scholarly journals Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

2020 ◽  
Author(s):  
Jasmine M Gardner ◽  
Lander Willem ◽  
Wouter Van Der Wijngaart ◽  
Shina Caroline Lynn Kamerlin ◽  
Nele Brusselaers ◽  
...  
Keyword(s):  
Public Health ◽  
Intensive Care ◽  
Healthcare System ◽  
Healthcare Workers ◽  
Health Interventions ◽  
Parameter Estimates ◽  
List Type ◽  
Public Health Interventions ◽  
Social Distancing ◽  
Health Measures

AbstractObjectivesDuring March 2020, the COVID-19 pandemic has rapidly spread globally, and non-pharmaceutical interventions are being used to reduce both the load on the healthcare system as well as overall mortality.DesignIndividual-based transmission modelling using Swedish demographic and Geographical Information System data and conservative COVID-19 epidemiological parameters.SettingSwedenParticipantsA model to simulate all 10.09 million Swedish residents.Interventions5 different non-pharmaceutical public-health interventions including the mitigation strategy of the Swedish government as of 10 April; isolation of the entire household of confirmed cases; closure of schools and non-essential businesses with or without strict social distancing; and strict social distancing with closure of schools and non-essential businesses.Main outcome measuresEstimated acute care and intensive care hospitalisations, COVID-19 attributable deaths, and infections among healthcare workers from 10 April until 29 June.FindingsOur model for Sweden shows that, under conservative epidemiological parameter estimates, the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000). The most stringent public-health measures examined are predicted to reduce mortality by approximately three-fold. Intensive-care load at the peak could be reduced by over two-fold with a shorter period at peak pandemic capacity.ConclusionsOur results predict that, under conservative epidemiological parameter estimates, current measures in Sweden will result in at least 40-fold over-subscription of pre-pandemic Swedish intensive care capacity, with 15.8 percent of Swedish healthcare workers unable to work at the pandemic peak. Modifications to ICU admission criteria from international norms would further increase mortality.What is already known?-The COVID-19 pandemic has spread rapidly in Europe and globally since March 2020.-Mitigation and suppression methods have been suggested to slow down or halt the spread of the COVID-19 pandemic. Most European countries have enacted strict suppression measures including lockdown, school closures, enforced social distancing; while Sweden has chosen a different strategy of milder mitigation as of today (10 April 2020).-Different national policy decisions have been justified by socio-geographic differences among countries. Such differences as well as the tempo and stringency of public-health interventions are likely to affect the impact on each country’s mortality and healthcare system.What this study adds?-Individual-based modelling of COVID-19 spread using Swedish demographics and conservative epidemiological assumptions indicates that the peak of the number of hospitalised patients with COVID-19 can be expected in early May under the current strategy, shifted earlier and attenuated with more stringent public health measures.-Healthcare needs are expected to substantially exceed pre-pandemic capacity even if the most aggressive interventions considered were implemented in the coming weeks. In particular the need for intensive care unit beds will be at least 40-fold greater than the pre-pandemic capacity if the current strategy is maintained, and at least 10-fold greater if strategies approximating the most stringent in Europe are introduced by 10 April.-Our model predicts that, using median infection-fatality-rate estimates, at least 96,000 deaths would occur by 1 July without mitigation. Current policies reduce this number by approximately 15%, while even more aggressive social distancing measures, such as adding household isolation or mandated social distancing can reduce this number by more than 50%.

scholarly journals Mathematical Parameters of the COVID-19 Epidemic in Brazil and Evaluation of the Impact of Different Public Health Measures

Biology ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 220 ◽  
Author(s):  
Renato M. Cotta ◽  
Carolina P. Naveira-Cotta ◽  
Pierre Magal
Keyword(s):  
Public Health ◽  
Initial Conditions ◽  
Transmission Rate ◽  
Time Variable ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Problem Model ◽  
Social Distancing ◽  
Health Measures ◽  
The Impact

