The date of first-confirmed case does not determine the date of an outbreak. Consider a scenario where 1 infected individual is confirmed in country A, and a week later 1 infected individual is confirmed in country B. However, 10 other infected but unconfirmed individuals have been spreading the virus in country B. Here, country B is on track for an earlier outbreak despite a later ‘first-confirmed’ date than country A.
Italy also has a number of other disadvantages such as having one of the oldest populations in Europe in addition to the highest smoking rates. There are several factors underlying the severity of the outbreak in Italy.