Lack of ICU beds in over half US counties could prove fatal for high-risk patients as coronavirus infections spike
As the number of confirmed cases and deaths continue to rise in the US, a critical question is whether hospitals are equipped to handle this surge, say experts. An analysis by Kaiser Health News paints a grim picture: it shows that over half the counties in the US do not have intensive care beds.
“Intensive care units have sophisticated equipment such as bedside machines to monitor a patient’s heart rate and ventilators to help them breathe. Overall, 18 million people live in counties that have hospitals but no ICU, about a quarter of them 60 or older. Nearly 11 million more Americans reside in counties with no hospital, some 2.7 million of them seniors,” shows the analysis.
The COVID-19 pandemic has generated concern that critically ill patients may overwhelm existing ICU bed availability. And the disastrous shortage of hospital beds, and intensive care beds in particular, could be fatal for high-risk groups, that is, those who are 60 and above. The analysis by Kaizer Health News shows that the non-availability of ICU beds in the counties poses a danger to over 7 million people who are 60 years and above.
Some of these counties include Bullock County, Alabama; Dallas County, Arkansas; Mariposa County, California; Jackson County, Colorado; Bradford County, Florida; Cook County, Georgia; Clark County, Illinois; Brown County, Kansas; Jackson County, Louisiana; Jefferson County, Mississippi; Orleans County, New York; Richmond County, North Carolina; Houston County, Tennessee; and Garfield County in Washington, among several others.
While severe illness and death from COVID-19 infection can occur in people of any age, 80% of US deaths so far have been in those 65 years and older, with the worst outcomes in people 85 and older, according to an analysis by US Centers for Disease Control and Prevention (CDC).
Early data from China suggest that a majority of COVID-19 deaths have occurred among adults aged 60 years and above and among people with serious underlying health conditions. The US CDC numbers are similar to the Chinese experience and show that the elderly have been the most affected. “Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions and 80% of deaths associated with COVID-19 were among adults aged 65 years and above in the US,” says the report which analyzed data from February 12 to March 16.
The Kaiser Health News report says that even in communities with ICU beds, the numbers vary wildly, “with some having just one bed available for thousands of senior residents, according to the analysis based on a review of data hospitals report each year to the federal government.”
Among counties with ICU beds, the average is 1,300 older people per bed in each county. In Michigan’s Clinton County, for example, there are two ICU beds for a population of 77,321, of which 22% or 16,938 are aged 60 years and above. This implies that each ICU bed in Clinton will serve 8,469 residents aged 60 and above. The state’s Livingston County has 8 ICU beds to serve a population of 186,946 -- of which 22% or 41,663 people are 60 years or older. The analysis further shows California’s Nevada County has 10 ICU beds for 98,838 people, of which 34% or 33,612 are 60 years and above. Madison in New York Madison has 6 ICU beds for 71,760 people, and among them 24% or 16,941 and 60 years or older.
“Consider the homes of two midsize cities: The Louisville area of Jefferson County, Kentucky, for instance, has one ICU bed for every 442 people aged 60 or older, while in Santa Cruz, California, that number stands at one bed for every 2,601 residents. Differences are vast within each state as well: San Francisco, with one bed for every 532 older residents, and Los Angeles, with 847 residents per bed, both have greater bed availability than does Santa Cruz,” says the report.
It adds, “Even counties that rank in the top 10% for ICU bed count still have as many as 450 older people potentially competing for each bed.”
The American Hospital Association’s annual survey of hospitals in the US shows that there are 5,198 community hospitals across the country. These community hospitals have 46,825 medical-surgical intensive care beds, 14,439 cardiac intensive care beds, 22,860 neonatal intensive care beds, 5,131 pediatric intensive care beds, and 7,323 other intensive care beds. There are also 1,198 burn care beds in community hospitals in the US.
Over 35,220 cases have been reported in the US so far, and over 400 have died. New York state accounts for 117 deaths currently, crossing Washington state, the initial epicenter of the pandemic in the US, in the number of fatal cases.
Members of the American Hospital Association have been advised to prepare for 96 million cases in the next few months, with 4.8 million additional admissions, 1.9 million intensive care unit (ICU) admissions and 480,000 excess deaths, which is about 10 times the number caused by a severe flu season, reports the New York Times.
Another report said that an estimated 160 million to 214 million people in the US could be infected in the COVID-19 pandemic. This is according to a worst-case scenario projection made by the CDC. In contrast, the US has around 924,107 staffed beds in all hospitals, and an estimated 100,000 ventilators, or even less.
A report by the US Department of Health and Human Services (HHS) estimates that in a severe pandemic, 90 million Americans could fall sick, 9,900,000 will need hospitalization, 45 million will need outpatient medical care, 1,485,000 will need ICU care, and there could be 1,903,000 deaths.
In a moderate pandemic, 90 million could fall sick, 45 million will need outpatient medical care, 865,000 will need to be hospitalized, 128,750 will need ICU care, and 209,000 could die. Projections made in the study also reveal that a severe influenza pandemic would require mechanical ventilators for 740,000 critically ill people, 64,875 ventilators will be needed in a moderate pandemic-like situation.
Dr Atul Grover, executive vice president of the Association of American Medical Colleges, tells Kaiser Health News, “No matter how you look at it, the numbers [of ICU beds] are too small. It’s scary.”