The Black Death reached Sicily in 1347, before it affected mainland Italy. This was during Elizabeth's reign, and was likely one of her prime concerns throughout the remainder of her time in power. Outbreaks of the Black Death had occurred in Italy before in the thirteenth century, but they were generally localized and confined to one or two towns. 1347 was the first severe case recorded in Sicily, and initiated the pandemic that would become an unfortunate and familiar aspect of European life for centuries. Elizabeth could do nothing to relieve the people, although she refrained from fleeing the country which was a common trend among those Italians who could afford to. Gabriel de Mussis, an Italian notary in the fourteenth century, recounts an attitude of despondency in Sicily; occurrences such as heavy rainfalls, the birth of Siamese twins, and horses refusing to enter Messina were all considered signs that God had abandoned the people. The plague had drastic economic effects on Italy as well, and contributed to the first significant economic crisis in centuries.