A SIRU-type epidemic model is employed for the prediction of the COVID-19 epidemy evolution in Brazil, and analyze the influence of public health measures on simulating the control of this infectious disease. The proposed model allows for a time variable functional form of both the transmission rate and the fraction of asymptomatic infectious individuals that become reported symptomatic individuals, to reflect public health interventions, towards the epidemy control. An exponential analytical behavior for the accumulated reported cases evolution is assumed at the onset of the epidemy, for explicitly estimating initial conditions, while a Bayesian inference approach is adopted for the estimation of parameters by employing the direct problem model with the data from the first phase of the epidemy evolution, represented by the time series for the reported cases of infected individuals. The evolution of the COVID-19 epidemy in China is considered for validation purposes, by taking the first part of the dataset of accumulated reported infectious individuals to estimate the related parameters, and retaining the rest of the evolution data for direct comparison with the predicted results. Then, the available data on reported cases in Brazil from 15 February until 29 March, is used for estimating parameters and then predicting the first phase of the epidemy evolution from these initial conditions. The data for the reported cases in Brazil from 30 March until 23 April are reserved for validation of the model. Then, public health interventions are simulated, aimed at evaluating the effects on the disease spreading, by acting on both the transmission rate and the fraction of the total number of the symptomatic infectious individuals, considering time variable exponential behaviors for these two parameters. This first constructed model provides fairly accurate predictions up to day 65 below 5% relative deviation, when the data starts detaching from the theoretical curve. From the simulated public health intervention measures through five different scenarios, it was observed that a combination of careful control of the social distancing relaxation and improved sanitary habits, together with more intensive testing for isolation of symptomatic cases, is essential to achieve the overall control of the disease and avoid a second more strict social distancing intervention. Finally, the full dataset available by the completion of the present work is employed in redefining the model to yield updated epidemy evolution estimates.

scholarly journals Reconceptualizing Social Distancing: Teletherapy and Social Inequality During the COVID-19 and Loneliness Pandemics

2020 ◽  
Vol 60 (5) ◽  
pp. 626-638 ◽  
Author(s):  
José G. Luiggi-Hernández ◽  
Andrés I. Rivera-Amador
Keyword(s):  
Public Health ◽  
Psychological Impact ◽  
Psychological Effects ◽  
Health Interventions ◽  
Negative Consequences ◽  
Cautionary Tale ◽  
Public Health Interventions ◽  
Social Distancing ◽  
Health Measures ◽  
The Impact

The purpose of this article is to highlight the impact of the COVID-19 pandemic amid a preexisting loneliness epidemic, as well as argue in favor of the reconceptualization of social distancing as physical distancing. As public health measures require us to take up possibly isolating practices in order to reduce and eliminate the spread of the virus, it is important to develop or take up new forms of prosocial yet physically distant dynamics in order to address the negative psychological impact of these measures. The negative consequences of public health interventions might increase feelings loneliness and isolation experienced within Western industrialized societies. For this reason, teletherapy serves as temporary (and limited) intervention that could ameliorate the psychological effects of isolation. It could also serve as a space for the development of critical consciousness, as people reflect on the sociopolitical and economic impacts these measures have on them, and how they wish to address them. Nevertheless, we also offer an ethical cautionary tale to the application of teletherapy beyond the current emergency pandemic of the COVID-19.

Public Health or Clinical Ethics: Thinking beyond Borders

2002 ◽  
Vol 16 (2) ◽  
pp. 35-45 ◽  
Author(s):  
Onora O'Neill
Keyword(s):  
Public Health ◽  
Medical Ethics ◽  
Clinical Medicine ◽  
Clinical Care ◽  
Effective Means ◽  
Cost Effective ◽  
Health Interventions ◽  
Individual Autonomy ◽  
Public Health Interventions ◽  
Health Measures

Most work in medical ethics across the last twenty-five years has centered on the ethics of clinical medicine. Even work on health and justice has, in the main, been concerned with the just distribution of (access to) clinical care for individual patients. By contrast, the ethics of public health has been widely neglected. This neglect is surprising, given that public health interventions are often the most effective (and most cost-effective) means of improving health in rich and poor societies alike.In this essay I explore two sources of contemporary neglect of public health ethics. One source of neglect is that contemporary medical ethics has been preoccupied—in my view damagingly preoccupied—with the autonomy of individual patients. Yet individual autonomy can hardly be a guiding ethical principle for public health measures, since many of them must be uniform and compulsory if they are to be effective. A second source of neglect is that contemporary political philosophy has been preoccupied—in my view damagingly preoccupied—with the requirements for justice within states or societies, and (until very recently) has hardly discussed justice across borders. Yet public health problems often cross borders, and public health interventions have to measure up to the problems they address.

scholarly journals Public Health Interventions’ Effect on Hospital Use in Patients With COVID-19: Comparative Study (Preprint)

2020 ◽  
Author(s):  
Xiaofeng Wang ◽  
Rui Ren ◽  
Michael W Kattan ◽  
Lara Jehi ◽  
Zhenshun Cheng ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
New York ◽  
New York State ◽  
The United States ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Social Distancing ◽  
Transmission Rates ◽  
Hospital Use

