PreprintPDF Available

COVID-19 healthcare demand and mortality in Sweden in response to non-pharmaceutical (NPIs) mitigation and suppression scenarios

  • May 2020
DOI:10.1101/2020.03.20.20039594
Authors:
Henrik Sjödin at Umeå University
Henrik Sjödin
Anders F Johansson
Anders F Johansson
Anders F Johansson
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Zia Farooq at Umeå University
Zia Farooq
Åke Brännström at Umeå University
Åke Brännström
Show all 9 authorsHide
Preprints and early-stage research may not have been peer reviewed yet.
Download file PDFDownload file PDF
Read file
Download citation

Abstract and Figures

Background While the COVID-19 outbreak in China now appears surpressed, Europe and the US have become the epicenters, both reporting many more deaths than China. Responding to the pandemic, Sweden has taken a different approach aiming to mitigate, not suppressing community transmission, by using physical distancing without lock-downs. Here we contrast consequences of different responses to COVID-19 within Sweden, the resulting demand for care, intensive care, the death tolls, and the associated direct healthcare related costs. Methods We use an age stratified health-care demand extended SEIR compartmental model calibrated to the municipality level for all municipalities in Sweden, and a radiation model describing inter-municipality mobility. Results Our model fit well with the observed deaths in Sweden up to 20 th of April, 2020. The intensive care unit (ICU) demand is estimated to reach almost 10,000 patients per day by early May in an unmitigated scenario, far above the pre-pandemic ICU capacity of 526 beds. In contrast, a scenario with moderate physical distancing and shielding of elderly in combination with more effective isolation of infectious individuals would reduce numbers to below 500 per day. This would substantially flatten the curve, extend the epidemic period, but a risk resurgence is expected if measures are relaxed. The different scenarios show quite different death tolls up to the 1 th of September, ranging from 5,000 to 41,000 deaths, exluding deaths potentially caused by ICU shortage. Further, analyses of the total all-cause mortality in Stockholm indicate that a confirmed COVID-19 death is associated with a additional 0.40 (95% Cl: 0.24, 0.57) all-cause death. Conclusion The results of this study highlight the impact of different combinations of non-pharmaceutical interventions, especially moderate physical distancing and shielding of elderly in combination with more effective isolation of infectious individuals, on reducing deaths and lower healthcare costs. In less effective mitigation scenarios, the demand on ICU beds would rapidly exceed capacity, showing the tight interconnection between the healthcare demand and physical distancing in the society. These findings have relevance for Swedish policy and response to the COVID-19 pandemic and illustrate the importance of maintaining the level of physical distancing for a longer period to suppress or mitigate the impacts from the pandemic. Key messages We find physical distancing and isolation of infectious individuals without lockdown is effective in mitigating much of the negative direct health impact from the COVID-19 pandemic in Sweden, but has a higher death toll compared to other Scandinavian countries who did implement a lockdown Between the start of the Swedish model of physical distancing and shiedling the elderly in March to late April, it appears Sweden has managed to ensure that ICU demands do not exceed ICU capacities and that deaths are substantially reduced compared to a counterfactual scenario. In the counterfactual scenario (eg no public health interventions), the intensive care unit demand is estimated to be almost 20 times higher than the intensive care capacity in Sweden and the number of deaths would be between 40,000 to 60,000 Under current mitigation strategies, the death toll, health care need, and its associated cost are, however, still substantial, and it is likely to continue to rise unless the virus is suppressed, or eliminated. In the stronger mitigation and suppression scenarios, including the scenario fitting best to data from Sweden by late April 2020, there is an obvious risk of resurgence of the epidemic unless physical distancing, shielding of the elderly, and home isolation are effectively sustained. Additional analyses indicate all-cause non COVID-19 excess mortality rises with 0.4 deaths per every reported COVID-19 death in the Stockholm area.
Figures - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
2020.03.20.20039594v3.fu
ll.pdf
Content uploaded by Henrik Sjödin
Author content
All content in this area was uploaded by Henrik Sjödin on May 12, 2020
Content may be subject to copyright.
