Impact of Nonpharmaceutical Interventions on ICU Admissions During Lockdown for Coronavirus Disease 2019 in New Zealand—A Retrospective Cohort Study

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Abstract

OBJECTIVES:

Nonpharmaceutical interventions are implemented internationally to mitigate the spread of severe acute respiratory syndrome coronavirus 2 with the aim to reduce coronavirus disease 2019–related deaths and to protect the health system, particularly intensive care facilities from being overwhelmed. The aim of this study is to describe the impact of nonpharmaceutical interventions on ICU admissions of non–coronavirus disease 2019–related patients.

DESIGN:

Retrospective cohort study.

SETTING:

Analysis of all reported adult patient admissions to New Zealand ICUs during Level 3 and Level 4 lockdown restrictions from March 23, to May 13, 2020, in comparison with equivalent periods from 5 previous years (2015–2019).

SUBJECTS:

Twelve-thousand one-hundred ninety-two ICU admissions during the time periods of interest were identified.

MEASUREMENTS:

Patient data were obtained from the Australian and New Zealand Intensive Care Society Adult Patient Database, Australian and New Zealand Intensive Care Society critical care resources registry, and Statistics New Zealand. Study variables included patient baseline characteristics and ICU resource use.

MAIN RESULTS:

Nonpharmaceutical interventions in New Zealand were associated with a 39.1% decrease in ICU admission rates ( p < 0.0001). Both elective (–44.2%) and acute (–36.5%) ICU admissions were significantly reduced when compared with the average of the previous 5 years (both p < 0.0001). ICU occupancy decreased from a mean of 64.3% (2015–2019) to 39.8% in 2020. Case mix, ICU resource use per patient, and ICU and hospital mortality remained unchanged.

CONCLUSIONS:

The institution of nonpharmaceutical interventions was associated with a significant decrease in elective and acute ICU admissions and ICU resource use. These findings may help hospitals and health authorities planning for surge capacities and elective surgery management in future pandemics.

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Most cited references 36

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Ranking the effectiveness of worldwide COVID-19 government interventions

Nils Haug, Lukas Geyrhofer, Alessandro Londei … (2021)

Assessing the effectiveness of non-pharmaceutical interventions (NPIs) to mitigate the spread of SARS-CoV-2 is critical to inform future preparedness response plans. Here we quantify the impact of 6,068 hierarchically coded NPIs implemented in 79 territories on the effective reproduction number, Rt, of COVID-19. We propose a modelling approach that combines four computational techniques merging statistical, inference and artificial intelligence tools. We validate our findings with two external datasets recording 42,151 additional NPIs from 226 countries. Our results indicate that a suitable combination of NPIs is necessary to curb the spread of the virus. Less disruptive and costly NPIs can be as effective as more intrusive, drastic, ones (for example, a national lockdown). Using country-specific 'what-if' scenarios, we assess how the effectiveness of NPIs depends on the local context such as timing of their adoption, opening the way for forecasting the effectiveness of future interventions.

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Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study

Nicholas Davies, Adam Kucharski, Rosalind M. Eggo … (2020)

