Testing and isolation to prevent overloaded health care facilities and to reduce death rates in the SARS-CoV-2 pandemic in Italy
Abstract
Background
During the first wave of COVID-19, hospital and intensive care unit beds got overwhelmed in Italy leading to an increased death burden. Based on data from Italian regions, we disentangled the impact of various factors contributing to the bottleneck situation of health care facilities, not well addressed in classical SEIR-like models. A particular emphasis was set on the dark figure, on the dynamically changing hospital capacity, and on different testing, contact tracing, quarantine strategies.
Methods
We first estimated the dark figure for different Italian regions. Using parameter estimates from literature and, alternatively, with parameters derived from a fit to the initial phase of COVID-19 spread, the model was optimized to fit data (infected, hospitalized, ICU, dead) published by the Italian Civil Protection.
Results
We showed that testing influenced the infection dynamics by isolation of newly detected cases and subsequent interruption of infection chains. The time-varying reproduction number ( R t ) in high testing regions decreased to < 1 earlier compared to the low testing regions. While an early test and isolate (TI) scenario resulted in up to ∼ 32% peak reduction of hospital occupancy, the late TI scenario resulted in an overwhelmed health care system.
Conclusions
An early TI strategy would have decreased the overall hospital accessibility drastically and, hence, death toll (∼ 45% reduction in Lombardia) and could have mitigated the lack of health care facilities in the course of the pandemic, but it would not have kept the hospitalization amount within the pre-pandemic hospital limit. We showed that contact tracing and quarantine without testing would have a similar effect and might be an efficient strategy when sufficient test capacities are not available.
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