COVID-19 healthcare demand and mortality in Sweden in response to non-pharmaceutical (NPIs) mitigation and suppression scenari
os.pdf
Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
•
•
•
•
•
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
•
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
•
•
•
•
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
0
1
2
3
4
5
Reported COVID-19 deaths
10
4
Sweden
a
Data
Model
0
2000
4000
6000
8000
Reported COVID-19 deaths
Region Stockholm
b
Data
Model
0
500
1000
1500
2000
ICU loa d
Region St ockh olm
c
Data
Model
0
2000
4000
6000
8000
Hospitalization load
Region Stockholm
d
Data
Model
0
1
2
3
4
Reported COVID-19 deaths
10
4
e
0
2000
4000
6000
8000
Reported COVID-19 deaths
f
0
500
1000
1500
2000
ICU loa d
g
0
1000
2000
3000
4000
5000
6000
Hospitalization load
h
0
1
2
3
4
Reported COVID-19 deaths
10
4
i
0
2000
4000
6000
8000
Reported COVID-19 deaths
j
0
500
1000
1500
ICU load
k
0
1000
2000
3000
4000
5000
Hospitalization load
l
0
2000
4000
6000
8000
10000
Reported COVID-19 deaths
m
0
500
1000
1500
2000
2500
3000
Reported COVID-19 deaths
n
0
50
100
150
200
250
ICU load
o
0
200
400
600
800
1000
Hospitalization load
p
Mar Apr May Jun Jul Aug Sep
2020
0
1000
2000
3000
4000
5000
Reported CO VID-19 death s
q
Mar Apr May Jun Jul Aug Sep
2020
0
500
1000
1500
2000
Reported CO VID-19 death s
r
Mar Apr May Jun J ul Aug Sep
2020
0
50
100
150
200
250
ICU load
s
Mar Apr May Jun Jul Aug Sep
2020
0
200
400
600
800
1000
Hospitalization load
t
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
Feb Mar Apr May Jun Jul Aug Sep Oct
0
2
4
6
8
Number of infected persons
10
5
a
Feb Mar Apr May Jun Jul Aug Sep Oct
0
2
4
6
8
Number of infected persons
10
5
b
Feb Mar Apr May Jun Jul Aug Sep Oct
0
1
2
3
4
5
6
Number of infected persons
10
5
c
Feb Mar Apr May Jun Jul Aug Sep Oct
0
0.5
1
1.5
2
Number of infected persons
10
5
d
Feb Mar Apr May Jun Jul Aug Sep Oct
0
0.5
1
1.5
2
Number of infected persons
10
5
e
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
Mar Apr May Jun Jul Aug Sep
2020
0
2000
4000
6000
8000
N
u
m
b
e
r
o
f
p
e
o
p
l
e
requiring intensive care
a
All
0-59
60-79
80+
Mar Apr May Jun Jul Aug Sep
2020
0
2000
4000
6000
b
Mar Apr May Jun Jul Aug Sep
2020
0
1000
2000
3000
4000
5000
c
Mar Apr May Jun Jul Aug Sep
2020
0
100
200
300
400
500
d
Mar Apr May Jun Jul Aug Sep
2020
0
100
200
300
400
500
e
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
Mar Apr May Jun Jul Aug Sep
2020
0
500
1000
1500
N
u
m
b
e
r
o
f
p
e
o
p
l
e
requiring intensive care
a
All
0 - 59
60 - 79
80+
Mar Apr May Jun Jul Aug Sep
2020
0
500
1000
1500
b
Mar Apr May Jun Jul Aug Sep
2020
0
500
1000
c
Mar Apr May Jun Jul Aug Sep
2020
0
50
100
150
200
250
d
Mar Apr May Jun Jul Aug Sep
2020
0
50
100
150
200
250
e
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
•
•
•
•
•
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
Mar Apr May Jun Jul Aug Sep
2020
0
2000
4000
6000
8000
N
u
m
b
e
r
o
f
p
e
o
p
l
e
requiring intensive care
a
All
0-59
60-79
80+
Mar Apr May Jun Jul Aug Sep
2020
0
2000
4000
6000
b
Mar Apr May Jun Jul Aug Sep
2020
0
1000
2000
3000
4000
5000
c
Mar Apr May Jun Jul Aug Sep
2020
0
100
200
300
400
500
d
Mar Apr May Jun Jul Aug Sep
2020
0
100
200
300
400
500
e
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 10, 2020. .https://doi.org/10.1101/2020.03.20.20039594doi: medRxiv preprint
... Quanto aos estudos que compõem esta revisão integrativa, todos são oriundos de revistas on-line e de institutos científicos renomados, a saber: Institutos -MedRxiv (9) , Imperial College London (10) ; Revistas -The New England Journal of Medicine (2) , The Lancet Respiratory Medicine (11) , Health Security (12) e NAM Perspectives (6) . A Nota Técnica (5) é um estudo selecionado que foi escolhido por meio de busca manual no site do Centro de Desenvolvimento e Planejamento Regional (CEDEPLAR), da Universidade Federal de Minas Gerais, sendo relevante por oferecer elementos para as discussões desta pesquisa. ...
