COVID-19 in Italy: did the virus run on an ancient Roman road?
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COVID-19 in Italy: did the virus run on an ancient Roman road? Elisa Maietti 1 & Davide Golinelli 1
&
Maria Pia Fantini 1
Received: 9 May 2020 / Accepted: 15 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Background
The Ferrara anomaly
In late February 2020, Coronavirus disease-2019 (COVID19) (Rodriguez-Morales et al. 2020) had aggressively spread around many bordering provinces of the three most productive regions of northern Italy: Lombardy, Veneto, and Emilia Romagna (Onder et al. 2020), the Italian “economic engine” that accounts for 40.1% of the country’s GDP (ISTAT 2020). The first outbreak exploded in the municipality of Codogno (Lombardy). Before the country’s lockdown of 10 March 2020, the virus had indeed freely circulated throughout northern Italy and beyond. Sadly, some provinces’ death toll currently (May 26, 2020) reflects a war bulletin (Nacoti et al. 2020), such as Bergamo (Lombardy, 1,114,590 inhabitants) and Piacenza (Emilia Romagna, 287,152 inhabitants) with 3085 and 944 deaths, and 11.62 and 15.55 cases per 1000 population, respectively (Italian Civil Protection 2020). Emilia Romagna and Veneto showed a similar, though less dramatic, trend, compared to Lombardy, with provinces presenting a high number of cases and others, just a few kilometers (km) away, with a lower incidence (Fig. 1). The latter is the case of Ferrara (Emilia Romagna, 345,691 inhabitants) and Ravenna (Emilia Romagna, 389,456 inhabitants), presenting a number of confirmed cases much lower than the other provinces (2.85 and 2.62 cases per 1000 population, respectively). Ferrara has been indicated as an anomaly due to its very low number of cases in the first days of the Italian outbreak and several hypotheses have been put forward to explain it.
The ancient city that hosted the Duchy of Este in the fifteenth and sixteenth centuries represents a real outlier. In fact, the data provided by the Civil Protection and Italian Ministry of Health (Italian Civil Protection 2020) clearly demonstrate that Ferrara is an area less affected by the infection with only 986 confirmed cases (total positive cases in Emilia Romagna: 27,587). What are the reasons for this anomaly? One of the hypotheses is the high prevalence of thalassemia/ microcythemia among the ferraresi, which may have protected the population as it did in the past century against malaria (Franceschini and Scutellari 2000). However, till now this theory does not have a convincing biological basis. Accordingly, we sought to test a geographical/behavioral hypothesis. Currently, the cities of Emilia Romagna are culturally, socially, and economically connected through an ancient Roman road called Via Emilia (completed in 187 BC), that runs through the Po River valley (Pianura Padana) from Piacenza (16 km from Codogno) to Rimini (Adriatic coast) passing through Forlì, Bologna, Modena, Reggio Emilia, and Parma. The construction of the Via Aemilia launched the intensive Roman colonization of the Pianura Padana and soon rendered it the most e
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