Abstract
BackgroundWhile the COVID-19 outbreak in China now appears suppressed, Europe and the USA have become the epicentres, both reporting many more deaths than China. Responding to the pandemic, Sweden has taken a different approach aiming to mitigate, not suppress, community transmission, by using physical distancing without lockdowns. Here we contrast the 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.MethodsWe used an age-stratified health-care demand extended SEIR (susceptible, exposed, infectious, recovered) compartmental model for all municipalities in Sweden, and a radiation model for describing inter-municipality mobility. The model was calibrated against data from municipalities in the Stockholm healthcare region.ResultsOur scenario with moderate to strong physical distancing describes well the observed health demand and deaths in Sweden up to the end of May 2020. In this scenario, the intensive care unit (ICU) demand reaches the pre-pandemic maximum capacity just above 500 beds. In the counterfactual scenario, the ICU demand is estimated to reach ∼20 times higher than the pre-pandemic ICU capacity. The different scenarios show quite different death tolls up to 1 September, ranging from 5000 to 41 000, excluding deaths potentially caused by ICU shortage. Additionally, our statistical analysis of all causes excess mortality indicates that the number of deaths attributable to COVID-19 could be increased by 40% (95% confidence interval: 0.24, 0.57).ConclusionThe results of this study highlight the impact of different combinations of non-pharmaceutical interventions, especially moderate physical distancing in combination with more effective isolation of infectious individuals, on reducing deaths, health demands and lowering 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 beyond the study period to suppress or mitigate the impacts from the pandemic.
Highlights
The novel SARS-CoV-2 is highly transmissible.[1]
We find that 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 with other Scandinavian countries who did implement a lockdown
Physical distancing was implemented at a grand scale, all mobility put to an halt, and the city of Wuhan was in lockdown for about 9 weeks.[5]
Summary
The novel SARS-CoV-2 is highly transmissible.[1] It has rapidly spread around the globe since it first emerged in Wuhan, China,[2] at a rate much faster than other emerging infectious diseases such as Ebola.[3] In response to the COVID-19 outbreak, China implemented extraordinary public health measures at great socio-economic cost They moved swiftly to ensure early identification of cases, with prompt laboratory testing, facility-based isolation of all cases, contact tracing and quarantine.[4] In the community, physical distancing was implemented at a grand scale, all mobility put to an halt, and the city of Wuhan was in lockdown for about 9 weeks.[5] China’s tremendous efforts showed success.[6] Other Asian countries facing a major explosion, such as South Korea, managed to curb the epidemic.
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