... Não foram encontrados manuscritos que façam uma análise específica e em profundidade sobre alocação de recursos humanos, financeiros e farmacológicos no contexto da pandemia de COVID-19. Em alguns estudos (9)(10) , entretanto, a disponibilização de recursos humanos, como elemento a ser considerado, é mencionada de forma breve. ...
... Os desfechos principais referem-se a: incertezas diante da supressão ou mitigação da propagação da COVID-19 e dos riscos das grandes demandas para os serviços de saúde (9) ; necessidade de desenvolver medidas para a tomada de decisão no que diz respeito à alocação de recursos (6) ; recomendações para se considerar os valores éticos diante da escassez de recursos (2) ; estratificação das intervenções (10) ; planejamento e gerenciamento da escassez de recursos para controlar a pandemia (11) ; colaboração global e capacidade de adaptação em cenários de pandemias (12) . Quadro 1 -Síntese dos estudos analisados segundo título, ano e país de publicação, delineamento, objetivo e desfechos, 2020 Os princípios dos padrões de atendimento à crise (CSC) são: justiça; dever de cuidar; dever de administrar recursos; transparência; consistência; proporcionalidade; prestação de contas. ...
Allocation of resources for health care in COVID-19 pandemic times: integrative review
Article
Full-text available
  • Sep 2020
Objective: To analyze information on resource allocation in the context of the COVID-19 pandemic, published in indexed scientific journals, from December 2019 to March 2020. Methods: This is an integrative literature review, which took place in March 2020. All databases were investigated and studies were found only in MEDLINE. After applying the established criteria, six articles were selected. Results: It was evident that the allocation of resources is carried out as the demands emerge. The fragility in presenting scientific-methodological evidence that can guide decision makers for assertive allocation of available resources is highlighted. The results showed that studies on this subject are incipient and need to be expanded. Final considerations: The need for health organizations and area authorities to be better prepared for the proper use of available resources, with allocation based on scientific evidence and maximization of resources is indicated.
View
... Second, mitigation which is a strategy that means letting the COVID-19 epidemic complete its course in a controlled way such as the idea of herd immunity. This strategy was initially applied by UK government, which becomes ineffective therefore, it was replaced with suppression strategy after the public release of report [9,10]. ...
... The ratio between positive tested cases and really infectious cases is called α ratio which is around one order of magnitude, mainly country dependent and uncertain. In the case of the Hubei province outbreak it was estimated that α = 0.05 [10]. ...
Control of COVID-19 system using a novel nonlinear robust control algorithm
Article
COVID-19 has been a worldwide concern since the outbreak. Many strategies have been involved such as suppression and mitigation strategies to deal with this epidemic. In this paper, a new mathematical-engineering strategy is introduced in order to control the COVID-19 epidemic. Thereby, control theory is involved in controlling the unstable epidemic alongside with the other suggested strategies until the vaccine will hopefully be invented as soon as possible. A new robust control algorithm is introduced to compensate the COVID-19 nonlinear system by propose a proper controller after using necessary assumptions and analysis are made. In addition, the Variable Transformation Technique (VTT) is used to simplify the COVID-19 system. Furthermore, the Most Valuable Player Algorithm (MVPA) is applied in order to optimize the parameters of the proposed controller. The simulation results are based on the daily reports of two cities Hubei (China) and Lazio (Italy) since the outbreak. It can be concluded that the proposed control algorithm can effectively compensate the COVID-19 system. In addition, it can be considered as an effective mathematical-engineering strategy to control this epidemic alongside with the other strategies.
View
... In Hong Kong and Taiwan, which experienced severe acute respiratory syndrome (SARS) epidemics in 2002-2003 6,7 , early government actions, strict social distancing measures, contact tracing, extensive and proactive testing, and high compliance of the population, have, to date, successfully mitigated the COVID-19 epidemic 8,9 . Following a herd immunity approach, similar to the one initially adopted by the UK government, the Swedish government did not introduce strict bans but formulated non-binding recommendations only (https:// www.folkhalsomyndigheten.se/nyheter-och-press/). Predictive models, however, suggest that such a strategy might ultimately overwhelm the healthcare system 10 . ...
