Was severe SARS-CoV-2 substantially spreading in Northern Italy before its first detection in February 2020? An evaluation of pneumonia-associated hospitalization trends from September 2014 to February 2020.

In particular, starting from two weeks before the date of first autochthonous case, the model predicted a descending number of hospitalizations while observations showed a trend inversion with an increase that became progressively more pronounced a week before the first local case detection.

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