Adaptive Response

April 1, 2020

It’s completely understandable that everyone wants to know, “When can we go out again.” But the question we must answer is: “What do we have to do, right now, so we reopen as soon and safely as possible?”

A key concept is that we need to reopen the faucet gradually, not allow the floodgates to reopen. We can then loosen or tighten physical distancing according to levels of virus transmission, healthcare preparedness and public health capacity.

Download the Fact Sheets on When to Loosen and When to Tighten

Dr. Cyrus Shahpar and Former CDC Director Dr. Tom Frieden: Number of intensive care beds needed for COVID-19 in the United States could far exceed the number available

March 19, 2020

Initially, we estimated that the surge of critically ill COVID-19 patients would require an increase of up to three times the supply of intensive-care unit (ICU) beds in the United States. Now, we believe there could be a need for ten times more intensive care beds and ventilators in some areas. This revision is based on new information from infectious disease modeling, evolving trends in Italy, and other location-specific analyses which account for local and regional critical care capacity.  We must continue to try to flatten the curve and reduce the demands on the health system. At the same time, we need to increase the number of available ICU beds, including the equipment and staff needed to expertly manage patients.

Source: Vox

The Imperial College modeling study projects that without any intervention, there will be a need for more than 250 critical care beds per 100,000 people. With maximum suppression strategies we can reduce this to less than 100 beds per 100,000 people.

Source: Imperial College

This article from the heavily-affected area of Lombardy, Italy, shows that ICU demand far outstrips supply. There were 482 ICU beds available, but projected needs ranged from 869 (1.8x) to 14,542 (30x) ICU admissions by March 20.

This recent analysis of hospital capacity in the United States showed that across the country, peak demand for hospital beds could far outstrip supply.  Overall, the author estimated that there could be six severely ill patients for every hospital bed.

Source: USA Today

COVID-19 Pandemic Severity Assessment Framework by age

March 10, 2020

 

*Adapted from Reed, et al. Emerg Infect Dis. 2013;19:85-91. Data as of March 9, 2020

The figure above shows that both COVID-19 spread and severity appear to increase with age, with the most severe cases in people 60 or older and those with underlying health conditions. Children appear much less likely to become severely ill, and for them this pandemic may be mild. For healthy adults between ages 20 and 60, it cannot yet be predicted whether this will be a moderate or more severe pandemic. For the vulnerable group of people who are over 60, particularly those with chronic health conditions, COVID-19 is currently projected to be a severe pandemic.

A pandemic framework allows for initial and ongoing assessment of how infectious and severe a pandemic is, and can help identify appropriate response strategies, including whether communities should cancel large events. To estimate the overall severity of a pandemic, the framework considers how easily the virus spreads and how severe the symptoms are that patients experience. The figure above shows past pandemics and seasonal influenza, including:

  • The 1918 Spanish flu pandemic (up to 675,000 deaths in the U.S. and up to 50 million deaths globally)
  • 1957 H2N2 pandemic (116,000 deaths in the U.S. and 1.1 million deaths globally)
  • 1968 H3N2 pandemic (100,000 deaths in the U.S. and 1 million deaths globally)
  • 2009 H1N1 pandemic (12,500 deaths in the U.S. and up to 575,000 deaths globally).
  • 2011-2012 seasonal influenza (12,000 deaths in the U.S.)
  • 2014-2015 seasonal influenza (51,000 deaths in the U.S.)

Many of these pandemics occurred in a much different global context than today. The US population in 1918 was less than one third of the current population. Vaccines and medications can be developed more rapidly than half a century ago. Intensive care is more effective now. But, today diseases can have greater impact due to increased travel and urbanization, we have a larger older population and more people with chronic health conditions, and wide disparities between the most and least prepared countries in the world. Although there is now more timely access to information, there is also faster spread of misinformation.

Global Health Minute: COVID-19

March 6, 2020

We’re excited to share our new video series, Global Health Minute.

