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

• Published in: Proceedings of the National Academy of Sciences - PNAS Vol. 117; no. 16; pp. 9122 - 9126
• Main Authors: Moghadas, Seyed M., Shoukat, Affan, Fitzpatrick, Meagan C., Wells, Chad R., Sah, Pratha, Pandey, Abhishek, Sachs, Jeffrey D., Wang, Zheng, Meyers, Lauren A., Singer, Burton H., Galvani, Alison P.
• Format: Journal Article
• Language: English
• Published: United States National Academy of Sciences 21.04.2020
• Series: From the Cover
• Subjects: Adequacy; Betacoronavirus; Biological Sciences; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Delay; Demographics; Demography; Disease Outbreaks - statistics & numerical data; Disease transmission; Emergency medical services; Employee benefits; Epidemics; Forecasting; Hospital Bed Capacity; Hospitals; Hospitals - statistics & numerical data; Humans; Intensive care units; Intensive Care Units - statistics & numerical data; Models, Theoretical; Outbreaks; Pandemics; Patient Acceptance of Health Care - statistics & numerical data; Patient Isolation; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Public health; SARS-CoV-2; Time Factors; United States; Ventilators; Viral diseases; United States; United States > US; SARS–CoV-2; hospitalization; critical care need; self-isolation
• ISSN: 0027-8424; 1091-6490; 1091-6490
• DOI: 10.1073/pnas.2004064117

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.