Coronavirus: USA could never handle Wuhan-like outbreak since only 35% hospital beds are available daily
If a Wuhan-like outbreak were to happen in an American city, the hospitals would be too overwhelmed to handle the crisis. That is the chilling conclusion of a new study by US researchers.
The first case of COVID-19 in the US was announced on January 21, 2020, in Washington. Since then, the numbers have gone up significantly across the country. According to figures updated till March 11, over 1,300 have fallen sick, and at least 38 have died.
“If a Wuhan-like outbreak were to take place in a US city, even with strong social distancing and contact tracing protocols as strict as the Wuhan lockdown, hospitalization and ICU needs from COVID-19 patients alone may exceed current capacity,” says the researchers in their findings, a pre-print version of which has been published.
They add, “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. During the peak of the Wuhan epidemic in February, nearly 20,000 COVID-19 patients were hospitalized simultaneously, with 10,000 in severe or critical conditions.”
The team includes experts from Harvard T.H. Chan School of Public Health, Boston; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Harvard Medical School, Boston; and Nanjing Medical University, Nanjing, China.
On any normal day, the occupancy rate of hospital beds in the US is about 65.5%, shows an estimate by the US Centers for Disease Control and Prevention (CDC).
Matt Boyce, a senior research associate at the Georgetown University Center for Global Health Science and Security, who was not involved in the study, agrees with the study’s conclusion.
“Yes, should a Wuhan-scale outbreak occur in any city — including those in the US — the local healthcare system would likely be overwhelmed,” Boyce told MEA WorldWide (MEAWW).
He said that many hospitals try to plan for something called “surge capacity,” which is an important part of preparedness for responding to emergencies and disasters. It essentially focuses on the ability of a healthcare system to provide medical care with sudden increases in the number of patients.
“The implementation of non-pharmaceutical interventions such as canceling or altering large public events or closing schools and businesses can work to reduce the burden felt by healthcare systems. Though unlikely to immediately halt an outbreak, they can reduce the number of patients presenting at the same time so that systems can adequately address the public health emergency. Lessons from past outbreaks suggest that these interventions can be especially effective when implemented quickly and in combination with other interventions,” Boyce told MEAWW.
The analysis
In the current study, the team describes the intensive care unit (ICU) and in-patient bed needs for confirmed COVID-19 patients in two Chinese cities (Wuhan and Guangzhou) from January 10 to February 29 and compares the timing of disease control measures in relation to the timing of COVID-19 community spread.
“We estimated the peak ICU bed needs in US cities if a Wuhan-like outbreak occurs. Describing and comparing the resource needs in both cities may serve as benchmarks to help other large metropolises in the world prepare for potential outbreaks,” they explain.
The analysis shows that in Wuhan, strict disease control measures were implemented six weeks after sustained local transmission of COVID-19.
The analysis shows that COVID-19 accounted for a total of 32,486 ICU-days and 176,136 serious in-patient days between January 10 and February 29. This is an average of 637 ICU patients and 3,454 serious in-patients on each day over those 51 days.
The researchers explain that during the peak of the epidemic from mid to late February, a maximum of 19,425 patients (24.5 per 10,000 adults) were hospitalized, 9,689 patients (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.
The team says in Guangzhou, strict disease control measures were implemented within one week of case importation. COVID-19 accounted for a total of 318 ICU-days and 724 in-patient-days between January 24 and February 29. This is an average of 9 ICU patients and 20 in-patients during that 37-day period.
“During the peak of the epidemic (early February), 15 patients were in critical condition, while 38 were hospitalized and classified as serious. Unlike Wuhan, where patients with mild COVID-19 disease were isolated in quarantine centers and not in designated hospitals, all confirmed patients in Guangzhou were hospitalized until cure. The maximum number of hospitalizations in Guangzhou on any day was 271 patients,” says the study.
According to the research team, based on these findings, the projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities ranges from 2.1 to 4.0 per 10,000 adults “when we took into account the difference in age distribution.”
“The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities ranges from 2.6 to 4.9 per 10,000 adults when we took into account the differences in comorbidity (hypertension) prevalence,” says the team.
The researchers further say if a Wuhan-like outbreak were to happen in a US city, the need for healthcare resources may be higher in cities where there is a higher prevalence of vulnerable populations (age and comorbidity) than in Wuhan.
“Exceeding healthcare capacity may increase the community spread of SARS-CoV-2,” they say. The team explains because of the exponential increase in the number of patients who developed serious illness but could not be hospitalized due to capped capacity, secondary transmission in the community continued as patients and their household contacts moved between hospitals seeking care.
“Exceeding healthcare capacity may also lead to decreased quality of care, such as not being able to get access to a ventilator, which would lead to an increased case fatality ratio,” says the study.
Some alarming numbers
According to Liz Specht, associate director of science and technology at The Good Food Institute, the US can expect that it will continue to see a doubling of cases every 6 days.
“This is a typical doubling time across several epidemiological studies. Here I mean actual cases. Confirmed cases may appear to rise faster in the short term due to new test kit rollouts. We’re looking at about 1M (million) US cases by the end of April, 2M by about May 5, 4M by about May 11, and so on. Exponentials are hard to grasp, but this is how they go,” she tweets.
Specht explains that as the healthcare system begins to saturate under this caseload, it will become increasingly hard to detect, track, and contain new transmission chains.
To explain what does caseload implies for the healthcare system, she analyzed two factors — hospital beds and masks — among several other things that are expected to be impacted.
“The US has about 2.8 hospital beds per 1,000 people. With a population of 330M, this is about 1M beds. At any given time, 65% of those beds are already occupied. That leaves about 330k beds available nationwide (perhaps a bit fewer this time of year with regular flu season, etc),” says the expert.
Let’s trust Italy’s numbers and assume that about 10% of cases are serious enough to require hospitalization. (Keep in mind that for many patients, hospitalization lasts for weeks — in other words, turnover will be very slow as beds fill with COVID-19 patients).
Specht argues that according to this estimate, by about May 8, all open hospital beds in the US will be filled. “This says nothing, of course, about whether these beds are suitable for isolation of patients with a highly infectious virus. If we’re wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by 6 days in either direction. If 20% of cases require hospitalization, we run out of beds by about May 2,” says Specht.
She adds, “If only 5% of cases require it, we can make it until May 14th. 2.5% gets us to May 20. This, of course, assumes that there is no uptick in demand for beds from other (non-COVID-19) causes, which seems like a dubious assumption.”
The expert warns that as the healthcare system becomes increasingly burdened, people with chronic conditions — which are normally well-managed — may find themselves slipping into severe states of medical distress, requiring intensive care and hospitalization.
“Undeserved panic does no one any good. But neither does ill-informed complacency,” Specht says.
“We've dealt with natural disasters and high casualties many times before. Our health system can adapt. But in most of these cases, we adapt by bringing in resources and personnel from unaffected cities, states, even countries. It becomes much, much harder to compensate for a sudden increase in caseload when this is happening simultaneously not only in every major city and state in one country, but also across virtually every country globally now,” she says.