Counties in five US states face severe hospital bed shortage, risking lives of 17M amid conoravirus pandemic
An estimated 155 of 3,111 counties that were analyzed across the US are densely populated, have low hospital bed capacity per capita and are home to at least 17M people. More than 40% of these counties are concentrated in Georgia, Virginia, Ohio, Kentucky and Michigan, and are at higher risk of being overwhelmed in the event of an outbreak, shows a new study. The findings are critical and come at a time when Georgia has decided to reopen the economy.
"Earlier today, I discussed Georgia's plan to reopen shuttered businesses for limited operations with @POTUS. I appreciate his bold leadership and insight during these difficult times and the framework provided by the White House to safely move states forward," Georgia Governor Brian P Kemp tweeted on April 23. "Our next measured step is driven by data and guided by state public health officials. We will continue with this approach to protect the lives — and livelihoods — of all Georgians. Just like the thousands of businesses currently operating throughout Georgia, I am confident that business owners who decide to reopen will adhere to minimum basic operations, which prioritize the health and well-being of employees and customers,” he said.
President Donald Trump had said on April 22 that he strongly disagrees with Kemp's decision to reopen some nonessential businesses on April 24, but added that it is up to the states to determine.
According to researchers of the current study, household size and characteristics like the number of generations living together will affect transmission rates, household vulnerability and the feasibility of social distancing measures. The spread of COVID-19 across the US confirms that not all Americans are equally at risk of infection, severe disease or mortality, says the team from the US. It includes experts from Harvard TH Chan School of Public Health, Harvard Medical School, Harvard University and Stanford University School of Medicine.
The researchers examined the overlapping risks of group quarters, population density and hospital bed capacity. They found that 371 of 3,111 US counties, with over 10M residents, have both a substantial proportion of the population living in group quarters and low ICU bed capacity, putting them at heightened risk of facing critical care capacity shortages.
"We identified key biological, demographic, and socio-economic characteristics influencing susceptibility to COVID-19, guided by international experiences, and consideration of epidemiological parameters of importance. We created county-level maps to illustrate examples of key relationships across these categories grouping age and poverty; comorbidities and lack of health insurance; proximity, density and bed capacity; and race and ethnicity, and premature mortality," says the team.
The experts cited an example, saying that a study looking at transmission among close contacts in Shenzhen, China, estimated a secondary attack rate of approximately 15% among household contacts. The prevalence of group quarters such as correctional facilities, nursing homes, student housing and homeless shelters also increases the risk of transmission for members of these communities, says the team.
According to the latest analysis, 527 of 3,111 counties have greater than 5% of their population living in group quarters. Additionally, say experts, high population density increases the risk of rapid transmission, especially in the absence of adequate or timely social distancing measures, as evidenced by the current scale of the outbreak in New York City. The analysis shows that 425 of 3,111 counties, mostly concentrated in the eastern US and on the West coast, have greater than 100 people living per square mile, compared to the national median of 45 people per square mile. The researchers argue that the ability of counties to respond to these additional risks will partly depend on local bed capacity.
"Several studies examining hospital capacity in the US predict substantial shortages in hospital and ICU-beds. 949 of 3,111 counties have fewer than 100 hospital beds per 100,000 people, as compared to the national median of 185. Further, 1,939 of 3,111 counties have fewer than 10 ICU beds per 100,000 population," says the study, a pre-print version of which has been published.
It further adds, "In terms of medical response capacity, approximately 60% of all counties have fewer than 10 ICU beds per 100,000 population and 30% of counties have just over half the number of hospital beds per capita than the national median. In anticipation of heightened demands on healthcare systems in counties that are vulnerable, states and the federal government need to ramp up inter-jurisdictional coordination efforts to move supplies and personnel to meet rapidly shifting local demands.”
Among other findings, the researchers found that over 20% of households in nearly one in five counties in the US are living below the poverty line. In more than 10% of all counties, more than half the population is non-Hispanic and non-White. Approximately 25% of all counties have a high proportion of elderly people. Together, these counties represent millions of Americans at heightened risk of COVID-19 infection and risk of severe disease and death given infection, say experts.
“Overall, 10% of the US population is over the age of 70, and 12% of the population lives below the poverty line. In 768 of 3,111 counties, at least 15% of the population is over 70 years old. In 667 of 3,106 counties, more than 20% of households live below the poverty line. 111 of 3,106 counties, accounting for about 1.6 million people, have both a high number of households below the poverty line and a high proportion of elderly residents. Georgia, Texas, and Arkansas are the states with the largest number of such counties,” the findings reveal.
While the East and West coast cities are particularly vulnerable due to their densities (and travel routes), a large number of counties in the Southeastern states have a multitude of interconnected risk factors. Many Americans with chronic comorbidities, lack (and recent loss) of health insurance, inability to work from home, and poor access to care, are likely to be disproportionately affected by COVID-19, due to their increased risk of both infection and severe disease.
“The majority of counties that carry these multiple burdens, however, are also located in states that have been tepid in their social-distancing response. Our analysis provides insights into how communities of color may likely continue to bear a disproportionately high burden of infection, severe disease, and mortality. Collecting and sharing data on COVID-19 outcomes by race/ethnicity, which surveillance systems hitherto have not been systematically reporting, will be crucial to understanding and rectifying inequities in the distribution of COVID-19 outcomes,” says the study.
For several years, most of the Southern states — that seceded during the Civil War — have consistently ranked among the worst in the US in health. Many have a high prevalence of obesity, a high prevalence of cardiovascular disease and death rate, as well as a high diabetes rate, said a previous report.
Pre-existing health conditions, including hypertension, diabetes and coronary heart disease, increase the likelihood of severe disease and death from COVID-19. In the current analysis, the research team found that 55 of 3,106 counties, where at least 20% of the population over 20 years old carries a diagnosis of diabetes, are primarily concentrated in the Southeast US, with the most in Georgia, Texas and Alabama.
The team also examined the relationship between the proportion of the population that is non-Hispanic and non-White and “age-adjusted years of potential life lost” before age 75 per 100,000 population in 2017.
In 366 of 3,111 counties, over 50% of the population is non-Hispanic and non-White. These communities are predominantly located in Southern states, in Texas, Georgia and Mississippi. In 758 of 3,051 counties, there are at least 10,000 years of potential life lost before age 75 per 100,000 population in 2017, in comparison to the national median of approximately 8,100. The analysis estimates that 162 of 3,051 counties, with over 5.6M residents, have a high proportion of the population that is non-Hispanic and non-White and has a high number of years of potential life lost. Approximately 44% of these counties fall in the states of Mississippi, Georgia, New Mexico and Alabama.
“At a time when the US continues to inadequately test its population or protect healthcare providers, the need for actionable, contextually relevant data that allows for judicious distribution of our limited resources becomes imperative. County, state, and national planners will benefit from examining and preparing for the local factors that are likely to influence their counties’ ability to respond,” says the research team. They add, “The morbidity and mortality toll, as early numbers indicate, will likely be disproportionately borne by communities of color in the absence of concerted, aggressive, and proactive responses across administrative boundaries that account for the vast inter-country variability in risks across populations.”
Over 869,170 coronavirus cases have been reported from across the US as of April 24, and more than 49,950 have died in the COVID-19 pandemic, according to the Johns Hopkins tracker.