• Affan Shoukat, Chad R Wells, Joanne M Langley, Burton H Singer, Alison P Galvani, and Seyed M Moghadas.
• Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont.
• CMAJ. 2020 May 11; 192 (19): E489-E496.

BackgroundIncreasing numbers of coronavirus disease 2019 (COVID-19) cases in Canada may create substantial demand for hospital admission and critical care. We evaluated the extent to which self-isolation of mildly ill people delays the peak of outbreaks and reduces the need for this care in each Canadian province.MethodsWe developed a computational model and simulated scenarios for COVID-19 outbreaks within each province. Using estimates of COVID-19 characteristics, we projected the hospital and intensive care unit (ICU) bed requirements without self-isolation, assuming an average number of 2.5 secondary cases, and compared scenarios in which different proportions of mildly ill people practised self-isolation 24 hours after symptom onset.ResultsWithout self-isolation, the peak of outbreaks would occur in the first half of June, and an average of 569 ICU bed days per 10 000 population would be needed. When 20% of cases practised self-isolation, the peak was delayed by 2-4 weeks, and ICU bed requirement was reduced by 23.5% compared with no self-isolation. Increasing self-isolation to 40% reduced ICU use by 53.6% and delayed the peak of infection by an additional 2-4 weeks. Assuming current ICU bed occupancy rates above 80% and self-isolation of 40%, demand would still exceed available (unoccupied) ICU bed capacity.InterpretationAt the peak of COVID-19 outbreaks, the need for ICU beds will exceed the total number of ICU beds even with self-isolation at 40%. Our results show the coming challenge for the health care system in Canada and the potential role of self-isolation in reducing demand for hospital-based and ICU care.© 2020 Joule Inc. or its licensors.

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