Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

Abstract

Purpose: The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods: We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The crosssectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results: We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = − 0.57; p < 0.001). Conclusion: Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.

COVID-19 in critical care: epidemiology of the first epidemic wave across England, Wales and Northern Ireland

“…system-level differences, beds per capita, staff to patient ratios, etc.) [23][24][25], there remains a need for greater standardisation in reporting of patient characteristics, acute illness severity, organ support and outcomes for critical care cohorts, particularly in the context of a global pandemic.…”

How the COVID-19 pandemic will change the future of critical care

“…Early simulations projected that the peak of the outbreak would require a multi-fold increase in ICU bed capacity [ 2 ]; projections that were soon realized in many countries [ 3 – 8 ]. Pre-pandemic ICU bed capacity varied considerably, from < 1 ICU bed per 100,000 population in Bangladesh to 24.6 in Germany [ 7 , 9 – 14 ]. Similarly, the proportion of hospitalized patients with COVID-19 admitted to the ICU also varied, from 3 to 81% [ 15 ].…”

“…While ICU bed capacity and occupancy have been used as an indicator of healthcare systems strain, whether this indicator allows comparison across settings is unclear. Nevertheless, ICU strain has been linked to a higher proportion of COVID-19 deaths [ 7 ].…”

The impact of COVID-19 on the epidemiology, outcome and management of cardiac arrest

“…A similar scenario has been described in the report of the first wave of the pandemic in Wuhan, China [ 7 ]. Lack of ICU beds may influence the outcome from severe COVID-19 as evidenced by a report from 14 European countries showing an inverse relationship between accessibility to ICU and case fatality from COVID-19 [ 8 ].…”