Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator-days and deaths by US state in the next 4 months

  1. IHME COVID-19 health service utilization forecasting team
  2. Christopher JL Murray

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Abstract

Importance

This study presents the first set of estimates of predicted health service utilization and deaths due to COVID-19 by day for the next 4 months for each state in the US.

Objective

To determine the extent and timing of deaths and excess demand for hospital services due to COVID-19 in the US.

Design, Setting, and Participants

This study used data on confirmed COVID-19 deaths by day from WHO websites and local and national governments; data on hospital capacity and utilization for US states; and observed COVID-19 utilization data from select locations to develop a statistical model forecasting deaths and hospital utilization against capacity by state for the US over the next 4 months.

Exposure(s)

COVID-19.

Main outcome(s) and measure(s)

Deaths, bed and ICU occupancy, and ventilator use.

Results

Compared to licensed capacity and average annual occupancy rates, excess demand from COVID-19 at the peak of the pandemic in the second week of April is predicted to be 64,175 (95% UI 7,977 to 251,059) total beds and 17,380 (95% UI 2,432 to 57,955) ICU beds. At the peak of the pandemic, ventilator use is predicted to be 19,481 (95% UI 9,767 to 39,674). The date of peak excess demand by state varies from the second week of April through May. We estimate that there will be a total of 81,114 (95% UI 38,242 to 162,106) deaths from COVID-19 over the next 4 months in the US. Deaths from COVID-19 are estimated to drop below 10 deaths per day between May 31 and June 6.

Conclusions and Relevance

In addition to a large number of deaths from COVID-19, the epidemic in the US will place a load well beyond the current capacity of hospitals to manage, especially for ICU care. These estimates can help inform the development and implementation of strategies to mitigate this gap, including reducing non-COVID-19 demand for services and temporarily increasing system capacity. These are urgently needed given that peak volumes are estimated to be only three weeks away. The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures in all states that have not done so already within the next week and maintenance of these measures throughout the epidemic, emphasizing the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths.

Data availability statement

A full list of data citations are available by contacting the corresponding author.

Funding Statement

Bill & Melinda Gates Foundation and the State of Washington

Key Points

Question

Assuming social distancing measures are maintained, what are the forecasted gaps in available health service resources and number of deaths from the COVID-19 pandemic for each state in the United States?

Findings

Using a statistical model, we predict excess demand will be 64,175 (95% UI 7,977 to 251,059) total beds and 17,380 (95% UI 2,432 to 57,955) ICU beds at the peak of COVID-19. Peak ventilator use is predicted to be 19,481 (95% UI 9,767 to 39,674) ventilators. Peak demand will be in the second week of April. We estimate 81,114 (95% UI 38,242 to 162,106) deaths in the United States from COVID-19 over the next 4 months.

Meaning

Even with social distancing measures enacted and sustained, the peak demand for hospital services due to the COVID-19 pandemic is likely going to exceed capacity substantially. Alongside the implementation and enforcement of social distancing measures, there is an urgent need to develop and implement plans to reduce non-COVID-19 demand for and temporarily increase capacity of health facilities.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.27.20043752: (What is this?)

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

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    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:
    The use of mobile military resources including the National Guard42–44 has the potential to address some capacity limitations, particularly given the differently timed epidemics across states. Other innovative strategies will need to be found, including the construction of temporary hospital facilities as was done in Wuhan,45 Washington state,46 and also New York.44,47 In this study, we have quantified the potential gap in physical resources, but there is an even larger potential gap in human resources (HR). Expanding bed capacity beyond licensed bed capacity may require an even larger increase in the HR to provide care. The average annual bed- day utilization rate in the US is 66% and ranges from 54% (Idaho) to 80% (Connecticut) by state. Most US hospitals are staffed appropriately at their usual capacity utilization rate, and expanding even up to, but then potentially well beyond, licensed capacity will require finding substantial additional HR. Strategies include increasing overtime, training operating room and community clinic staff in inpatient care or physician specialties in COVID-19 patient care, rehiring recently separated workers, and the use of volunteers. For example, UW Medicine has been fortunate that clinical faculty time can be redirected from research and teaching to clinical care during the COVID-19 surge. Other hospitals may not have this same ability. The most concerning HR bottleneck identified for UW Medicine is for ICU nurses, for which there are very l...

    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.

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  2. Version published to 10.1101/2020.03.27.20043752v1 on medRxiv