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FluSurge Modeling of the COVID-19 Pandemic for the Iloilo Province

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By using FluSurge with the analysis of COVID-19 case data in Iloilo, we have built projections to estimating the sufficiency of the hospital resources in the province during the pandemic.

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FluSurge Modeling of the COVID-19 Pandemic for the Iloilo Province

  1. 1. FluSurge Modeling of the COVID-19 Pandemic Contributors: Jonathan Adam A. Rico, MSc. Pia Regina Fatima C. Zamora, M.D., Ph.D. Jiye Kwon Raphael Nelo S. Aguila Jesus Emmanuel A. Sevilleja, M.D., MPhil Romulo de Castro, Ph.D. University of San Agustin Center for Informatics Iloilo City, 5000 April 10, 2020 Estimating the Sufficiency of Iloilo Province’s Hospital Resources during the COVID-19 Pandemic
  2. 2. March 20 Iloilo City ECQ April 1 Panay-wide Quarantine March 15 Iloilo CQ March 21 Iloilo # of cases: 1 CoViD-19 Timeline: Province of Iloilo April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph ILOILO March 27 Iloilo # of cases: 3 March 28 Iloilo # of cases: 6 March 29 Iloilo # of cases: 8 March 31 Iloilo # of cases: 9 April 1 Iloilo # of cases: 10
  3. 3. Input Variable COVID-19 (Iloilo Province) Population 2,524,213 0-19 years old 939,743 20-64 years old 1,395,011 65 years old and above 189,459 Basic Hospital Resources Total licensed non-ICU beds 1832 Licensed non-ICU beds staffed (%) 100% Total licensed ICU beds 115 Licensed ICU beds staffed (%) 100% Total number of ventilators 125 Ventilators available (%) 100% Assumptions Pandemic duration (6, 8, 12) 12 weeks Gross clinical attack rate (15%, 25%, 35%) 25% Average length of non-ICU hospital stay (1-14 days) 14 days Average length of ICU stay (1-20 days) 8 days Average length of ventilator usage (1-20 days) 7 days Average proportion of admitted patients will need ICU care (%) 20% Average proportion of admitted patients will need ventilators (%) 5% Average proportion of deaths assumed to be hospitalized (%) 90% Daily percentage increase in cases arriving compared to preceding day (0.1% - 20%) 17% SUMMARY OF INPUTS TO THE FLUSURGE TOOL Based on Wuhan, Hubei Experience Data from DOH, WVMC, TMCI Projected Data from PSA April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph ASSUMPTIONS FluSurge 2.0 operates under non-quarantine conditions FULL CAPACITY of DOH-retained hospitals Utilize 50% of the capacity of other Level II and Level III hospitals Pandemic duration of at least 12 weeks (March 20 – June 5) Gross clinical attack rate (AR) = 25%
  4. 4. Pandemic Impact/ Attack Rate 25% Total Hospital Admissions Most Likely Scenario 7,259 Minimum Scenario 2,556 Maximum Scenario 10,390 Total Deaths Most Likely Scenario 1270 Minimum Scenario 620 Maximum Scenario 2,347 April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph At the end of 12 weeks, Peak of hospital admissions: Weeks 6 and 7 Accumulated hospital admissions: 7,259 Accumulated deaths: 1,270
  5. 5. CoViD-19 Impact Weeks 1 2 3 4 5 6 7 8 9 10 11 12 Hospital Admission Weekly admissions 73 290 508 726 944 1089 1089 944 726 508 290 73 Peak admissions / day 237 237 Non-ICU Bed Capacity Total = 1832 CoViD-19 PUIs/cases in non-ICU facilities 73 363 799 1234 1670 2033 2382 2382 1954 1575 1139 704 % non-ICU capacity needed 4% 20% 44% 67% 91% 111% 130% 130% 107% 86% 62% 38% ICU Bed Capacity Total = 115 CoViD-19 PUIs/cases in the ICU 15 61 114 167 220 259 305 259 220 167 114 61 % ICU capacity needed 13% 53% 99% 146% 192% 225% 265% 225% 192% 146% 99% 53% Ventilator Capacity Total = 125 CoViD-19 PUIs/cases on ventilators 4 15 25 36 47 54 69 53 45 34 23 12 % ventilator usage 3% 12% 20% 29% 38% 44% 55% 42% 36% 27% 18% 10% peak Admissions vs Capacity Weeks 6 - 9 Non-ICU admissions > hospital capacity Weeks 4 - 10 ICU admissions > hospital capacity April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph
  6. 6. April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph PEAK of CoViD-19 outbreak vs Hospital capacity: Other simulations (pandemic duration = 6, 8, 12, weeks; AR = 15%, 25%,35%) Impact on Hospital Resources/ Duration, Attack Rate 6 Weeks 8 Weeks 12 Weeks 15% 25% 35% 15% 25% 35% 15% 25% 35% Non-ICU capacity needed (%) 108% 179% 251% 97% 161% 226% 78% 130% 182% ICU capacity needed (%) 223% 371% 519% 201% 336% 470% 159% 265% 371% Ventilator capacity needed (%) 46% 77% 108% 42% 70% 98% 33% 55% 77% Admissions will exceed ICU and Non-ICU capacity (except Non-ICU capacity at 8,12 wks duration; AR = 15%) Ventilator use will exceed ventilator capacity at 6 weeks pandemic duration, AR = 35%
