Critical Care Demand and Intensive Care Supply for Patients in Japan with COVID-19 at the Time of the State of Emergency Declaration in April 2020: A Descriptive Analysis

  1. Yosuke Fujii
  2. Kiichi Hirota

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Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is overwhelming Japan’s intensive care capacity. This study aimed to determine the number of patients with COVID-19 who required intensive care and to compare the numbers with Japan’s intensive care capacity. Materials and Methods: Publicly available datasets were used to obtain the number of confirmed patients with COVID-19 undergoing mechanical ventilation and extracorporeal membrane oxygenation (ECMO) between 15 February and 19 July 2020 to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan. Results: During the epidemic peak in late April, 11,443 patients (1.03/10,000 adults) had been infected, 373 patients (0.034/10,000 adults) were in ICU, 312 patients (0.028/10,000 adults) were receiving mechanical ventilation, and 62 patients (0.0056/10,000 adults) were under ECMO per day. At the peak of the epidemic, the number of infected patients was 651% of designated beds, and the number of patients requiring intensive care was 6.0% of ICU beds, 19.1% of board-certified intensivists, and 106% of designated medical institutions in Japan. Conclusions: The number of critically ill patients with COVID-19 continued to rise during the pandemic, exceeding the number of designated beds but not exceeding ICU capacity.

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  1. Version published to 10.3390/medicina56100530
  2. Version published to 10.1101/2020.06.20.20136150v2 on medRxiv
  3. Version published to 10.21203/rs.3.rs-40419/v1 on Research Square
  4. ScreenIT

    SciScore for 10.1101/2020.06.20.20136150: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical approval: Institutional review board approval and patient informed consent were not required for this study, as this study did not involve human participant research or any interventions.
    Consent: Ethical approval: Institutional review board approval and patient informed consent were not required for this study, as this study did not involve human participant research or any interventions.
    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:
    Our study had several limitations. First, the number of critically ill patients requiring intensive care was not completely addressed in the JSICM database. This database has been estimated to capture >80% of clinical cases [25,26]; however, it relies heavily on the cooperation of physicians struggling to treat large numbers of critically ill patients. Second, the extent of the ICU capacity and the number of patients requiring admission to ICUs were not completely validated. The JSICM reported the estimated number of ventilators and ECMO machines according to responses to a questionnaire sent to its member hospitals. Therefore, there was a risk of overestimating ICU capacity. Third, the assumption of one critically ill patient to one depressurized area per hospital did not necessarily reflect the real-life situation. For example, one author’s institution was designated as a Category II infectious diseases institution with eight ICU beds, one depressurized area, and six Category II beds, with one board-certified intensivist. This institution was not a member of the ECMO project. Six Category II beds were fully occupied as soon as the number of infected patients threatened to overwhelm the capacity of the ICU, and other wards were then rearranged to manage patients with mild manifestations of COVID-19. There were two alternatives to treat critically ill patients with COVID-19: one was to use an ICU depressurized bed, and the other was to rearrange the beds in the emergency depa...

    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

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  5. Version published to 10.1101/2020.06.20.20136150v1 on medRxiv