... In order to highlight country-based differences in the timeline of implementation, we used the epidemic age instead of calendar time. For a given day, t, in a certain country, the epidemic age is defined as the time difference, t-t 0 , measured in days, where t 0 is the first day when the number of confirmed cases was greater or equal to 10 www.nature.com/scientificdata www.nature.com/scientificdata/ ...
A structured open dataset of government interventions in response to COVID-19
Article
Full-text available
  • Aug 2020
In response to the COVID-19 pandemic, governments have implemented a wide range of non-pharmaceutical interventions (NPIs). Monitoring and documenting government strategies during the COVID-19 crisis is crucial to understand the progression of the epidemic. Following a content analysis strategy of existing public information sources, we developed a specific hierarchical coding scheme for NPIs. We generated a comprehensive structured dataset of government interventions and their respective timelines of implementation. To improve transparency and motivate collaborative validation process, information sources are shared via an open library. We also provide codes that enable users to visualise the dataset. Standardization and structure of the dataset facilitate inter-country comparison and the assessment of the impacts of different NPI categories on the epidemic parameters, population health indicators, the economy, and human rights, among others. This dataset provides an in-depth insight of the government strategies and can be a valuable tool for developing relevant preparedness plans for pandemic. We intend to further develop and update this dataset until the end of December 2020.
View
... The world faces a great challenge as the new coronavirus continues to spread. Countries have developed strategies in many areas, including working arrangements, health services, the economy, and educational establishments (3)(4). Furthermore, no one is able to predict the world's pandemic situation for the coming months. ...
... As part of its policy of social distancing, China has encouraged people to stay at home, canceled major public events; and closed schools, libraries and factories. China stated in March 2020 that the crisis was coming to an end in its territory (5) In Europe, the containment strategy differs from one country to another from Sweden to Italy via Germany (3,4). In response, many European countries implemented late interventions, including case isolation, school closings and large-scale social distancing, including local and national closings. ...
View
... Each of these was considered from March 21 onward, and the relative impact estimated on mortality, ICU demand, and individuals infected (Figs. 2 and S3). In agreement with prior predictions [34,35], these results suggest that strong public-health mandates greatly reduce mortality and healthcare need. Surprisingly, voluntary self-isolation overlaid on the existing public-health mandates achieved results within 9-fold of strong mandates at a voluntary adherence rate of 30%, within 7-fold if mild social distancing were overlaid, and within 5-fold at an adherence rate of 50% with mild social distancing. ...
... Our analysis yields qualitatively similar results to those obtained using other model formalisms [8,34]; one advantage of an individual-based model is explicit representation of demographic data, so differences between countries can be analyzed based purely on data rather than parameterized. In addition, individual-based models facilitate examination of nonuniform behaviors across a population: self-isolation by 50% of the population all the time has markedly different effects than self-isolation by all of the population 50% of the time. ...
Managing COVID-19 spread with voluntary public-health measures: Sweden as a case study for pandemic control
Article
Background: The COVID-19 pandemic has spread globally, causing extensive illness and mortality. In advance of effective antiviral therapies, countries have applied different public-health strategies to control spread and manage healthcare need. Sweden has taken a unique approach of not implementing strict closures, instead urging personal responsibility. We analyze the results of this and other potential strategies for pandemic control in Sweden. Methods: We implemented individual-based modeling of COVID-19 spread in Sweden using population, employment, and household data. Epidemiological parameters for COVID-19 were validated on a limited date range; where substantial uncertainties remained, multiple parameters were tested. The effects of different public-health strategies were tested over a 160-day period, analyzed for their effects on ICU demand and death rate, and compared to Swedish data for April 2020. Results: Swedish mortality rates fall intermediate between European countries that quickly imposed stringent public-health controls and countries that acted later. Models most closely reproducing reported mortality data suggest large portions of the population voluntarily self-isolate. Swedish ICU utilization rates remained lower than predicted, but a large fraction of deaths occurred in non-ICU patients. This suggests that patient prognosis was considered in ICU admission, reducing healthcare load at a cost of decreased survival in patients not admitted. Conclusions: The Swedish COVID-19 strategy has thus far yielded a striking result: mild mandates overlaid with voluntary measures can achieve results highly similar to late-onset stringent mandates. However, this policy causes more healthcare demand and mortality than early stringent control and depends on continued public will.
