Projecting hospital utilization during the COVID-19 outbreaks in the United States
Top Cited Papers
Open Access
- 3 April 2020
- journal article
- research article
- Published by Proceedings of the National Academy of Sciences in Proceedings of the National Academy of Sciences of the United States of America
- Vol. 117 (16), 9122-9126
- https://doi.org/10.1073/pnas.2004064117
Abstract
In the wake of community coronavirus disease 2019 (COVID-19) 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 R0. Without self-isolation, when R0 = 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 R0 = 2, twice as many ICU beds would be required at the peak of outbreak in the absence of self-isolation. 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.Keywords
Funding Information
- National Institutes of Health (UO1-GM087719)
- Burnett & Stender Families Endowment (Endowment funds)
- Notsew Orm Sands Foundation (Endowment funds)
- National Institutes of Health (1RO1AI151176-01)
- National Institutes of Health (KO1AI141576)
- Canada Institute of health Research (DC0190GP)
This publication has 18 references indexed in Scilit:
- First Case of 2019 Novel Coronavirus in the United StatesThe New England Journal of Medicine, 2020
- A Novel Coronavirus from Patients with Pneumonia in China, 2019The New England Journal of Medicine, 2020
- Risk of influenza infection with low vaccine effectiveness: the role of avoidance behaviourEpidemiology and Infection, 2019
- Projecting social contact matrices in 152 countries using contact surveys and demographic dataPLoS Computational Biology, 2017
- The Effect of Individual Movements and Interventions on the Spread of Influenza in Long-Term Care FacilitiesMedical Decision Making, 2017
- Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000–2010Critical Care Medicine, 2016
- On the relative role of different age groups in influenza epidemicsEpidemics, 2015
- Traveling Towards Disease: Transportation Barriers to Health Care AccessJournal of Community Health, 2013
- Effectiveness of a School District Closure for Pandemic Influenza A (H1N1) on Acute Respiratory Illnesses in the Community: A Natural ExperimentClinical Infectious Diseases, 2012
- Critically Ill Patients With 2009 Influenza A(H1N1) Infection in CanadaJAMA, 2009