Covid-19 health care demand and mortality in Sweden in response to non-pharmaceutical (NPIs) mitigation and suppression scenarios

Rocklov, Joacim

BackgroundWhile the COVID-19 outbreak in China now appears contained, Europe has become the epicenter, with both Italy and Spain reporting more deaths than China. Here we analyse the potential consequences of different response strategies to COVID-19 within Sweden, the resulting demand for care, critical care, deaths and their associated direct health care related costs. MethodsWe use an age stratified health-care demand extended SEIR compartmental model fitted to the municipality level for all municipalities in Sweden, and a radiation model describing inter-municipality mobility. ResultsOur models fit well with the observed deaths in Sweden up to 25th of March. The critical care demand is estimated to peak just above 16,000 patients per day by early May in the unmitigated scenario, while isolation of elderly and intermediate social distancing can reduce it to around 5000-9000 per day peaking in June. These peaks exceed the normal critical care capacity in Sweden at 526 beds by an order of magnitude. We find, however, that by employing strong social distancing and isolation of families with confirmed cases, as guided by testing, the outbreak can be suppressed to levels below the normal critical care capacity. We estimate death rates in COVID-19 are closely related to the different response strategies. ConclusionThe impact of different combinations of non-pharmaceutical interventions, especially the extent of social distancing and isolation, reduce deaths and lower health care costs in Sweden. In most mitigation scenarios, demand on ICU beds would rapidly exceed total ICU capacity, thus calling for immediate expansion of ICU beds. These findings have relevance for Swedish policy and response to the COVID-19 pandemic.