View
... Reakcije vlada i ministarstava na novonastalu situaciju su bile uglavnom temeljene na smjernicama i uputama svojih znanstvenika, sveučilišta, udruženja i instituta. Pojedine države su se posebno istakle kada je u pitanju otvoreno povjerenje u znanstvenike sa svojih sveučilišta poput Švedske, Njemačke, ali i manjih država poput Hrvatske i Slovenije (16,17). Vlade, ministri i druge društvene organizacije su se prepustili zdravstvu i medicini u svojim zemljama kako bi reagirali prema svim segmentima krizne situacije, ubrzali razvoj cjepiva, objasnili situaciji javnosti i usmjerili druge aktivnosti u cilju zaštite od pandemije (18). ...
View
... Another recently published study, focused on Swedish residents, shows higher COVID-19 death rates amongst refugees from the Middle East and Africa compared to the rest of the population (15), which is partly explained by lower socioeconomic position and poor housing conditions (15). The health care system in Sweden, as well as globally, has faced challenges in order to maintain its function during the recent and ongoing pandemic, including the lack of sufficient resources for covering health care during the pandemic (16). In recent years, prior to the pandemic, there has been evidence that refugees faced significant challenges seeking healthcare in Sweden (6,7,17). ...
Working With Refugees' Health During COVID-19—The Experience of Health- and Social Care Workers in Sweden
Article
Full-text available
  • May 2022
Introduction In Sweden, often seen as one of the most egalitarian countries, the COVID-19 pandemic exposed high levels of health inequality, especially harming people with a refugee background. This is also despite Sweden's image as a refugee-friendly country. In this context, the aim of this paper is to better understand how Swedish health- and social workers have reacted to the health- and social needs of refugees during the pandemic. The Swedish case is particularly interesting because, as seen in the paper, health- and social workers had the task of communicating health guidance to refugees who were sometimes more reliant on information from abroad where the consensus on COVID-19 restrictions ran contrary to the approach recommended by the Swedish public health authority. Method The study utilizes a qualitative content analysis of 13 in-depth interviews with health- and social workers in Sweden, active in the care of refugees within different kinds of health- and social care settings. Results The analysis showed that healthcare services have remained open during the pandemic but with new precautions at reception areas impacting how refugees access healthcare. As discussed in the article, the shift to digital tools has particularly impacted refugees, worsening already existing barriers to healthcare services faced by those with refugee status. Public health recommendations were poorly designed to the needs of refugees whose living conditions often prevented them from self-isolation and social distancing. Furthermore, Sweden's initially non-restrictive approach to the pandemic instructed health- and social-workers to encourage refugees to take far fewer precautions (e.g., self-isolation, home-schooling, pregnant women to avoid virus hotspots) compared both with European neighbors and the international media typically used by refugees. When Sweden shifted toward a more restrictive approach, health- and social-workers had to revise their guidance in relation to the new recommendations around precautions. Conclusion Refugees have faced increased barriers to maintaining their health and wellbeing during the pandemic that exceed those experienced by the rest of the Swedish population. Refugees have, in general, taken precautions in regard to social distancing and followed recommendations but faced challenges with social distancing due to isolation and crowded living. Public health authorities have often failed to acknowledge that individuals use increasingly diverse sources of knowledge when trying to protect their health, and that not everyone has access to the knowledge needed to access healthcare and social systems. At the same time, there is a need to acknowledge that refugees are sometimes a source of expertise that was ignored by the Swedish health and social system during the pandemic. There is a need for urgent efforts to halt the worsening health conditions for this specific group, but also to counter knock-on societal effects and rising health inequity.
View
... Health systems around the world have been faced with the challenge of managing the surge of COVID-19 patients as the waves of infection continue to sweep across the globe. The increased demands for beds and ICUs have been observed in the Lombardy region of Italy, Australia, the United States and Sweden, etc. [5,[12][13][14]. In December 2019, Wuhan, a city in China with a population of 11 million, was the first location in the world facing the COVID-19 outbreak with 50 008 confirmed cases within two months of the first case [15]. ...
