The pandemic spread rapidly across Italy, putting the region’s health system on the brink of collapse, and generating concern regarding the government’s capacity to respond to the needs of patients considering isolation measures. This study developed a sentiment analysis using millions of Twitter data during the first wave of the COVID-19 pandemic in 10 metropolitan cities in Italy’s (1) north: Milan, Venice, Turin, Bologna; (2) central: Florence, Rome; (3) south: Naples, Bari; and (4) islands: Palermo, Cagliari. Questions addressed are as follows: (1) How did tweet-related sentiments change over the course of the COVID-19 pandemic, and (2) How did sentiments change when lagged with policy shifts and/or specific events? Findings show an assortment of differences and connections across Twitter sentiments (fear, anger, and joy) based on policy measures and geographies during the COVID-19 pandemic. Results can be used by policy makers to quantify the satisfactory level of positive/negative acceptance of decision makers and identify important topics related to COVID-19 policy measures, which can be useful for imposing geographically varying lockdowns and protective measures using historical data.