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The new coronavirus was circulating in Italy since September 2019, a study by the National Cancer Institute (INT) of the Italian city of Milan shows, signaling that COVID-19 might have spread beyond China earlier than previously thought.

The World Health Organization has said the new coronavirus and COVID-19, the respiratory disease it causes, were unknown before the outbreak was first reported in Wuhan, in central China, in December.

Italy’s first COVID-19 patient was detected on Feb. 21 in a little town near Milan, in the northern region of Lombardy.

But the Italian researchers’ findings, published by the INT’s scientific magazine Tumori Journal, show that 11,6% of 959 healthy volunteers enrolled in a lung cancer screening trial between September 2019 and March 2020, had developed coronavirus antibodies well before February.

A further specific SARS-CoV-2 antibodies test was carried out by the University of Siena for the same research titled “Unexpected detection of SARS-CoV-2 antibodies in the pre-pandemic period in Italy”.

It showed that four cases dated back to the first week of October were also positive for antibodies neutralizing the virus, meaning they had got infected in September, Giovanni Apolone, a co-author of the study, told Reuters.

“This is the main finding: people with no symptoms not only were positive after the serological tests but had also antibodies able to kill the virus,” Apolone said.

“It means that the new coronavirus can circulate among the population for long and with a low rate of lethality not because it is disappearing but only to surge again,” he added.