Coronavirus hospital overload will likely be worse than predicted

One of the healthcare nightmares of COVID-19 is that hospitals could be so overwhelmed by coronavirus patients that they will run out of beds and resources to treat them. In the worst case, already playing out in Italy, this could lead to wartime-style triaging, with patients less likely to survive simply denied treatment, or even removed from their beds, to focus limited resources where they would save the most lives.

To help hospitals prepare for the deluge, the New York Times recently partnered with Harvard Global Health on an analysis of where and how badly hospitals are likely to run out of room. The results are sobering, to say the least. In some scenarios, hospitals would be slammed with 5 or more times their capacity. When it comes to intensive care (ICU) rooms or special medical equipment like ventilators, the numbers look even worse.

However, as dire as the situation already seems, that analysis likely underestimates its magnitude by a factor of 2 or more.

The peak of the outbreak will be far above its average. That means the worst week for hospitals will be far worse than the projections in the New York Times / Harvard Global Health report.

The problem isn’t with the number of patients, it’s how they’re distributed in time. The calculations assumed that for, e.g., a 6-month outbreak, the cases would come in at a steady rate for the whole 6 months. However, as we know from flattening the curve, epidemic curves have a sharp peak in infections right at the center, which is much greater than the average over the whole outbreak.

The HGH/Times report was a massive and time-pressured undertaking in data collection, curation, analysis, and visualization. Everyone involved deserves full credit and our thanks for bringing attention to an oncoming crisis. Hopefully their advance warning will at least help us mitigate the consequences. However, if hospitals and local officials are using this report to help plan for capacity overflow, they should prepare for a peak crisis of at least double the scale.

Please note that helping hospitals prepare includes all of us, so aggressively socially distance to fight the outbreak, and if you have N95 or surgical masks that you can donate to front-line healthcare workers, please do so here!

Methods

My interpretation here is based on the study’s data found here. For example, in a scenario with 20% of the population infected over 6 months, Abilene, Texas has 9,563 projected hospitalizations. Multiply that by 12 days per hospital stay and divide by 180 days as the duration of the outbreak, and you get the report’s projected number of beds needed: 638. Thus, the report’s calculations seem to have evenly distributed the patients throughout the epidemic.

The 638 patients for Abilene projected in this (relatively mild) scenario is within the hospital’s capacity, but when you double that average at the outbreak’s peak, the hospital will be out of beds.

Generally curious. Scientist (bacteria, antibiotic resistance, synthetic biology, PhD from Princeton), science policy & advocacy, runner.

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