Preventing disproportionate mortality in ICU overload situations: Empirical evidence from the first COVID-19 wave in Europe

Abstract

Avoiding overloading the healthcare system remains a central issue during the COVID-19 pandemic. The logic of preventing such overload situations is intuitive since the level and quality of critical care is a function of the available capacity to provide it. Where this capacity is no longer available due to a surge in admissions, patient outcomes will invariably deteriorate in the long run, which ultimately leads to disproportionate mortality. In this paper, we study the three worst affected regions in Italy, the Netherlands, and Germany during the first COVID-19 wave in the spring of 2020. We report on quantitative analyses that show how mortality rises non-linearly as the proportion of COVID-19 patients in the ICU increases. We identify changes to the patient-staff ratio, increasing exhaustion and infection levels amongst staff, as well as equipment shortages as likely causes driving this rise in mortality. We explore these findings further with interviews of key stakeholders in the respective healthcare systems. Our results demonstrate that the common approach of managing COVID-19 surges by stretching ICU capacity in hotspot regions may be detrimental to patient outcomes. Instead, we posit that transferring patients proactively out of developing hotspots to less affected regions, well before high ICU workload situations emerge, will improve patient outcomes.

Complexity measure based on sensitivity analysis applied to an intensive care unit system

“…ICU occupation rates above 85% -reaching 100% in numerous cases -have been observed since the pandemic www.nature.com/scientificreports/ beginning 64 . The ICU systems overload is addressed in studies performed in hospitals in China 65 and the United States, the main pandemic epicenters 66,67 , in Italy, one of the most affected countries by the pandemic in contaminated percentage 68,69 , in the Netherlands, Germany 69 and around 216 countries analyzed by Rocks and Idriss 70 and Sen-Crowe et al 63 . From the hierarchical organization of complex systems point of view, the ICU system has subsystems meanwhile is part of a larger system: the hospital system.…”

Complexity Measure based on Sensitivity Analysis Applied to an Intensive Care Unit system

“…ICU occupation rates above 85% -reaching 100% in numerous cases -have been observed since the pandemic beginning 65 . The ICU systems overload is addressed in studies performed in hospitals in China 66 and the United States, the main pandemic epicenters 67,68 , in Italy, one most affected countries by the pandemic in contaminated percentage 69,70 , in the Netherlands, Germany 70 and around 216 countries analyzed by Rocks and Idriss (2020) 71 and Sen-Crowe et al (2021) 64 .…”