Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada

• Published in: Canadian Medical Association journal (CMAJ) Vol. 192; no. 24; pp. E640 - E646
• Main Authors: Barrett, Kali, Khan, Yasin A, Mac, Stephen, Ximenes, Raphael, Naimark, David M J, Sander, Beate
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 15.06.2020; CMA Impact, Inc
• Subjects: Analysis; Betacoronavirus; Canada; Communicable Disease Control; Computer Simulation; Coronavirus Infections - epidemiology; Coronavirus Infections - mortality; Coronavirus Infections - prevention & control; Coronaviruses; COVID-19; Disease transmission; Health care expenditures; Health Resources; Health Services Needs and Demand; Hospital Bed Capacity; Hospital patients; Hospitals; Humans; Intensive Care Units; Mortality; Ontario; Ontario - epidemiology; Pandemics - prevention & control; Pneumonia, Viral - epidemiology; Pneumonia, Viral - mortality; Pneumonia, Viral - prevention & control; Prognosis; Resource allocation; SARS-CoV-2; Surge Capacity; Ventilators; Ventilators, Mechanical; Ontario; Canada; Ontario Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.200715

The global spread of coronavirus disease 2019 (COVID-19) continues in several jurisdictions, causing substantial strain to health care systems. The purpose of our study was to predict the effect of the COVID-19 pandemic on patient outcomes and use of hospital resources in Ontario, Canada. We developed an individual-level simulation to model the flow of patients with COVID-19 through the hospital system in Ontario. We simulated different combined scenarios of epidemic trajectory and hospital health care capacity. Our outcomes included the number of patients who needed admission to the ward or to the intensive care unit (ICU) with or without the need for mechanical ventilation, number of days to resource depletion, number of patients awaiting resources and number of deaths. We found that with effective early public health measures, hospital system resources would not be depleted. For scenarios with late or ineffective implementation of physical distancing, hospital resources would be depleted within 14-26 days, and in the worst case scenario, 13 321 patients would die while waiting for needed resources. Resource depletion would be avoided or delayed with aggressive measures to increase ICU, ventilator and acute care hospital capacities. We found that without aggressive physical distancing measures, the Ontario hospital system would have been inadequately equipped to manage the expected number of patients with COVID-19 despite a rapid increase in capacity. This lack of hospital resources would have led to an increase in mortality. By slowing the spread of the disease using public health measures and by increasing hospital capacity, Ontario may have avoided catastrophic stresses to its hospitals.