Correction of Italian under-reporting in the first COVID-19 wave via age-specific deconvolution of hospital admissions

PLoS One. 2023 Dec 7;18(12):e0295079. doi: 10.1371/journal.pone.0295079. eCollection 2023.

Abstract

When the COVID-19 pandemic first emerged in early 2020, healthcare and bureaucratic systems worldwide were caught off guard and largely unprepared to deal with the scale and severity of the outbreak. In Italy, this led to a severe underreporting of infections during the first wave of the spread. The lack of accurate data is critical as it hampers the retrospective assessment of nonpharmacological interventions, the comparison with the following waves, and the estimation and validation of epidemiological models. In particular, during the first wave, reported cases of new infections were strikingly low if compared with their effects in terms of deaths, hospitalizations and intensive care admissions. In this paper, we observe that the hospital admissions during the second wave were very well explained by the convolution of the reported daily infections with an exponential kernel. By formulating the estimation of the actual infections during the first wave as an inverse problem, its solution by a regularization approach is proposed and validated. In this way, it was possible to compute corrected time series of daily infections for each age class. The new estimates are consistent with the serological survey published in June 2020 by the National Institute of Statistics (ISTAT) and can be used to speculate on the total number of infections occurring in Italy during 2020, which appears to be about double the number officially recorded.

Grants and funding

This research was supported by EU funding within the NextGenerationEU-MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT), and the Italian Ministry for Research in the framework of the 2022 PRIN, Grant no. 2022LP77J4, Proliferation, Resistance and Infection Dynamics in Epidemics (PRIDE). Both fundings were received by Professor G. De Nicolao. The funders did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.