Summary Background Non-pharmaceutical interventions have been implemented to reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the UK. Projecting the size of an unmitigated epidemic and the potential effect of different control measures has been crucial to support evidence-based policy making during the early stages of the epidemic. This study assesses the potential impact of different control measures for mitigating the burden of COVID-19 in the UK. Methods We used a stochastic age-structured transmission model to explore a range of intervention scenarios, tracking 66·4 million people aggregated to 186 county-level administrative units in England, Wales, Scotland, and Northern Ireland. The four base interventions modelled were school closures, physical distancing, shielding of people aged 70 years or older, and self-isolation of symptomatic cases. We also modelled the combination of these interventions, as well as a programme of intensive interventions with phased lockdown-type restrictions that substantially limited contacts outside of the home for repeated periods. We simulated different triggers for the introduction of interventions, and estimated the impact of varying adherence to interventions across counties. For each scenario, we projected estimated new cases over time, patients requiring inpatient and critical care (ie, admission to the intensive care units [ICU]) treatment, and deaths, and compared the effect of each intervention on the basic reproduction number, R 0. Findings We projected a median unmitigated burden of 23 million (95% prediction interval 13–30) clinical cases and 350 000 deaths (170 000–480 000) due to COVID-19 in the UK by December, 2021. We found that the four base interventions were each likely to decrease R 0, but not sufficiently to prevent ICU demand from exceeding health service capacity. The combined intervention was more effective at reducing R 0, but only lockdown periods were sufficient to bring R 0 near or below 1; the most stringent lockdown scenario resulted in a projected 120 000 cases (46 000–700 000) and 50 000 deaths (9300–160 000). Intensive interventions with lockdown periods would need to be in place for a large proportion of the coming year to prevent health-care demand exceeding availability. Interpretation The characteristics of SARS-CoV-2 mean that extreme measures are probably required to bring the epidemic under control and to prevent very large numbers of deaths and an excess of demand on hospital beds, especially those in ICUs. Funding Medical Research Council.

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Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries

Vasilis Kontis, James E Bennett, Theo Rashid … (2020)

The Coronavirus Disease 2019 (COVID-19) pandemic has changed many social, economic, environmental and healthcare determinants of health. We applied an ensemble of 16 Bayesian models to vital statistics data to estimate the all-cause mortality effect of the pandemic for 21 industrialized countries. From mid-February through May 2020, 206,000 (95% credible interval, 178,100-231,000) more people died in these countries than would have had the pandemic not occurred. The number of excess deaths, excess deaths per 100,000 people and relative increase in deaths were similar between men and women in most countries. England and Wales and Spain experienced the largest effect: ~100 excess deaths per 100,000 people, equivalent to a 37% (30-44%) relative increase in England and Wales and 38% (31-45%) in Spain. Bulgaria, New Zealand, Slovakia, Australia, Czechia, Hungary, Poland, Norway, Denmark and Finland experienced mortality changes that ranged from possible small declines to increases of 5% or less in either sex. The heterogeneous mortality effects of the COVID-19 pandemic reflect differences in how well countries have managed the pandemic and the resilience and preparedness of the health and social care system.

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Author and article information

Journal

Journal ID (nlm-ta): Crit Care Med

Journal ID (iso-abbrev): Crit Care Med

Journal ID (publisher-id): CCM

Title: Critical Care Medicine

Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )

ISSN (Print): 0090-3493

ISSN (Electronic): 1530-0293

Publication date (Electronic): 11 June 2021

Publication date (Print): October 2021

Volume: 49

Issue: 10

Pages: 1749-1756

Affiliations

[1 ] Cardiothoracic and Vascular ICU (CVICU), Auckland City Hospital, Auckland, New Zealand.

[2 ] Medical Research Institute of New Zealand, Wellington, New Zealand.

[3 ] ANZIC-Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

[4 ] School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Author notes

Address requests for reprints to: Tobias Gonzenbach, MD, Auckland City Hospital, CVICU, 2 Park Road, Grafton, Auckland 1023, New Zealand. E-mail: tobiasg@ 123456adhb.govt.nz

Article

Accession ID: 00014

DOI: 10.1097/CCM.0000000000005166

PMC ID: 8439630

PubMed ID: 34115636

SO-VID: 6d34a745-c2cf-46d8-9b89-82ebe9378747

License:

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

Impact of Nonpharmaceutical Interventions on ICU Admissions During Lockdown for Coronavirus Disease 2019 in New Zealand—A Retrospective Cohort Study

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Abstract

OBJECTIVES:

DESIGN:

SETTING:

SUBJECTS:

MEASUREMENTS:

MAIN RESULTS:

CONCLUSIONS:

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Novel Coronavirus Disease COVID-19

Most cited references 36

Ranking the effectiveness of worldwide COVID-19 government interventions

Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study

Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries

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