BACKGROUND Different states in the United States had different nonpharmaceutical public health interventions during the COVID-19 pandemic. The effects of those interventions on hospital use have not been systematically evaluated. The investigation could provide data-driven evidence to potentially improve the implementation of public health interventions in the future. OBJECTIVE We aim to study two representative areas in the United States and one area in China (New York State, Ohio State, and Hubei Province), and investigate the effects of their public health interventions by time periods according to key interventions. METHODS This observational study evaluated the numbers of infected, hospitalized, and death cases in New York and Ohio from March 16 through September 14, 2020, and Hubei from January 26 to March 31, 2020. We developed novel Bayesian generalized compartmental models. The clinical stages of COVID-19 were stratified in the models, and the effects of public health interventions were modeled through piecewise exponential functions. Time-dependent transmission rates and effective reproduction numbers were estimated. The associations of interventions and the numbers of required hospital and intensive care unit beds were studied. RESULTS The interventions of social distancing, home confinement, and wearing masks significantly decreased (in a Bayesian sense) the case incidence and reduced the demand for beds in all areas. Ohio’s transmission rates declined before the state’s “stay at home” order, which provided evidence that early intervention is important. Wearing masks was significantly associated with reducing the transmission rates after reopening, when comparing New York and Ohio. The centralized quarantine intervention in Hubei played a significant role in further preventing and controlling the disease in that area. The estimated rates that cured patients become susceptible in all areas were small (<0.0001), which indicates that they have little chance to get the infection again. CONCLUSIONS The series of public health interventions in three areas were temporally associated with the burden of COVID-19–attributed hospital use. Social distancing and the use of face masks should continue to prevent the next peak of the pandemic.

scholarly journals Effect of public health interventions during the first epidemic wave of COVID-19 in Cyprus: a modelling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilias Gountas ◽  
Annalisa Quattrocchi ◽  
Ioannis Mamais ◽  
Constantinos Tsioutis ◽  
Eirini Christaki ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare System ◽  
Credible Interval ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Case Ascertainment ◽  
Dynamic Stochastic ◽  
The Republic ◽  
Republic Of Cyprus ◽  
The Impact

Abstract Background Cyprus addressed the first wave of SARS CoV-2 (COVID-19) by implementing non-pharmaceutical interventions (NPIs). The aims of this study were: a) to estimate epidemiological parameters of this wave including infection attack ratio, infection fatality ratio, and case ascertainment ratio, b) to assess the impact of public health interventions and examine what would have happened if those interventions had not been implemented. Methods A dynamic, stochastic, individual-based Susceptible-Exposed-Infected-Recovered (SEIR) model was developed to simulate COVID-19 transmission and progression in the population of the Republic of Cyprus. The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use. Results By May 8th, 2020, the infection attack ratio was 0.31% (95% Credible Interval [CrI]: 0.15, 0.54%), the infection fatality ratio was 0.71% (95% CrI: 0.44, 1.61%), and the case ascertainment ratio was 33.2% (95% CrI: 19.7, 68.7%). If Cyprus had not implemented any public health measure, the healthcare system would have been overwhelmed by April 14th. The interventions averted 715 (95% CrI: 339, 1235) deaths. If Cyprus had only increased ICU beds, without any social distancing measure, the healthcare system would have been overwhelmed by April 19th. Conclusions The decision of the Cypriot authorities to launch early NPIs limited the burden of the first wave of COVID-19. The findings of these analyses could help address the next waves of COVID-19 in Cyprus and other similar settings.

scholarly journals Spread of COVID-19 through Georgia, USA. Near-term projections and impacts of social distancing via a metapopulation model

2020 ◽  
Author(s):  
Stephen J Beckett ◽  
Marian Dominguez-Mirazo ◽  
Seolha Lee ◽  
Clio Andris ◽  
Joshua S Weitz
Keyword(s):  
Public Health ◽  
Disease Risk ◽  
State Level ◽  
Health Interventions ◽  
County Level ◽  
Public Health Interventions ◽  
Social Distancing ◽  
Viral Spread ◽  
Near Term ◽  
Premature Removal