The health and economic impact of constructing temporary field hospitals to meet the COVID-19 pandemic surge: Wuhan Leishenshan Hospital in China as a case study
Article
Full-text available
  • Dec 2021
Background: In response to the COVID-19 pandemic, two new temporary hospitals were constructed in record time in Wuhan, China, to help combat the fast-spreading virus in February 2020. Using the experience of one of the hospitals as a case study, we discuss the health and economic implications of this response strategy and its potential application in other countries. Methods: This retrospective observational study analyzed health resource utilization and clinical outcomes data for 2011 inpatients diagnosed with COVID-19 and admitted to Leishenshan Hospital during its 67 days of operation from February 8th to April 14th, 2020. We used a top-down costing approach to estimate the total cost of treating patients at the Leishenshan Hospital, including capital cost for hospital construction, health personnel costs, and direct health care costs. We used a multivariate generalized linear model to examine risk factors associated with in-hospital deaths. Results: During the 67 days of hospital operation, 19 medical teams comprising of 933 doctors and 2312 nurses were gradually transferred to Leishenshan Hospital from across China. Of the 2011 admissions, 4.5% used intensive care and 2.0% used ventilators. Overall median length of stay was 19 days, and 21 days for patients in the intensive care unit (ICU). The case fatality rate (CFR) was 2.3% overall, 41.8% in the ICU, and 0.4% in general ward (GW). CFRs were 55% and 50% among patients using non-invasive and invasive ventilators, respectively. The mean total cost and direct health care cost were CNY806 997 (US$114 793) and CNY16 087 (US$2288), respectively. Patients admitted to the ICU had much higher direct health care costs, on average, compared to those in the GW (CNY150 415 vs CNY9720, or US$21 396 vs US$1383). The mean direct health care cost per patient with severe or critical diseases was more than five times higher than those with mild or moderate diseases (CNY45 191 vs CNY8838, or US$6428 vs US$1257). Older age, having comorbidities, and critical disease were associated with higher risks of death from COVID-19. Lower health worker to patient ratio (<2.6) was not associated with in-hospital death. Conclusion: An adequate health workforce were mobilized and deployed to a new temporary hospital. The Leishenshan Hospital increased access to care during the surge in COVID-19 infections, facilitated timely treatment, and transferred COVID-19 patients between GWs and ICUs within the hospital, all of which are potential contributors to lowering the CFR. Patients in the ICU experienced a much higher CFR and a greater burden of health care cost than those in GW. Our results have important implications for other countries interested in constructing temporary emergency hospitals, such as the need for adequate infrastructure capacities and financial support, centralized strategies to mobilize health workforce and to provide respiratory protective devices, and improvement in access to health care.
View
Containment and mitigation strategies during the first wave of Covid-19 pandemic. A territorial approach in CCE countries
Article
Full-text available
  • Mar 2021
The paper analysis the situation in CEE countries in terms of containment and mitigation strategies for the pandemic, but with a focus on the health systems and vulnerability factors (low scores for global health security index, understaffed health systems, higher shares of vulnerable people-obese persons, diabetic or those living in poor quality housing). As the new SARS-COV-2 spread throughout the world, Central and Eastern European governments rushed to preventive actions to reduce its spread, all the more considering that the first cases were imported from abroad (mainly from Italy). Public health measures carried out during the spring outbreak were effective, mainly due to the significant reduction in the contact rates and social distancing, which was partly voluntary, partly enforced. Thus, in early March, in person classes were suspended, persons returning from the areas with community spread of the virus were forced into quarantine, along with workplace closures, travel restrictions and shielding measures for individuals. In CEE countries, the lockdown, when enforced, preceded the curve of infections. There was little variation in the design and implementation of mitigation strategies, which were deployed very quickly, hence a much lower infection rate that did not pose additional strain on the health system. Rezumat. Strategii pentru limitare și diminuare a primului val al pandemiei de Covid-19. O abordare teritorială în țările din Europa Centrală și de Est Lucrarea analizează situația din statele ECE cu privire la strategiile de limitare și diminuare a pandemiei, punând accent pe sistemele de sănătate și factorii de vulnerabilitate (valori mici ale indicelui de securitate globală a sănătății, sistemel de sănătate cu personal puțin, ponderi mari ale populației vulnerabile-persoane obeze, cu diabet sau cele care locuiesc în condiții precare). Pe măsură ce virusul SARS-COV-2 s-a răspândit în tot maimulte state, guvernele țărilor din ECE s-au grăbit să ia măsuri preventive pentru limitarea răspândirii, cu atât mai mult cu cât primele cazuri au fost importate din străinătate (în principal din Italia). Măsurile de sănătate publică luate în timpul epidemiei în primăvară au fost eficiente, în principal datorită reducerii semnificative a infectărilor datorită contactului și distanțării sociale, care a fost parțial voluntară, parțial impusă. Astfel, la începutul lunii martie, școlile au fost închise, persoanele care se întorceau din zonele cu răspândire comunitară a virusului au fost forțate să intre in carantină, urmate apoi de limitarea deplasărilor și măsuri de protecție individuale. În statele din ECE, restricțiile severe, atunci când au fost aplicate, au precedat curba infecțiilor. Au existat foarte puține diferențe în ceea ce privește conceperea și implementarea strategiilor de diminuare, care au puse în practică rapid, de unde și o rată suficient de mică a infectărilor care să nu pună o presiune mult prea mare pe sistemul de sănătate publică.
