Tracking the progressive spread of the SARS-CoV-2 Omicron variant in Italy, December 2021 to January 2022

Background: The SARS-CoV-2 variant of concern Omicron was first detected in Italy in November 2021. Aim: To comprehensively describe Omicron spread in Italy in the 2 subsequent months and its impact on the overall SARS-CoV-2 circulation at population level. Methods: We analyse data from four genomic surveys conducted across the country between December 2021 and January 2022. Combining genomic sequencing results with epidemiological records collated by the National Integrated Surveillance System, the Omicron reproductive number and exponential growth rate are estimated, as well as SARS-CoV-2 transmissibility. Results: Omicron became dominant in Italy less than 1 month after its first detection, representing on 3 January 76.9-80.2% of notified SARS-CoV-2 infections, with a doubling time of 2.7-3.3 days. As of 17 January 2022, Delta variant represented < 6% of cases. During the Omicron expansion in December 2021, the esti-mated mean net reproduction numbers respectively rose from 1.15 to a maximum of 1.83 for symptomatic cases and from 1.14 to 1.36 for hospitalised cases, while remaining relatively stable, between 0.93 and 1.21, for cases needing intensive care. Despite a reduc-tion in relative proportion, Delta infections increased in absolute terms throughout December contributing to an increase in hospitalisations. A significant repro-duction numbers' decline was found after mid-January, with average estimates dropping below 1 between 10 and 16 January 2022. Conclusion: Estimates suggest a marked growth advantage of Omicron compared with Delta variant, but lower disease severity at popula-tion level possibly due to residual immunity against severe outcomes acquired from vaccination and prior infection.