Epidemiological forecasts of COVID-19 spread at the country and/or state level have helped shape public health interventions. However, such models leave a scale-gap between the spatial resolution of actionable information (i.e. the county or city level) and that of modeled viral spread. States and nations are not spatially homogeneous and different areas may vary in disease risk and severity. For example, COVID-19 has age-stratified risk. Similarly, ICU units, PPE and other vital equipment are not equally distributed within states. Here, we implement a county-level epidemiological framework to assess and forecast COVID-19 spread through Georgia, where 1,933 people have died from COVID-19 and 44,638 cases have been documented as of May 27, 2020. We find that county-level forecasts trained on heterogeneity due to clustered events can continue to predict epidemic spread over multi-week periods, potentially serving efforts to prepare medical resources, manage supply chains, and develop targeted public health interventions. We find that the premature removal of physical (social) distancing could lead to rapid increases in cases or the emergence of sustained plateaus of elevated fatalities.

scholarly journals Public Health Policies and Global COVID-19 Outbreak

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Komaroff ◽  
A A Belhouchet
Keyword(s):  
Public Health ◽  
South Korea ◽  
Health Interventions ◽  
Health Policies ◽  
P Value ◽  
Public Health Interventions ◽  
Public Health Policies ◽  
The Public ◽  
Health Measures ◽  
The Usa

Abstract Background Was the world prepared to face the pandemic with a standard strategy? Objectives To evaluate the association between public health interventions against the COVID-19 outbreak and the outcome. Methods The observational study included data on incidence of confirmed COVID-19 cases (outcome) and public health non-pharmaceutical interventions (exposure) from five countries: France, Italy, Japan, South Korea, and the USA, December 31, 2019 through April 12, 2020. The public health measures were grouped into five categories: lockdown, movement restrictions, public health measures, social (including social distancing) and economic measures, and use of facial mask. The multiple linear regressions were utilized to test the hypothesis that implementation of some public health measures was associated with the change in the incident number of COVID-19 cases, 2-sided, α = 0.05. Results The incidence of COVID-19 would be significantly greater without lockdown (1.89 times, p-value <.0001), public health and economic measures (25.17, p-value <.0001), and using masks (11.93, p-value=0.002), assuming that all other public health policies are the same. The effectiveness increases with earlier time of implementation. Among considered countries, South Korea was the most efficacious, where all measures were statistically significantly efficacious (p-value <0.05). Conclusions The findings demonstrate an association between public health measures and the outcome. The experience from South Korea should be studied further as the most effective non-pharmacological approach to fight the disease. This paper is the first step to develop the standardized approach utilizing the public health interventions to be applied effectively to the globe population. Key messages the most effective measures to control the COVID-19, and future outbreaks. The effect of particular measure varied by country and time of implementation.

scholarly journals Modelling the COVID-19 epidemics in Brasil: Parametric identification and public health measures influence

2020 ◽  
Author(s):  
R.M. Cotta ◽  
C.P. Naveira-Cotta ◽  
P. Magal
Keyword(s):  
Public Health ◽  
Initial Conditions ◽  
Transmission Rate ◽  
Parametric Identification ◽  
Parametric Estimation ◽  
Health Interventions ◽  
Problem Analysis ◽  
Public Health Interventions ◽  
Problem Model ◽  
Health Measures

ABSTRACTA SIRU-type epidemic model is proposed for the prediction of COVID-19 spreading within Brasil, and analyse the influence of public health measures on simulating the control of this infectious disease. Since the reported cases are typically only a fraction of the total number of the symptomatic infectious individuals, the model accounts for both reported and unreported cases. Also, the model allows for the time variation of both the transmission rate and the fraction of asymptomatic infectious that become reported symptomatic individuals, so as to reflect public health interventions, towards its control, along the course of the epidemic evolution. An analytical exponential behaviour for the accumulated reported cases evolution is assumed at the onset of the epidemy, for explicitly estimating initial conditions, while a Bayesian inference approach is adopted for parametric estimations employing the present direct problem model with the data from the known portion of the epidemics evolution, represented by the time series for the reported cases of infected individuals. The direct-inverse problem analysis is then employed with the actual data from China, with the first half been employed for the parametric estimation and the second half for validation of the predictive capability of the proposed approach. The full dataset for China is then employed in another parameter identification, aimed at refining the values for the average times that asymptomatic infectious individuals and that symptomatic individuals remain infectious. Following this validation, the available data on reported cases in Brasil from February 15th till March 29th, 2020, is used for estimating parameters and then predict the epidemy evolution under these conditions. Finally, public health interventions are simulated, aimed at diminishing the effects of the disease spreading, by acting on both the transmission rate and the fraction of the total number of the symptomatic infectious individuals, considering time variable exponential behaviours for these two parameters, usually assumed constant in epidemic evolutions without intervention. It is demonstrated that a combination of actions to affect both parameters can have a much faster and effective result in the control of the epidemy dynamics.

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