Impact of the increase in the number of coronavirus beds on infection and the economy

■Average rate of COVID-19 hospital bed utilization in Tokyo in the first half of 2021
　■Seriously ill patients (Tokyo standard): approx. 24% [Secured beds as of June 30: 373]
　■Seriously ill patients (national standard): approx. 43% [Secured beds as of June 30: 1207]
　■Total (severe, moderate, mild, asymptomatic): approx. 40% [Secured beds as of June 30: 5594]

■Average rate of COVID-19 hospital bed non-usage in Tokyo in the first half
　■Seriously ill patients (Tokyo standard): approx. 76%
　■Seriously ill patients (national standard): approx. 57%
　■Total (severe, moderate, mild, asymptomatic): approx. 60%

■Consideration was given to the following questions: “If only we had more of the unused beds for COVID in operation“, “If only we had more secured beds”, and “If only we could have made the economy run better by doing so”
　■The above questions were addressed using the Fujii-Nakata model based on the following counterfactual experiments (from January 1 to June 30, 2021)
　　→Analysis: "If I had acted at that time ・・・"
　　■If the 2nd and 3rd state of emergency declarations (January 8 and April 26, 2021) were delayed for X and Y weeks...(X, Y=[0,1,...,4])
　■Good for the economy, but leads to more deaths→Analyze this content quantitatively
■Please note that, as described later, we are analyzing the impact of the “allowable increase in the number of infected persons” due to the increase in the number of utilized beds.
　■"Reduction in average fatality rate" associated with enhanced medical systems is not the subject of this analysis

■Given the current medical system, “economic losses can be reduced in the medium to long term by the lifting of emergency declarations after infection has been controlled to some extent”
　■One of the key messages of the Fujii-Nakata analysis
　　■"Breaking up the trade-off curve"：https://covid19outputjapan.github.io/JP/tokyo_20210202.html
　■This is a message that is particularly pertinent when vaccination is not in progress
　　■Given the transmissibility of the Delta variant, this message applies until vaccination is well advanced
■Without taking the healthcare system as a given, we quantitatively analyzed: “if the number of hospitals receiving COVID patients increases” and “if the number of infected patients is allowed to increase”
■We would like this paper to be used as a reference when considering “what is the optimal COVID-19 care system for society”
　■Whether the number of secured beds should remain the same, how much should the number be increased in the case of an increase, whether the hospitalization rate should remain the same, etc.

■In this simulation, economic activities are incorporated into the SIRD model, and the risk of spread of infectious diseases and economic losses are analyzed simultaneously.
■The following parameters and predicted values were used in the simulation. Parameters are estimated before applying the model.

■Parameters
　・Relationship between people flow and GDP
　・Delta mutation rate (percentage of patients infected with delta variants among those positive)
　・Severity rate (percentage of patients with severe symptoms among those who tested positive)
　・fatality rate (percentage of deaths among those who tested positive)
　・Hospitalization rate (percentage of patients with positive results who are hospitalized)

■Predicted values
　・Changes in the number of newly infected patients per day (average number of infected patients from Monday to Sunday)
　・Number of vaccinations per day

■Model Details 　Fujii and Nakata , “Covid-19 and Output in Japan",
　https://covid19outputjapan.github.io/JP/files/FujiiNakata_Covid19.pdf

■Using the above model, analysis was performed on the basis of the assumptions (If we allow more hospitals to accept patients,) described in pp. 3 -4, and the results were compared with the actual measurements.

■Economic loss: approx. 218.9 billion yen decrease(See "GDP" on page 28 and Table on page 35)
　■by shortening the state of emergency duration by 6 weeks
■Total deaths: 2,776 increase
■Average of utilized beds: 2479 increase
　■Hospital bed utilization rate
　　■Case 1: If the current number of secured beds were secured from January 1
　　　■Severely ill (national) 94%, Severely ill (Tokyo) 41%, Total 101%
　　■Case 2: Twice the number of secured beds as Case 1
　　　■Severely ill (national) 47%, Severely ill (Tokyo) 21%, Total 51%

■Impact of increasing the number of beds used in Tokyo (severe, moderate, mild, and asymptomatic) by 100 (first half of 2021)
　■Economic Impact: approx. 9 billion yen (=100*2189/2497)
　■Direct increase in deaths: approx. 110 (=100*2776/2497)

