Projections of the number of deaths, hospitalizations, and ICU admissions based on the characteristics of COVID-19 cases observed in Hubei Province, China. Comparison with the characteristics of patients hospitalized in France with a diagnosis of influenza from 2012 to 2017

Projection scenarios for the number of COVID-19 deaths in France were developed based on the number of deaths and cases reported in China’s Hubei province as of March 8, 2020. Three impact levels were proposed, depending on whether or not they included the city of Wuhan, the epicenter of the outbreak. These are broken down into three scenarios: Scenario 1 (the most favorable), corresponding to Hubei Province excluding the city of Wuhan; Scenario 2 (intermediate), corresponding to the entire province of Hubei; and Scenario 3 (the most unfavorable), corresponding to the city of Wuhan alone. In addition, projections of the number of ICU admissions and hospitalizations were developed by analogy with the ratio of ICU admissions to deaths observed among hospitalized flu cases in France. The advantage of this approach is that it avoids relying on Covid-19 case counts and their associated uncertainties. The projections will need to be refined, particularly with Italian data. Projections of the number of deaths from COVID-19 in France: Scenario 1: 1,290 deaths; Scenario 2: 5,082 deaths; Scenario 3: 21,456 deaths. Projections of the number of ICU cases (estimated based on an "ICU admission to death" ratio by age group): Scenario 1: 2,786 cases; Scenario 2: 10,974 cases; Scenario 3: 46,328 cases. Projections of the number of hospitalizations estimated based on projections of the number of cases in intensive care, to which the proportions of intensive care admissions among hospitalized cases by age (influenza data) were applied: Scenario 1: 19,391 cases, rate of 30 per 100,000 inhabitants; Scenario 2: 76,374 cases, rate of 119 per 100,000 inhabitants; Scenario 3: 322,437 cases, rate of 504 per 100,000 inhabitants. The average length of stay for hospitalized cases in China is high (12 days) and similar to that observed among the elderly during influenza epidemics in France. The results of these scenarios were compared with the characteristics of hospitalized influenza cases between 2012 and 2017 [1], both based on the average of the 5 seasons and on the 2016–17 epidemic—the largest one—linked to the A(H3N2) subtype. Scenario 1 produces an impact slightly higher than the average of influenza epidemics between 2012 and 2017 and close to an epidemic involving the A(H3N2) subtype, which is the most severe form of influenza. Scenario 2 leads to projections four times higher, and Scenario 3, 16 times higher than Scenario 1, respectively. These different scenarios correspond to mortality observations in three different contexts in China. These three scenarios correspond to contexts that differ due to the level of preparedness/response time, the extent to which the healthcare system’s capacity is overwhelmed, and likely also the baseline health status of the affected population. The scenario corresponding to the city of Wuhan most likely combines these three aspects in an unfavorable way. In contrast, Scenario 1 (Hubei excluding Wuhan) demonstrates that a less severe outcome is possible in terms of mortality when drastic measures can be implemented and adhered to; however, this scenario is not the most likely one for France at this time. These scenarios do not preclude the possibility of a second wave in this province following the easing of these measures. Regardless of the estimated figures for the various scenarios, this work of projecting available Chinese data onto France and comparing them to seasonal influenza indicates that the impact will be greater, or even much greater, than that of seasonal influenza, particularly given France’s capacity for intensive care beds, at least in the case of Scenarios 2 and 3. These projections justify, on the one hand, strong mitigation measures to limit the strain on the healthcare system and, on the other hand, operational preparedness and organizational measures within the healthcare system.

Author(s): Hubert Bruno, Gagnière Bertrand, Pivette Mathilde, Desenclos Jean-Claude

Publishing year: 2020

Pages: 21 p.

Collection: Current State of Knowledge

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