(Xinhua) — A new study has found evidence of COVID-19 in a boy from the Milan area as early as the end of November 2019, months before the first identified coronavirus disease case in Italy.

Researchers from Italy and Canada analyzed oropharyngeal swab specimens collected from September 2019 to February 2020 from 39 consenting patients, and a sample tested positive from the 4-year-old boy who lived in the surrounding area of Milan and had no reported travel history, according to the study published by the U.S. Centers for Disease Control and Prevention on Tuesday.

The child had cough and rhinitis on Nov. 21, 2019, and his specimen was obtained on Dec. 5, two weeks after the symptom onset, for clinical diagnosis of suspected measles, the article said.

“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. “Long-term, unrecognized spread of SARS-CoV-2 in northern Italy would help explain, at least in part, the devastating impact and rapid course of the first wave of COVID-19 in Lombardy.”