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Covid antibodies found in stored blood samples Milan Institute for Tumour Diseases, Coronavirus antibodies, September, 2019 Unexpected detection of SARS-CoV-2 antibodies in the prepandemic period in Italy (October 2021) https://pubmed.ncbi.nlm.nih.gov/33176598/ Full text version https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8529295/ Screening and Multiple Intervention on Lung Epidemics (SMILE https://clinicaltrials.gov/ct2/show/NCT03654105 There are no robust data, coronavirus 2 (SARS-CoV-2) infection and spread, prepandemic period worldwide We investigated the presence of SARS-CoV-2 receptor-binding domain (RBD)-specific antibodies Blood samples of 959 asymptomatic individuals, enrolled in a prospective lung cancer screening trial, between September 2019 and March 2020 Plasma samples repository Results SARS-CoV-2 RBD-specific antibodies were detected in, 111 of 959 (11.6%) individuals All the patients were asymptomatic at the time of blood sample collection. Actual timeframe First positive test, 3rd September September 2019 23/162 (14.2%) October 2019 27/166 (16.3%) Second week of February 2020, (more than 30%) By the end of September, Lombardy, Veneto, Piedmont, Emilia Romagna, Liguria, Lazio, Campania, Friuli. Official timeframe End of December 2019, coronavirus 2 identified in Wuhan, Hubei Province, China January 30th 2020 Italy’s first two cases, (two tourists from China tested positive in Rome) February 20, 2020 Lombardy, 38-year-old man, no history of travel Authors This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals Several months before the first patient was identified Finding SARS-CoV-2 antibodies in asymptomatic people before the COVID-19 outbreak in Italy may reshape the history of pandemic. Phenomena 1 Underestimation of prevalence Swabs and serology, focused on symptomatic cases Therefore, an underestimation of overall COVID-19 infections (Selection bias) Therefore overestimation of mortality rate May 25 and July 15 (2020) SARS-CoV-2 seroprevalence study, n = 64,660 Prevalence rate was 2.5% Approximately 1.5 million, (many of whom were asymptomatic) Estimate almost 5 times higher than official reports Phenomena 2 Onset of the epidemic, likely to have preceded identification of the first case November–December 2019 Doctors reporting, severe respiratory symptoms in elderly and frail, with atypical bilateral bronchitis, which was attributed to aggressive forms of seasonal influenza Based on these findings, a prior unnoticed circulation of the virus among the Italian population could be hypothesized. October 2019 to February 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428442/ Molecular analysis, PCR, 40 wastewater samples Milan/Lombardy, Turin/Piedmont, and Bologna/Emilia Romagna) Presence of viral RNA, December 18th in Milan and Turin So, in which direction did the virus travel? 7th Military World Games 第七届世界军人运动会 Commonly known as Wuhan 2019 October 18–27, 2019 Around 230,000 volunteers 9,308 athletes from 109 countries competing in 329 events

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