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Competing Interests: Intérêts concurrents: Joanne Langley est titulaire de la chaire en vaccinologie pédiatrique des Instituts de recherche en santé du Canada et de GlaxoSmithKline, à l’Université Dalhousie. L’Université Dalhousie a reçu du financement de recherche de Sanofi Pasteur, Merck, Janssen, VBI et Pfizer. Aucun autre intérêt concurrent n’a été déclaré.

Competing Interests: Intérêts concurrents: Joanne Langley signale que l’Université Dalhousie a reçu des fonds de Sanofi, de GlaxoSmithKline, de Merck, de Janssen, de VBI et de Pfizer pour la tenue d’études sur des vaccins. La Dre Langley est titulaire de la chaire en vaccinologie pédiatrique des Instituts de recherche en santé du Canada et de GlaxoSmithKline. Aucun autre intérêt concurrent déclaré.

Background: Estimates of the case-fatality rate (CFR) associated with coronavirus disease 2019 (COVID-19) vary widely in different population settings. We sought to estimate and compare the COVID-19 CFR in Canada and the United States while adjusting for 2 potential biases in crude CFR., Methods: We used the daily incidence of confirmed COVID-19 cases and deaths in Canada and the US from Jan. 31 to Apr. 22, 2020. We applied a statistical method to minimize bias in the crude CFR by accounting for the survival interval as the lag time between disease onset and death, while considering reporting rates of COVID-19 cases less than 50% (95% confidence interval 10%-50%)., Results: Using data for confirmed cases in Canada, we estimated the crude CFR to be 4.9% on Apr. 22, 2020, and the adjusted CFR to be 5.5% (credible interval [CrI] 4.9%-6.4%). After we accounted for various reporting rates less than 50%, the adjusted CFR was estimated at 1.6% (CrI 0.7%-3.1%). The US crude CFR was estimated to be 5.4% on Apr. 20, 2020, with an adjusted CFR of 6.1% (CrI 5.4%-6.9%). With reporting rates of less than 50%, the adjusted CFR for the US was 1.78 (CrI 0.8%-3.6%)., Interpretation: Our estimates suggest that, if the reporting rate is less than 50%, the adjusted CFR of COVID-19 in Canada is likely to be less than 2%. The CFR estimates for the US were higher than those for Canada, but the adjusted CFR still remained below 2%. Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2., Competing Interests: Competing interests: Joanne Langley holds the Canadian Institutes of Health Research- GlaxoSmithKline Chair in Pediatric Vaccinology at Dalhousie University. Dalhousie University has received funding for research studies from Sanofi Pasteur, Merck, Janssen, VBI and Pfizer. No other competing interests were declared., (© 2020 Joule Inc. or its licensors.)

Background: Increasing 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., Methods: We 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., Results: Without 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., Interpretation: At 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., Competing Interests: Competing interests: Joanne Langley reports that Dalhousie University has received payment for conduct of vaccine studies from Sanofi, Glaxo-SmithKline, Merck, Janssen, VBI and Pfizer. Dr. Langley holds the Canadian Institutes of Health Research-GlaxoSmithKline Chair in Pediatric Vaccinology. No other competing interests were declared., (© 2020 Joule Inc. or its licensors.)