The estimated disease burden of acute COVID-19 in the Netherlands in 2020, in disability-adjusted life-years
Authors: McDonald Scott A. , Lagerweij Giske R. , de Boer Pieter , de Melker Hester E. , Pijnacker Roan , Mughini Gras Lapo , Kretzschmar Mirjam E. , den Hartog Gerco , van Gageldonk-Lafeber Arianne B. ,   RIVM COVID-19 surveillance, epidemiology team, Hofhuis Agnetha , Teirlinck Anne , van Lier Alies , Boudewijns Bronke , de Dreu Miek , Valk Anne-Wil , Jongenotter Femke , Verstraten Carolien , Broekhaar Gert , Willekens Guido , Veldhuijzen Irene , Polman Jan , van de Kassteele Jan , Alblas Jeroen , van Heereveld Janneke , Heijne Janneke , Bulsink Kirsten , Wielders Lieke , van Asten Liselotte , Jenniskens Liz , Soetens Loes , Mulder Maarten , Schipper Maarten , de Lange Marit , Smorenburg Naomi , Neppelenbroek Nienke , van den Berg Patrick , de Oliveira Bressane Lima Priscila , van Gaalen Rolina , Wijburg Sara , de Bruijn Shahabeh Abbas Zadeh Siméon , van Iersel Senna , Andeweg Stijn , Wierenga Sjoerd , Lanooij Susan , Keijser Sylvia , Smit Tara , Klinkenberg Don , Backer Jantien , de Boer Pieter , McDonald Scott , Maxwell Amber , Niessen Annabel , de Gier Brechje , Berry Danytza , van Wees Daphne , van Meijeren Dimphey , Vos Eric R. A. , Dijkstra Frederika , Kemmeren Jeanet , Ainslie Kylie , Middeldorp Marit , Kooijman Marjolein , Knol Mirjam , Faber Timor , Hoek Albert , Geubbels Eveline , van Benthem Birgit , de Melker Hester , Wallinga Jacco , van Gageldonk-Lafeber Arianne B. , Hahné Susan , van den Hof Susan , van den f Susan , Wallinga Jacco 
Published: August 2022

The impact of COVID-19 on population health is recognised as being substantial, yet few studies have attempted to quantify to what extent infection causes mild or moderate symptoms only, requires hospital and/or ICU admission, results in prolonged and chronic illness, or leads to premature death. We aimed to quantify the total disease burden of acute COVID-19 in the Netherlands in 2020 using the disability-adjusted life-years (DALY) measure, and to investigate how burden varies between age-groups and occupations. Using standard methods and diverse data sources (mandatory notifications, population-level seroprevalence, hospital and ICU admissions, registered COVID-19 deaths, and the literature), we estimated years of life lost (YLL), years lived with disability, DALY and DALY per 100,000 population due to COVID-19, excluding post-acute sequelae, stratified by 5-year age-group and occupation category. The total disease burden due to acute COVID-19 was 286,100 (95% CI: 281,700–290,500) DALY, and the per-capita burden was 1640 (95% CI: 1620–1670) DALY/100,000, of which 99.4% consisted of YLL. The per-capita burden increased steeply with age, starting from 60 to 64 years, with relatively little burden estimated for persons under 50 years old. SARS-CoV-2 infection and associated premature mortality was responsible for a considerable direct health burden in the Netherlands, despite extensive public health measures. DALY were much higher than for other high-burden infectious diseases, but lower than estimated for coronary heart disease. These findings are valuable for informing public health decision-makers regarding the expected COVID-19 health burden among population subgroups, and the possible gains from targeted preventative interventions.