MILAN (Reuters) - Italian researchers are looking at whether a higher than usual number of cases of severe pneumonia and flu in Lombardy in the last quarter of 2019 may be a signal that the new coronavirus might have spread beyond China earlier than previously thought.

FILE PHOTO: An employee controls the temperature of a man at the entrance of a supermarket, as the spread of the coronavirus disease (COVID-19) continues, in Milan, Italy March 23, 2020. REUTERS/Daniele Mascolo - RC2TPF994GAU/File Photo

Adriano Decarli, an epidemiologist and medical statistics professor at the University of Milan, said there had been a “significant” increase in the number of people hospitalized for pneumonia and flu in the areas of Milan and Lodi between October and December last year.

He told Reuters he could not give exact figures but “hundreds” more people than usual had been taken to hospital in the last three months of 2019 in those areas - two of Lombardy’s worst hit cities - with pneumonia and flu-like symptoms, and some of those had died.

Decarli is reviewing the hospital records and other clinical details of those cases, including people who later died at home, to try to understand whether the new coronavirus epidemic had already spread to Italy back then.

“We want to know if the virus was already here in Italy at the end of 2019, and - if yes - why it remained undetected for a relatively long period so that we could have a clearer picture in case we have to face a second wave of the epidemic,” he said.

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.

Decarli said once his research was concluded, local health authorities might decide to request authorisation to exhume bodies of people with suspect symptoms.

Other experts cast doubt on the hypothesis that the new virus could have been circulating in Europe before the end of 2019.

“I think it extremely unlikely that the virus was present in Europe before January,” said Paul Hunter, a professor in medicine at Britain’s University of East Anglia who has been tracking the evolving pandemic.

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Hunter said that unless Italian scientists get positive results from samples taken and stored at that time, then the suggestion should not be given credence.

He added that, given what we know about how infectious the virus is, and the ratio of patients showing no symptoms compared with those that get sick, “it is inconceivable that we would not have had a pretty major epidemic in Europe much earlier if these cases had in fact been COVID-19”.

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Italy, which now has the highest number of COVID-19 deaths in the world, recorded its first case of infection on Feb. 21, though some scientists think the virus began circulating in the country at least a month earlier.

“The virus was already here in the second half of January,” said Massimo Galli, head of the infectious disease unit at Milan’s Sacco hospital and a professor at the department of biomedical and clinical sciences at the University of Milan.

He said, however, that the probability of the virus circulating in Italy before January was “very low”.

Giuseppe Remuzzi, director of the Mario Negri Institute for Pharmacological Research, in Milan, said some family doctors in Lombardy had reported unusual cases of pneumonia late last year that now looked potentially suspicious.

He said among those were several cases of bilateral pneumonia - which means both lungs are affected - in the areas of Gera D’Adda and Crema in late November and December, with high fever, cough, fatigue and difficulty breathing.

“None of these cases have been documented as COVID-19 because there was no evidence yet of the existence of COVID-19,” he said.

Remuzzi said that if evidence of COVID-19 cases in Italy as far back as November was confirmed, this may signal that the virus can go undetected for months.

He said some reports in scientific journals had also led other scientists to question whether the virus may have emerged in China as early as October.