Early spread of COVID-19 in Romania: imported cases from Italy and human-to-human transmission networks

We describe the early spread of the novel coronavirus (COVID-19) and the first human-to-human transmission networks, in Romania. We profiled the first 147 cases referring to sex, age, place of residence, probable country of infection, return day to Romania, COVID-19 confirmation date and the probable modes of COVID-19 transmissions. Also, we analysed human-to-human transmission networks and explored their structural features and time dynamics. In Romania, local cycles of transmission were preceded by imported cases, predominantly from Italy. We observed an average of 4.8 days (s.d. = 4.0) between the arrival to a Romanian county and COVID-19 confirmation. Furthermore, among the first 147 COVID-19 patients, 88 were imported cases (64 carriers from Italy), 54 were domestic cases, while for five cases the source of infection was unknown. The early human-to-human transmission networks illustrated a limited geographical dispersion, the presence of super-spreaders and the risk of COVID-19 nosocomial infections. COVID-19 occurred in Romania through case importation from Italy. The largest share of the Romanian diaspora is concentrated especially in the northern parts of Italy, heavily affected by COVID-19. Human mobility (including migration) accounts for the COVID-19 transmission and it should be given consideration while tailoring prevention measures.