Projecting hospital utilization during the COVID-19 outbreaks in the United States

Abstract

In the wake of community coronavirus disease 2019 transmission in the United States, there is a growing public health concern regarding the adequacy of resources to treat infected cases. Hospital beds, intensive care units (ICUs), and ventilators are vital for the treatment of patients with severe illness. To project the timing of the outbreak peak and the number of ICU beds required at peak, we simulated a COVID-19 outbreak parameterized with the US population demographics. In scenario analyses, we varied the delay from symptom onset to self-isolation, the proportion of symptomatic individuals practicing self-isolation, and the basic reproduction number R 0 . Without self-isolation, when R 0 = 2.5, treatment of critically ill individuals at the outbreak peak would require 3.8 times more ICU beds than exist in the United States. Self-isolation by 20% of cases 24 h after symptom onset would delay and flatten the outbreak trajectory, reducing the number of ICU beds needed at the peak by 48.4% (interquartile range 46.4-50.3%), although still exceeding existing capacity. When R 0 = 2, twice as many ICU beds would be required at the peak of outbreak in the absence of selfisolation. In this scenario, the proportional impact of self-isolation within 24 h on reducing the peak number of ICU beds is substantially higher at 73.5% (interquartile range 71.4-75.3%). Our estimates underscore the inadequacy of critical care capacity to handle the burgeoning outbreak. Policies that encourage self-isolation, such as paid sick leave, may delay the epidemic peak, giving a window of time that could facilitate emergency mobilization to expand hospital capacity. SARS-CoV-2 | hospitalization | self-isolation | critical care need

Mathematical model of COVID-19 intervention scenarios for São Paulo-Brazil

“…We found hospitalization periods of 4.4 days and ICU period of 13.4 days for both Brazil and São Paulo. The estimation for ICU time is similar to (23) (https://www.pnas.org/content/suppl/2020/04/03/2004064117.DCSupplemental), which estimates 13.5 days, and mean total hospital time, including ICU time, is in accordance with (9), which estimates around 16 days. Similar or even the same coefficients were expected for both places, since São Paulo is the epicenter of the pandemic in Brazil containing 22% of all active cases of the country.…”

COVID-19 length of hospital stay: a systematic review and data synthesis

“…There have been numerous previous studies which have aimed to forecast the number of hospital beds required for COVID-19 patients [16][17][18][19][20][21][22]54]. Many of these studies published so far have used point estimates, only originating from one study which often does not reflect the context of interest.…”

Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity

“…[41][42][43][44][45][46][47][48][49] Intensive care capacity is projected to become a particular bottleneck, as shown in other countries. [50][51][52] For Sweden, this is in particular worrisome considering the relatively low availability of beds prior to the pandemic compared to other European countries 22 24 and recent reports challenging Swedish disaster preparedness. 53 We predict that aggressive suppressive measures can substantially reduce this healthcare capacity deficit but only if implemented in a timely manner.…”