The COVID-19 pandemic has significantly impacted human society at many levels, from public health to economics and transports, highlighting the need of approaches integrating all available information to better understand and model similar phenomena, also in order to develop early detection and responses. In this paper we show the result of an analysis of COVID-19 pandemic in the metropolitan area of Bologna, Italy, integrating an epidemiological mathematical model, SARS-CoV-2 virus quantification in wastewater, clinical hospitalization, vaccination campaign, virus geno-typization and human mobility data in the period 2020-2022. We were able to follow the evolution of epidemic, observing the effect of vaccination and other factors that produced significant changes in hospitalizations. Moreover, by considering a mathematical model of COVID-19 epidemics spread, with parameters selected partly from literature and partly adapted to the local situation on a weekly basis, we identified a strict relation between human mobility at mesoscopic level and a sociability rate (related to model reproduction number) revealing the mutual impact of health issues on human activity and viceversa.

The authors have declared no competing interest.

This project was funded through the European Union's Horizon 2020 VEO (Versatile emerging infectious disease observatory - forecasting, nowcasting, and tracking in a changing world) project no. 874735. The PhD scholarship of Giulia Gatti was funded by the European Union - NextGenerationEU through the Italian Ministry of University and Research under PNRR-Mission 4 Component 2, Investment 3.3 "Partnerships extended to universities, research centers, companies and funding of basic research projects" D.M. 352/2021-CUP J33C22001330009. The NGS sequence activity performed in the Unit of Microbiology "Romagna" was partially funded by the ISS Project "Strategie di sequenziamento per l'identificazione delle varianti di SARS-CoV-2 ed il monitoraggio della loro circolazione in Italia" and the data are available from the ICoGen database. This research was partially supported by the EU funding within the NextGenerationEU - MUR PNRR Extended Partnership initiative on Emerging Infectious Diseases (Project no. PE00000007, INF-ACT). This research was co-funded by the Italian Ministry of University and Research within the Complementary National Plan PNC-I.1 "Research initiatives for innovative technologies and pathways in the health and welfare sector", project DARE - Digital Lifelong Prevention project, no. PNC0000002.

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Among positive leftover samples, random nasopharyngeal swabs were selected to be sequenced from March 2021 to May 2022 and during the daily routine. Ethical approval or informed consent were not required because the study has been performed using exclusively anonymized, leftover samples derived from the routine diagnostic procedures. The anonymization of genomic data was achieved by using the current procedure (AVR-PPC P09, rev.2) checked by the AUSL Romagna Ethical Committee (Italy).

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