The COVID-19 pandemic presented an unprecedented challenge for governments globally, leading to various measures to control the virus’s spread and mitigate its impact. This chapter examines the performance of Italian regions in managing COVID-19 during the first wave of the pandemic using nonparametric frontiers. Existing studies are often based on unreliable confirmed case data, leading to biased estimates of infection and mortality rates. This chapter addresses these limitations by using data from serological surveys, which offer a more accurate picture of COVID-19 prevalence. Results reveal that regions heavily impacted, like Lombardy and Veneto, performed better than previous studies suggested. This highlights how using biased data and non-robust methodologies can lead to incorrect conclusions.