*Calculated from the results shown on page 6

■Going forward, the increase in deaths from increasing the number of hospital beds will be very different from the first half of 2021
　■Why?
　　■The average fatality rate going forward will be significantly lower than the average fatality rate in the first half of 2021
　　　■As of August 2, 86.2% of the elderly, who have a relatively high fatality rate, have received their first dose of vaccine
　　　　■Fatality rate is reduced by about 90% from the first vaccine dose
　　　　　■SPI-M-O: Summary of further modelling of easing restrictions – Roadmap Step 4 on 19 July 2021, 7 July 2021
　　　　　■https://www.gov.uk/government/publications/spi-m-o-summary-of-further-modelling-of-easing-restrictions-roadmap-step-4-on-19-july-2021-7-july-2021
　　■On the other hand, the Delta variant will increase the number of people infected due to “shortening the state of emergency duration and moving the economy”
　　　■Even if the fatality rate decreases, the cumulative number of deaths could increase if the number of infected people increases

■Increasing the number of beds utilized has the aspect of “allowing the increase in the number of infected people”, which is analyzed in this section.
　■This analysis does not deal with the aspect that "the average fatality rate is reduced by strengthening the medical system", such as the fact that by increasing the number of beds (and enhancing the corresponding doctors and nurses), people with mild or no symptoms, or people receiving overnight or home care can respond to sudden deterioration in their condition.

■Direct COVID-19 Deaths (as of July 2021)
　■Japan: 15,000, 12.5 per 100,000 people
　■Low/very low compared to other countries
　　■USA (182), UK (190), Germany (109), France (169), India (29), Indonesia (28), Canada (70), Brazil (242), Malaysia (21.5)
　　■Exceptions: Taiwan (2.3), South Korea (3.9), Australia (3.6), Singapore (0.6)

■Economic losses (as of February 2021)
　■Japan: 5.5% of GDP
　■About the same/somewhat better/very good compared to other countries
　　■USA (6.4%), UK (12.5%), Germany (7.7%), France (10.8%), India (12.3%), Indonesia (7.0%), Canada (8.2%), Brazil (6.1%), Malaysia (8.3%), Australia (4.9%), Singapore (11.2%)
　　■Exceptions: Taiwan (1.5% growth), South Korea (3.2%)

Total deaths(Log Scale)

Economic Loss (deviation from pre-COVID-19 trend: OECD Monthly Economic Indicators)

Total deaths

Economic Loss (deviation from pre-COVID-19 trend: OECD Monthly Economic Indicators)

Fernandez-Villaverde and Chad Jones (2020), “Macroeconomic Outcomes and COVID-19: A Progress Report” Brookings Papers on Economic Activity.

■Average rate of COVID-19 hospital bed utilization in Tokyo in the first half of 2021
　■Seriously ill patients (Tokyo standard): approx. 24%
　■Seriously ill patients (national standard): approx. 43%
　■Total (severe, moderate, mild, asymptomatic): approx. 40%

■Average rate of COVID-19 hospital bed non-usage in Tokyo in the first half
　■Seriously ill patients (Tokyo standard): approx. 76%
　■Seriously ill patients (national standard): approx. 57%
　■Total (severe, moderate, mild, asymptomatic): approx. 60%

*Criterias for severely ill patient
　・metropolitan standard: Patients on mechanical ventilation or ECMO
　 ・national standard: Patients requiring intensive care unit (ICU) management, ventilator management, or extracorporeal cardiopulmonary support (ECMO) management

Note: For the number of critical care beds (national) secured from January 1 to February 16, the average of NHK's announcement and subsequent figures (750) were used because Tokyo did not report accurate figures.

■Average rate of COVID-19 hospital bed utilization Nationwide in the first half of 2021
　■Seriously ill: approx. 28%
　■Total (severe, moderate, mild, asymptomatic): approx. 36%

■Average rate of COVID-19 hospital bed non-usage Nationwide in the first half of 2021
　■Seriously ill: approx. 72%
　■Total (severe, moderate, mild, asymptomatic): approx. 64%

■Analysis updated weekly on Tuesdays
　■https://Covid19OutputJapan.github.io/JP/

■Questions, requests for analysis, etc.
　■dfujii@e.u-tokyo.ac.jp
　■taisuke.nakata@e.u-tokyo.ac.jp