View
Models for COVID-19 Pandemic: A Comparative Analysis
Article
  • Sep 2020
COVID-19 pandemic represents an unprecedented global health crisis in the last 100 years. Its economic, social and health impact continues to grow and is likely to end up as one of the worst global disasters since the 1918 pandemic and the World Wars. Mathematical models have played an important role in the ongoing crisis; they have been used to inform public policies and have been instrumental in many of the social distancing measures that were instituted worldwide. In this article we review some of the important mathematical models used to support the ongoing planning and response efforts. These models differ in their use, their mathematical form and their scope.
View
Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China
Article
Full-text available
  • Apr 2020
Importance Coronavirus disease 2019 (COVID-19) has become a pandemic, and it is unknown whether a combination of public health interventions can improve control of the outbreak. Objective To evaluate the association of public health interventions with the epidemiological features of the COVID-19 outbreak in Wuhan by 5 periods according to key events and interventions. Design, Setting, and Participants In this cohort study, individual-level data on 32 583 laboratory-confirmed COVID-19 cases reported between December 8, 2019, and March 8, 2020, were extracted from the municipal Notifiable Disease Report System, including patients’ age, sex, residential location, occupation, and severity classification. Exposures Nonpharmaceutical public health interventions including cordons sanitaire, traffic restriction, social distancing, home confinement, centralized quarantine, and universal symptom survey. Main Outcomes and Measures Rates of laboratory-confirmed COVID-19 infections (defined as the number of cases per day per million people), across age, sex, and geographic locations were calculated across 5 periods: December 8 to January 9 (no intervention), January 10 to 22 (massive human movement due to the Chinese New Year holiday), January 23 to February 1 (cordons sanitaire, traffic restriction and home quarantine), February 2 to 16 (centralized quarantine and treatment), and February 17 to March 8 (universal symptom survey). The effective reproduction number of SARS-CoV-2 (an indicator of secondary transmission) was also calculated over the periods. Results Among 32 583 laboratory-confirmed COVID-19 cases, the median patient age was 56.7 years (range, 0-103; interquartile range, 43.4-66.8) and 16 817 (51.6%) were women. The daily confirmed case rate peaked in the third period and declined afterward across geographic regions and sex and age groups, except for children and adolescents, whose rate of confirmed cases continued to increase. The daily confirmed case rate over the whole period in local health care workers (130.5 per million people [95% CI, 123.9-137.2]) was higher than that in the general population (41.5 per million people [95% CI, 41.0-41.9]). The proportion of severe and critical cases decreased from 53.1% to 10.3% over the 5 periods. The severity risk increased with age: compared with those aged 20 to 39 years (proportion of severe and critical cases, 12.1%), elderly people (≥80 years) had a higher risk of having severe or critical disease (proportion, 41.3%; risk ratio, 3.61 [95% CI, 3.31-3.95]) while younger people (<20 years) had a lower risk (proportion, 4.1%; risk ratio, 0.47 [95% CI, 0.31-0.70]). The effective reproduction number fluctuated above 3.0 before January 26, decreased to below 1.0 after February 6, and decreased further to less than 0.3 after March 1. Conclusions and Relevance A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan, China. These findings may inform public health policy in other countries and regions.