This series focuses on public health practices that maximize impact and save lives, all in sixty seconds or less. Our inaugural video is about COVID-19: what we know, what we need to learn, and how to prevent future epidemics. Future videos will focus on diverse health topics from prototyping to field supervision.

Insights from the WHO-China Joint Mission on Coronavirus

March 5, 2020

A joint mission of national and international experts was recently conducted in China from February 16-24, to better understand the COVID-19 outbreak and what works to control it. A detailed mission report was released on February 28, and experts from Resolve to Save Lives identified some key insights from it.

China has taken historic measures to aggressively control the spread of COVID-19, including coordination at the highest level of government, closing wet markets, control of transportation, cancellation of mass gatherings, and full engagement of society to adhere to containment measures.

Although the overall case fatality ratio in China is high (3.8%), provinces outside of the epicenter in Wuhan had a much lower case-fatality ratio (0.7%) as seen in the figure below. Nationwide, the case fatality ratio was 0.7% for patients with symptom onset after Feb 1. Provinces outside of Hubei had more time to prepare for containment and a lower burden of cases to manage. They also had sufficient capacity (intensive care beds, trained staff, supplies and equipment) to treat the most severe cases.

The massive cordon sanitaire (restricting the movement of people) in Wuhan and neighboring areas effectively prevented ongoing spread of disease to the rest of the country.

The scale and speed of the Chinese response will be difficult to match in other large countries or those without manufacturing capacity. In China local producers of test kits were able to produce and distribute as many as 1.6 million test kits a week. China was also able to urgently escalate the number of acute care beds to treat patients, including increasing bed capacity by more than 50,000 in Wuhan alone.

Detecting COVID-19 deaths soon after realizing coronavirus is spreading in a country is a serious concern

March 3, 2020

The time between first recognized case and first recognized death may be an indicator of how capable a country is at finding and responding to diseases. A new analysis from Resolve to Save Lives suggests that if deaths are identified soon after cases, it could mean that there is unrecognized spread in the community before the first diagnosed case. Therefore, more people may be at risk of severe illness and may be recognized at a more advanced stage of their illness, increasing their risk of both transmitting infection and of death. Resolve to Save Lives looked at ten countries with 50 or more coronavirus cases as of March 2, 2020. Countries were divided into two categories based on when they identified their first death in relation to when they identified their first case. The five countries (France, Iran, Italy, Japan and South Korea) that had their first death within 30 days had a much higher total case and death count, higher case-fatality rate, and more average cases per day overall. The other five countries (Germany, Kuwait, Singapore, Spain and the US) that had no death within the first 30 days had a much lower total case and death count, lower case-fatality rate, and fewer average cases per day. In conclusion, if a country identifies its first coronavirus death soon after initial cases are recognized, this may reflect wider-than-recognized spread in the country and predict a larger, more deadly outbreak.

 

Case information
Country category Total cases Average cases per day since first case
First death within 30 days or less of first case 8,337 50
No death within 30 days of first case 544 4

 

Death information
Country category Total deaths Case-Fatality Rate
First death within 30 days or less of first case 155 2%
No death within 30 days of first case 6 1%

 

 

Adaptive Response to COVID-19

February 20, 2020

This image outlines response measures in COVID-19 containment and mitigation. Activities that help reduce spread of the disease and effectively treat those infected should be in place from the beginning of an outbreak. During the containment phase tracking down contacts of infected individuals is important, but wouldn’t be helpful when there is already extensive spread of the disease in a community. Routine strategies you might use during a typical flu season are also used, and include washing hands, covering coughs, staying home when ill, and making sure surfaces are cleaned. As COVID-19 becomes a pandemic, additional strategies may be implemented, including staying home if a family member is sick, and community measures such as closing schools, mandatory telework and cancelling mass gatherings. These measures will dampen the impact of the pandemic, and improve survival, and delay cases in the hope that pharmaceutical interventions such as antiviral treatments and vaccines will become available.

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