Estimating number of cases and spread of coronavirus disease (COVID-19) using critical care admissions, United Kingdom, February to March 2020

  1. Mark Jit
  2. Thibaut Jombart
  3. Emily S Nightingale
  4. Akira Endo
  5. Sam Abbott
  6. LSHTM Centre for Mathematical Modelling of Infectious Diseases COVID-19 Working Group
  7. W John Edmunds

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Abstract

An exponential growth model was fitted to critical care admissions from two surveillance databases to determine likely coronavirus disease (COVID-19) case numbers, critical care admissions and epidemic growth in the United Kingdom before the national lockdown. We estimate, on 23 March, a median of 114,000 (95% credible interval (CrI): 78,000–173,000) new cases and 258 (95% CrI: 220–319) new critical care reports, with 527,000 (95% CrI: 362,000–797,000) cumulative cases since 16 February.

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    SciScore for 10.1101/2020.04.05.20054528: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our investigations revealed weaknesses in two early sources of CC surveillance (FF100 and CHESS). In particular, the number of cases reported in the two databases markedly differ, with the FF100 reporting far fewer CC cases (e.g. 6 cases on 6 March from FF100 compared to 100 on 18 March from CHESS) even after accounting for different periods of coverage and delays to reporting. Further analysis also suggested delays between the date of being reported as a case and the date on which a case actually appears in the FF100 database which made correcting for right-truncation of cases difficult (see Supplement S2). Also, the proportion of cases estimated to require CC treatment is substantially lower than observed elsewhere (and hence the multipliers are higher) because of the young profile of CC cases in both FF100 and CHESS. For example, 34%of CC patients were below 45 years old in CHESS compared to only 12%in published US data up to March 16 [4]. This may reflect biases in CHESS reporting, differential propensity to test by age, a higher triage threshold for CC admission of older patients than in the USA, or be an indication of hospital-based COVID-19 transmission affecting mainly younger children. However, the overall conclusion that COVID-19 daily incidence in the UK on 23 March was in the hundreds of thousands of infections and cumulative incidence approaching a million appears to be robust even when challenged by a range of sensitivity analyses to account for different assump...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.2807/1560-7917.es.2020.25.18.2000632
  3. Version published to 10.1101/2020.04.05.20054528v1 on medRxiv