report the analysis on other municipalities in the Appendix. This paper aims at assessing the plausibility that coronavirus spread in Italy before 21st February and to investigate approximately when. ( 2020) estimate that the virus reached Southern-Lombardy around a week before the case of Codogno. Moreover, by analyzing the first 5,830 laboratory-confirmed cases in Lombardy through standardized interviews of confirmed cases and their close contacts, Cereda et al. The possibility that the virus might have spread in Italy long before 21st February is quite likely also considering that from 17th November, i.e., the date of the first case in Wuhan (China) to 31st January, i.e., the date in which Italy suspended flights to and from China, there were 203,894 arrivals from China, of which 15,400 from Wuhan to Fiumicino (Rome) and 125,000 to Malpensa (Milan). This means that as those infected spread the disease, everybody was looking for patient zero, i.e., the patient coming from China, but nobody was looking at patient one, i.e., the patient not directly connected with China. The medical protocols to test for the presence of the virus involved not only that the patient had respiratory problems, but also that he/she had come from China, or that he/she was in contact with people coming from China. Medical professionals did not attribute these cases to coronavirus. ![]() These pneumonia cases had similar characteristics to interstitial pneumonia caused by coronavirus, even if no tests were done to confirm the virus that caused them. A press review (LIBERTÀ 2020 CORRIERE DELLA SERA 2020b CORRIERE DELLA SERA 2020a) identifies that on 30th December, the Piacenza Hospital had 40 cases of pneumonia in the previous week, and on 7th January, Milan had a peak of pneumonia cases with requests for extra hospital beds. According to a survey conducted by the television broadcast Report, aired on 30th March, it seems that there had already been a large number of pneumonia cases at the start of 2020 in Northern Italy, particularly in Piacenza (Emilia-Romagna), located 18 km from Codogno (Lombardy) where the first Italian case of coronavirus was officially reported. Moreover, there is increasing anecdotal evidence that the virus might have reached Italy sooner, with a consequent early spread leading to the pandemic expolosion in late February. The first official case in Italy was detected on 21st February 2020 in the Northern area. Likewise, a German businessman with mild symptoms tested positive with coronavirus on the 27th January 2020 (Rothe et al. For instance, it has been confirmed that a patient hospitalized on 27th December for suspected pneumonia near Paris had coronavirus as claimed in France 24 ( 2020). Recent evidence shows sporadic first cases of coronavirus (SARS-CoV-2) in Europe since the end of 2019.
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