ROME - Researchers from Italy and Canada recently have found that COVID-19 started circulating in Italy as early as November 2019, about three months before the country's first case was reported.

According to the study published by the US Centers for Disease Control and Prevention, an oropharyngeal swab specimen collected in early December 2019 from a four-year-old boy who lived in the surrounding area of Milan tested positive for COVID-19.

The boy, who had no reported travel history, had cough and rhinitis on Nov 21, 2019, and was taken to the emergency department with respiratory symptoms and vomiting.

On Dec 1, he had onset a measles-like rash, but the oropharyngeal swab specimen eventually tested negative for measles.

"Maculopapular lesions have been among the most prevalent cutaneous manifestations observed during the COVID-19 pandemic," noted the study.

These findings, in agreement with other evidence of early COVID-19 spread in Europe, advance the beginning of the outbreak to late autumn 2019, the study said. Italy is among the countries hard hit by the pandemic.

The country reported its first known COVID-19 case in late February 2020.