Covid-19: idealism vs Pragmatism

Covid-19: idealism vs Pragmatism, case study of Sweden

Background

Recently Sweden has applied a limited quarantine of max 50 persons in gatherings and meetings. While many Swedes think that Sweden has to go to full quarantine, but there is a big question, and that is, for how long and on what cost?!

Firstly, full quarantine in China is different than full quarantine in Europe. In Wuhan, the authorities welded doors of buildings, all city was a prison, you can find many videos in youtube about it . In other places in China they arrested everyone who had fever, and now in streets drones are flying , watching everyone from close distance.
Italy applied the hardest “European quarantine” since 9th March, one month before writing this article. See how the spreading develops in Italy here.

Second, what happens without any quarantine: You can see in simulations done in [1] in most cases hospitals will be overwhelmed. It is in this conditions that the death/sick ratio increases dramatically. In China fatality is around 3%, in Italy the health care system has collapsed so the ratio is 12.6% as of today, 9th April (139,422 cases/17,669 death). In addition to that, the population age is another factor. The bottleneck is ICU units.

Fig 1: Source: https://www.worldometers.info/coronavirus/country/sweden/ (9th April)

Forecast model

Figure 1 above shows the new cases in Sweden based on data on [3]. Figure 2 shows a forecast by the end of May with this level of quarantine (max 50 persons at a gathering) This was a conservative forecast, the more aggressive forecast shows higher numbers.

Fig 2: The forecast of new cases vs needed ICU beds till end of April. The forecast was performed by 27th of March , almost two weeks ago with slight correction of parameters on April 2.

The assumptions:

  • Ratio of infected/are tested= 8 (this is probably higher than many contries as Swedish authorities have asked people with mild/ intermediate symptoms stay home and only severe cases will be tested)
  • In need of ICU=15% (this found from comparing total infected numbers and ICU cases and is higher than [1] (=5%) because the hospitals in Sweden only accept patients with relatively serious conditions, otherwise recommend at stay home and self-quarantine without doing a test)
  • Each sick person can contaminate others for 14 days [1]
  • Every patient spends almost 10 days in hospital [2]

Health care system is ready, but…

Now lets come back to Sweden. In Sweden prior to break-down there was 5 ICU units per 100,000 population. This made it 500 units in whole country. By default Swedes follow social distancing more, but also the health care system, before Corona, was on the edge of saturation. The available corona-dedicated “ICU beds/ occupied ICU beds” ratio changed from 260/214 on Friday 27th March to 331/269 on Sunday 29th of March, and to 817/662 on 8th of April[2] Today, 9th of April this ratio has changed to 889/772. The numbers are changing quickly and that is scary. It means that the health care is preparing the best they can, according to guidelines in [1] to fight the upcoming wave. [2] also shows the new ICU cases in daily basis.

1500 ICU beds= 10 months!

But the big question is, for how long and how much the health care system with the help of military can stretch the facilities? We know that the resources are limited. Already 800 ICU units are beyond my primary guess, but let us assume that the healthcare can eventually provide 1500 ICU units.

This means that by the third week of April Sweden has to go to full quarantine if she wants that the hospitals are not overwhelmed. In that case in April between 300,000 to 400, 000 will be infected.

If we assume full quarantine starts at the beginning of May, we can hope that it takes 2 weeks to see the first changes in trend. . With 1500 ICU beds, by then end of May we cannot have more than total 400,000 infected , otherwise we dont have enough ICU beds and that increases fatality.

Assuming that eventually 60% of population will be suffered, and instead of normal distribution, we use simplified pyramid distribution, thus target of 3,000,000 infected in Sweden, it takes “10 months” with this rate that 3,000,000 become infected. We hope that within 1.5 years a vaccine will be developed and will be distributed to all. This is in case the survivors become immune to the virus, something that has not yet proven.

No quarantine needed, but…

Assessing the responsiveness of health care system, it can be concluded that it is too early to shut down the country. The measures that the government has taken seems to be efficient in slowing down the spreading in a way that matches the health care expansion, at least for now.

But the current situation is here to stay for at least 10 months. It is naive to think that a two week full quarantine will be suffice to eliminate the virus. It is out there and is waiting for new victims, as soon as it finds a pray. 10 months is enough to destroy many infrastructures, and this is not Sweden’s problem only. It seems to me that the only way to shorten this process is to increase the number of ICU units, to as much as possible. With imaginary number of 2500 ICU beds for example, it would take only 4 to 5 months to reach the other side of the curve.

[1] https://www.ecdc.europa.eu/…/RRA-sixth-update-Outbreak-of-n…
[2] https://www.icuregswe.org/…/covid-19-in-swedish-intensive-…/
[3] https://www.worldometers.info/world-popu…/sweden-population/

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