COVID-19 represents a major public health issue in Italy; estimating the size of the outbreak could direct public health policies and inform us on the extent of the reorganization needed in the healthcare system, on the efficacy of quarantine measures and eventually on the achievement of herd immunity. In order to chart the real extent of COVID-19 infection in Italy, official data need to be interpreted considering various aspects such the “suspected-case” definition, that changed during the past months, the management of asymptomatic and untested symptomatic cases, the deaths reporting system and short-term fluctuations. All these aspects should be taken into consideration when reflecting about the meaning of the official COVID-19 figures in Italy. Regionalization of the healthcare system and fragmentation of data represent real challenges in the management of the COVID-19 outbreak in Italy. Authors’ opinion is that a transparent and accurate reporting could guide policymaking and help reorganize health services.