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On February 20, 2020, a patient in his 30s admitted to the intensive care unit (ICU) in Codogno Hospital (Lodi, Lombardy, Italy) tested positive for a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). He had a history of atypical pneumonia that was not responding to treatment, but he was not considered at risk for COVID-19 infection.1 The positive result was immediately reported to the Lombardy health care system and governmental offices. During the next 24 hours, the number of reported positive cases increased to 36. This situation was considered a serious development for several reasons: the patient (“patient 1”) was healthy and young; in less than 24 hours, 36 additional cases were identified, without links to patient 1 or previously identified positive cases already in the country; it was not possible to identify with certainty the source of transmission to patient 1 at the time; and, because patient 1 was in the ICU and there were already 36 cases by day 2, chances were that a cluster of unknown magnitude was present and additional spread was likely.
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Corresponding Author: Antonio Pesenti, MD, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli studi di Milano, Via F. Sforza 35, 20122 Milan, Italy (email@example.com).
Published Online: March 13, 2020. doi:10.1001/jama.2020.4031
Conflict of Interest Disclosures: Dr Grasselli reports receiving payment for lectures and travel support for conferences from Getinge, payment for lectures from Draeger Medical, payment for lectures and an unrestricted research grant from Fisher & Paykel, payment for lectures from Thermofisher, and receiving payment for lectures and travel support for conferences from Biotest. Dr Pesenti reports receiving personal fees from Maquet, Novalung/Xenios, Baxter, and Boehringer Ingelheim. Dr Cecconi reports consulting for Edwards Lifesciences, Directed Systems, and Cheetah Medical.
Additional Contributions: We acknowledge the COVID-19 Lombardy ICU Network for their remarkable efforts to provide care for the critically ill patients with COVID-19 (listed in the Supplement).
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