View
Only strict quarantine measures can curb the coronavirus disease (COVID-19) outbreak in Italy, 2020
Article
Full-text available
Several Italian towns are under lockdown to contain the COVID-19 outbreak. The level of transmission reduction required for physical distancing interventions to mitigate the epidemic is a crucial question. We show that very high adherence to community quarantine (total stay-home policy) and a small household size is necessary for curbing the outbreak in a locked-down town. The larger the household size and amount of time in the public, the longer the lockdown period needed. © 2020 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
View
COVID-19 epidemic in Switzerland: on the importance of testing, contact tracing and isolation
Article
Full-text available
Switzerland is among the countries with the highest number of coronavirus disease-2019 (COVID-19) cases per capita in the world. There are likely many people with undetected SARS-CoV-2 infection because testing efforts are currently not detecting all infected people, including some with clinical disease compatible with COVID-19. Testing on its own will not stop the spread of SARS-CoV-2. Testing is part of a strategy. The World Health Organization recommends a combination of measures: rapid diagnosis and immediate isolation of cases, rigorous tracking and precautionary self-isolation of close contacts. In this article, we explain why the testing strategy in Switzerland should be strengthened urgently, as a core component of a combination approach to control COVID-19.
View
Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19)
Article
Full-text available
The number of novel coronavirus (COVID-19) cases worldwide continues to grow, and the gap between reports from China and statistical estimates of incidence based on cases diagnosed outside China indicates that a substantial number of cases are underdiagnosed (Nishiura et al., 2020a). Estimation of the asymptomatic ratio—the percentage of carriers with no symptoms—will improve understanding of COVID-19 transmission and the spectrum of disease it causes, providing insight into epidemic spread. Although the asymptomatic ratio is conventionally estimated using seroepidemiological data (Carrat et al., 2008, Hsieh et al., 2014), the collection of these data requires significant logistical effort, time, and cost. Instead, we propose a method of estimating the asymptomatic ratio by using information on Japanese nationals who were evacuated from Wuhan, China on charter flights.
View
Estimating the reproductive number and the outbreak size of Novel Coronavirus disease (COVID-19) using mathematical model in Republic of Korea
Article
Full-text available
  • Mar 2020
Objectives: Since the first novel coronavirus disease(COVID-19) patient was diagnosed on 20-Jan, about 30 patients were diagnosed in Korea until 17-Feb. However, 5,298 more patient were confirmed until 4-Mar. The purpose is to estimate and evaluate the effectiveness of preventive measures using mathematical modeling. Methods: Deterministic mathematical model(SEIHR) has been established to suit the Korean outbreak. The number of confirmed patients in Daegu and North Gyeongsang Province(Daegu/NGP), the main area of outbreak, were used. The first patient's symptom onset date was assumed on 22-Jan. We estimate the reproduction number(R), and the effect of preventive measures, assuming that the effect has been shown from 29-Feb. or 5-Mar. Results: The estimated R in Hubei Province was 4.2655, while the estimated initial R in Korea was 0.5555, but later in Daegu/NGP, the value was between 3.4721 and 3.5428. When the transmission period decreases from 4 days to 2 days, the outbreak finished early, but the peak of the epidemic has increased, and the total number of patients has not changed much. If transmission rate decreases about 90% or 99%, the outbreak finished early, and the size of the peak and the total number of patients also decreased. Conclusion: To early end of the COVID-19 epidemic, efforts to reduce the spread of the virus such as social distancing and mask wearing are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through efforts by the quarantine authorities.
View
Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data
Article
Full-text available
  • Feb 2020
The geographic spread of 2019 novel coronavirus (COVID-19) infections from the epicenter of Wuhan, China, has provided an opportunity to study the natural history of the recently emerged virus. Using publicly available event-date data from the ongoing epidemic, the present study investigated the incubation period and other time intervals that govern the epidemiological dynamics of COVID-19 infections. Our results show that the incubation period falls within the range of 2-14 days with 95% confidence and has a mean of around 5 days when approximated using the best-fit lognormal distribution. The mean time from illness onset to hospital admission (for treatment and/or isolation) was estimated at 3-4 days without truncation and at 5-9 days when right truncated. Based on the 95th percentile estimate of the incubation period, we recommend that the length of quarantine should be at least 14 days. The median time delay of 13 days from illness onset to death (17 days with right truncation) should be considered when estimating the COVID-19 case fatality risk.
View
Tracking online heroisation and blame in epidemics
Article
Full-text available
  • Feb 2020
The ongoing coronavirus disease 2019 (COVID-19) outbreak is giving rise to worldwide anxieties, rumours, and online misinformation. But it offers an opportunity to put into practice some lessons learned in studies of social media during epidemics, particularly with respect to the dynamics of online heroisation and blame.
View
View
View
View