  7. 7. RECOMMENDATIONS April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph Extension of the ECQ in Iloilo Province beyond April 14, 2020 to prevent a surge of cases and deaths, and/or set up other mitigating measures to keep the number of cases below hospital capacity. Augment hospital capacity quickly - add non-ICU beds - add ICU beds - add ventilators - add personnel Enhance CoViD-19 testing and contact tracing Protect the frontliners - provision of adequate PPEs - routine testing of hospital personnel, even when they do not show symptoms This model simulates the impact of the CoViD-19 outbreak in the Iloilo Province, if no preventive measures are in place. If the ECQ were to be lifted without any mitigating measures, it is possible to experience the disease trajectory projected here. SUMMARY
  8. 8. April 04, 2020 Center for Informatics, University of San Agustin, Iloilo City/ informatics@usa.edu.ph ACKNOWLEDGEMENTS REFERENCES [1] Baker, et. al. (September 9, 2011). Epidemiologic Modeling with FluSurge for Pandemic (H1N1) 2009, Outbreak, Queensland, Australia. [2] Feng Z, et. al. (February 17, 2020). Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. China CDC Weekly, 2020, 2(8): 113-122. Accessed from http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51. [3] Grasseli, et. al. (March 13, 2020). Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. Journal of the American Medical Association (JAMA) Network. doi:10.1001/jama.2020.4031. Accessed from https://jamanetwork.com/journals/jama/fullarticle/2763188. [4] Guan, et. al. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. DOI: 10.1056/NEJMoa2002032 [5] Momblan, Gail. (March 21, 2020). Iloilo province confirms 1st Covid-19-positive patient. Retrieved from https://www.pna.gov.ph/articles/1097383 [6] Qun Li, et. al. (January 29, 2020). Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. New England Journal of Medicine. doi Baker, et. al. (September 9, 2011). Epidemiologic Modeling with FluSurge for Pandemic (H1N1) 2009 a2001316. [7] Tang B, Xia F, Tang S, Bragazzi NL, Li Q, Sun X, Liang J, Xiao Y, Wu J, The effectiveness of quarantine and isolation determine the trend of the COVID-19 epidemics in the final phase of the current outbreak in China, International Journal of Infectious Diseases (2020), doi: https://doi.org/10.1016/j.ijid.2020.03.018 [8] Tantuco, V. (March 28, 2020). Philippine hospital capacity data https://www.rappler.com/newsbreak/in-depth/256133-numbers-what-hospitals-need-treat-coronavirus. [9] Wu Z and McGoogan J. (February 24, 2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. Journal of the American Medical Association (JAMA) Network. doi:10.1001/jama.2020.2648. Accessed from Baker, et. al. (September 9, 2011). Epidemiologic Modeling with FluSurge for Pandemic (H1N1) 2009 https://jamanetwork.com/journals/jama/article-abstract/2762130. [10] Zhang, et. al. (2006). FluSurge—A Tool to Estimate Demand for Hospital Services during the Next Pandemic Influenza. DOI: 10.1177/0272989X06295359. [11] Zhou, et. al. (March 11, 2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. doi: 10.1016/S0140-3. Accessed from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext [12]https://www.rappler.com/nation/254904-list-areas-visayas-under-community-quarantine- curfews-state-calamity-coronavirus [13] Iloilo City Mar 20: https://www.rappler.com/nation/255350-iloilo-city-under-community- quarantine [14] Antique Mar 22: https://www.pna.gov.ph/articles/1097530 [15] Capiz Mar 25: https://pia.gov.ph/news/articles/1037135 [16] Capiz, ECQ: https://dailyguardian.com.ph/capiz-under-enhanced-community-quarantine/ [17] Panay-wide ECQ Apr 1: https://www.pna.gov.ph/articles/1096857 [18] China reports zero new cases in coronavirus epicenter Hubei. Retrieved from: https://www.latimes.com/world-nation/story/2020-03-19/coronavirus-china-cases-hubei. [19] Philippine Health Atlas. Accessed from http://healthatlas.doh.gov.ph/. March 29, 2020. [20] Population Projection Statistics. Accessed from https://psa.gov.ph/statistics/census/projected- population. March 27, 2020 Dr. Sarah De Leon (IMH) Dr. Al Jeson Chin (WVMC) Mr. Patrick B. Jalandoni (TMCI)

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