Different Patterns of the SARS-CoV-2 Epidemic across Italian Regions: a Hierarchical Clustering on Principal Components approach

Abstract

Italy has experienced the epidemic of severe acute respiratory syndrome coronavirus 2, which spread at different times and with different intensities throughout its territory. We aimed to identify clusters with similar epidemic patterns across Italian regions. To do that, we defined a set of regional indicators reflecting different domains and employed a hierarchical clustering on principal component approach to obtain an optimal cluster solution. As of 24 April 2020, Lombardy was the worst hit Italian region and entirely separated from all the others. Sensitivity analysis - by excluding data from Lombardy - partitioned the remaining regions into four clusters. Although cluster 1 (i.e. Veneto) and 2 (i.e. Piedmont and Emilia-Romagna) included the most hit regions beyond Lombardy, this partition reflected differences in the efficacy of restrictions and testing strategies. Cluster 3 was heterogeneous and comprised regions where the epidemic started later and/or where it spread with the lowest intensity. Regions within cluster 4 were those where the epidemic started slightly after Veneto, Emilia-Romagna and Piedmont, favoring timely adoption of control measures. Our findings provide policymakers with a snapshot of the epidemic in Italy, which might help guiding the adoption of countermeasures in accordance with the situation at regional level.

Epidemiological Philosophy of Pandemics

“…Family and community clusters of severe COVID-19 infection have been reported early in this pandemic. 27,28…”

Epidemiological philosophy of pandemics

“…[22][23][24][25][26] Family and community clusters of severe COVID-19 infection have been reported early in this pandemic. [27][28] Reported excess deaths estimates were thought to represent misclassified COVID-19 deaths or potentially those indirectly related to the COVID-19 pandemic. It was suggested that this excess number was related to the pandemic itself and not to disease, it was attributed to lack of facilities during the pandemic.…”