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    Original Investigation
    Infectious Diseases
    May 6, 2020

    Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China

    Author Affiliations
    • 1Harvard T.H. Chan School of Public Health, Center for Communicable Disease Dynamics, Department of Epidemiology, Boston, Massachusetts
    • 2Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Health Security and the Department of Environmental Health and Engineering, Baltimore, Maryland
    • 3Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
    • 4Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
    JAMA Netw Open. 2020;3(5):e208297. doi:10.1001/jamanetworkopen.2020.8297
    Key Points español 中文 (chinese)

    Question  What level of hospital capacity is needed to respond to outbreaks of severe coronavirus disease 2019 in US cities, and how is this associated with intervention timing?

    Findings  In this comparative effectiveness study, higher inpatient and intensive care unit utilization in Wuhan was compared with lower utilization in Guangzhou, which implemented strict social distancing measures as well as contact tracing and quarantine protocols earlier than Wuhan. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence.

    Meaning  The findings of this study suggest that strict disease control strategies should be implemented early to mitigate the demand for inpatient and intensive care unit beds during a coronavirus disease 2019 outbreak.

    Abstract

    Importance  Sustained spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has happened in major US cities. Capacity needs in cities in China could inform the planning of local health care resources.

    Objectives  To describe and compare the intensive care unit (ICU) and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak ICU bed needs in US cities if an outbreak equivalent to that in Wuhan occurs.

    Design, Setting, and Participants  This comparative effectiveness study analyzed the confirmed cases of COVID-19 in Wuhan and Guangzhou, China, from January 10 to February 29, 2020.

    Exposures  Timing of disease control measures relative to timing of SARS-CoV-2 community spread.

    Main Outcomes and Measures  Number of critical and severe patient–days and peak number of patients with critical and severe illness during the study period.

    Results  In Wuhan, strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, 2020, patients with COVID-19 accounted for a median (interquartile range) of 429 (25-1143) patients in the ICU and 1521 (111-7202) inpatients with serious illness each day. During the epidemic peak, 19 425 patients (24.5 per 10 000 adults) were hospitalized, 9689 (12.2 per 10 000 adults) were considered in serious condition, and 2087 (2.6 per 10 000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within 1 week of case importation. Between January 24 and February 29, COVID-19 accounted for a median (interquartile range) of 9 (7-12) patients in the ICU and 17 (15-26) inpatients with serious illness each day. During the epidemic peak, 15 patients were in critical condition and 38 were classified as having serious illness. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence.

    Conclusions and Relevance  Even after the lockdown of Wuhan on January 23, the number of patients with serious COVID-19 illness continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on the local health care systems in US cities.

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