The demand for inpatient and ICU beds for COVID-19 in the US: lessons from Chinese cities

  1. Ruoran Li
  2. Caitlin Rivers
  3. Qi Tan
  4. Megan B Murray
  5. Eric Toner
  6. Marc Lipsitch

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Abstract

Background

Sustained spread of SARS-CoV-2 has happened in major US cities. Capacity needs in Chinese cities could inform the planning of local healthcare resources.

Methods

We described the intensive care unit (ICU) and inpatient bed needs for confirmed COVID-19 patients in two Chinese cities (Wuhan and Guangzhou) from January 10 to February 29, 2020, and compared the timing of disease control measures in relation to the timing of SARS-CoV-2 community spread. We estimated the peak ICU bed needs in US cities if a Wuhan-like outbreak occurs.

Results

In Wuhan, strict disease control measures were implemented six weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, COVID-19 patients accounted for an average of 637 ICU patients and 3,454 serious inpatients on each day. During the epidemic peak, 19,425 patients (24.5 per 10,000 adults) were hospitalized, 9,689 (12.2 per 10,000 adults) were considered to be in serious condition, and 2,087 patients (2.6 per 10,000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within one week of case importation. Between January 24 and February 29, COVID-19 accounted for an average of 9 ICU patients and 20 inpatients on each day. During the epidemic peak, 15 patients were in critical condition, and 38 were classified as serious. If a Wuhan-like outbreak were to happen in a US city, the need for healthcare resources may be higher in cities with a higher prevalence of vulnerable populations.

Conclusion

Even after the lockdown of Wuhan on January 23, the number of seriously ill COVID-19 patients continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the effect of COVID-19 outbreaks on the local healthcare system in US cities.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.09.20033241: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. We relied on officially reported statistics, which may not represent the change of actual case counts over time, but rather a reflection of testing and hospitalization capacity. The trend in Wuhan of the number of serious cases and hospitalizations is thus not reflective of actual need, but rather the trend in maximum capacity of the Wuhan system in diagnosis and treatment. We are therefore more confident of the hospitalization and serious case counts in Wuhan after mid-February, and in Guangzhou, where excess capacities in diagnosis and treatment were reported based on both official and unofficial sources. In addition, our projection of the ICU bed needs in US cities does not take into account scenarios where local transmission may differ from that of Wuhan. The contact rate in Wuhan during the early phase of the epidemic may have been much higher than what we expect to occur in US cities because of the increased number of social contacts that occurred in Wuhan due to the Lunar New Year celebrations. If social distancing measures are effectively implemented early in US cities, the growth of the epidemic may be delayed. But it is also possible that US cities may not be able to implement the extreme social distancing measures that were put into place later in the epidemic in Wuhan. Therefore, the actual number of hospital and ICU beds that will be needed over the course of a COVID-19 outbreak in a US city is impossible to estimate precisely....

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.03.09.20033241v2 on medRxiv
  3. Version published to 10.1101/2020.03.09.20033241v1 on medRxiv