Italy’s new ‘patient 1’ identified: Milan woman had coronavirus in November 2019

A woman in Milan was positive for the new coronavirus in November 2019, researchers have found, making her the earliest known patient in Italy to date.

Italy's new 'patient 1' identified: Milan woman had coronavirus in November 2019
A new study indicates the coronavirus was circulating in Italy in early November 2019. Photo: Miguel Medina/AFP

Traces of the virus were detected in skin cells from a 25-year-old woman who had a biopsy for an unusual skin condition on November 10th 2019, according to Raffaele Gianotti, a researcher in dermatology at the University of Milan, who believes she could be “the dermatological Italian patient zero”. 

At the time the woman reported having a mild sore throat, and months later tested positive for Covid-19 antibodies in her blood.

Previously the first confirmed Covid-19 patient in Italy was a child in Milan, who was swabbed after developing a measles-like rash in early December 2019 – two months before it became clear that the virus was circulating in the nearby town of Codogno, where 'native' cases were first detected in mid-February.

READ ALSO: Coronavirus was already in Italy by December, waste water study shows

Gianotti and a team from the European Institute of Oncology (IEO) and the Italian Diagnostic Centre analysed skin samples taken in the autumn of 2019 to investigate whether any of the patients who reported unexplained skin conditions might in fact have been showing symptoms of Covid-19.

Their study, to be published in the British Journal of Dermatology, found molecular traces of the SARS-CoV-2 virus in the biopsy taken from areas of reddened skin on the Milan woman's arms, which fitted a pattern seen in other Covid-19 patients. The virus can cause skin disorders including rashes and discolouration of fingers or toes, though they are less common than the 'classic' symptoms (fever, tiredness and a dry cough). 

The woman, who had no other symptoms apart from a sore throat and was not tested for coronavirus at the time, reported that her rash disappeared by April 2020 and she tested positive for antibodies in June.

“All these facts lead us to believe that our patient could represent the oldest case in literature of
detection of the virus on tissue sample,” the researchers write.

They do not believe that she was the first person in Italy to contract the new coronavirus, however: “Probably, continuing to search, we would also find [the virus] in samples from October 2019”, Gianotti told Ansa news agency.

A separate study found traces of SARS-CoV-2 in samples of waste water in Milan and Turin from December 2019, though not from October or November.

Meanwhile more than 100 people who enrolled in a lung cancer screening trial between September 2019 and March 2020 were discovered to have antibodies in their blood, indicating that they had already been exposed to the virus without noticing symptoms. A handful of people had developed antibodies as early as the first week of September 2019, recent research found.

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Semen ‘a vehicle’ for monkeypox infection, say Italian health experts

Researchers in Italy who were first to identify the presence of monkeypox in semen are broadening their testing, saying early results suggest sperm can transmit infection.

Semen 'a vehicle' for monkeypox infection, say Italian health experts

A team at Rome’s Spallanzani Hospital, which specialises in infectious diseases, revealed in a study published on June 2nd that the virus DNA was detected in semen of three out of four men diagnosed with monkeypox.

They have since expanded their work, according to director Francesco Vaia, who said researchers have found the presence of monkeypox in the sperm of 14 infected men out of 16 studied.

READ ALSO: EXPLAINED: How is Italy dealing with rising monkeypox cases?

“This finding tells us that the presence of the virus in sperm is not a rare or random occurrence,” Vaia told AFP in an interview.

He added: “The infection can be transmitted during sexual intercourse by direct contact with skin lesions, but our study shows that semen can also be a vehicle for infection.”

Researchers at Spallanzani identified Italy’s first cases of monkeypox, found in two men who had recently returned from the Canary Islands.

The latest results reported by Vaia have not yet been published or subject to peer review.

Since early May, a surge of monkeypox cases has been detected outside of the West and Central African countries where the disease has long been endemic. Most of the new cases have been in Western Europe.

More than 3,400 confirmed cases and one death have now been reported to the World Health Organisation from more than 50 countries this year.

The vast majority of cases so far have been observed in men who have sex with men, of young age, chiefly in urban areas, in “clustered social and sexual networks”, according to the WHO.

It is investigating cases of semen testing positive for monkeypox, but has maintained the virus is primarily spread through close contact.

Meg Doherty, director of the WHO’s global HIV, hepatitis and sexually-transmitted infection programmes, said last week: “We are not calling this a sexually-transmitted infection.”

Could antivirals curb the spread of monkeypox?

Spallanzani researchers are now trying to ascertain how long the virus is present in sperm after the onset of symptoms.

In one patient, virus DNA was detected three weeks after symptoms first appeared, even after lesions had disappeared – a phenomenon Vaia said had been seen in the past in viral infections such as Zika.

That could indicate that the risk of transmission of monkeypox could be lowered by the use of condoms in the weeks after recovery, he said.

The Spallanzani team is also looking at vaginal secretions to study the presence of the virus.

A significant finding from the first study was that when the virus was cultured in the lab, it was “present in semen as a live, infectious virus efficient in reproducing itself”, Vaia told AFP.

Vaia cautioned that there remained many unanswered questions on monkeypox, including whether antiviral therapies could shorten the time in which people with the virus could infect others.

Another is whether the smallpox vaccine could protect people from the monkeypox virus.

“To study this we will analyse people who were vaccinated 40 years ago before human smallpox was declared to have disappeared,” Vaia said.