Hospitals could need 7.5 times the number of critical care beds to treat virus patients

Comment by George Batchelor in The Telegraph 15 March 2020

The data tell us that COVID-19 is spreading exponentially. The number of confirmed cases in the UK has increased from 36 on 1 March to 1140 on Saturday – a daily growth rate of 119 per cent. If this pattern continues, the number of confirmed cases will exceed 15,000 by the end of the month, and this is just the reported tip of the iceberg.

In China we have seen that the spread of infections has dropped significantly since Chinese New Year. A clinician and friend at the Xi’an University Hospital tells me that there have been no new cases in his area for the past 21 days, but they are still on lock-down.

The Chinese have cut the coronavirus spread by introducing extreme quarantine measures, which has been both self-imposed and Government enforced. The Chinese public have worn face masks in public and the Chinese government co-ordinated food deliveries through online platform WeChat.

The attitude to the approach taken by society in China seems to be very different to that taken in the UK. In China face masks are worn to stop people spreading the virus to others. In the UK people are fighting the urge for a firm handshake while drinking and eating in hospital coffee shops and canteens.

In our modelling, which is based on a degree of uncertainty in a rapidly evolving situation, the growth of confirmed cases in the UK could peak at 3.7 million in May if left unchecked. It is hard to predict when the peak will occur, although in this scenario most of these new cases would be in April.

Most people will not get severely ill, but the evidence from other countries suggests that around 15 per cent will become severely ill and a further 5 per cent will become critically ill. This would place pressure on the NHS in England to scale never yet seen. It would require around 560,000 beds and another 93,000 beds with ventilators – critical care beds. The NHS currently has just under 150,000 beds in total, around 4,000 of which are for critical care.

This unchecked scenario will not happen.

Under a more balanced scenario where the growth of daily infections is slowed to 106 per cent by the end of this month, total cases would peak at 1.2 million around the middle of July. This would reduce the requirement on hospital beds and ventilators to 180,000 and 30,000, which would still mean 7.5 times the number of critical care beds currently available. This is before adding in current demand, which currently fills 83 per cent of existing critical care beds.

Hopefully we can reduce the growth rate more effectively by taking firmer action collectively. But the NHS will need a lot of additional beds and ventilator capacity, and the staff to run them. China managed this by consolidating additional capacity in a few big centres, which allows the additional capacity to be more effectively utilised. Learning from this, the NHS will have to find a fundamentally different way of how to use and expand its bed base to cope with COVID-19.

We must also consider other measures to reduce demand and that includes isolating people with underlying health conditions.

This may be undesirable to the individual but it is important to remember that a bed for one means no bed for someone else. The consequences of this level of isolation are not trivial and will require social care support if people are to cope with the the emotional effects of isolation. It will require a collective societal effort as well as government leadership.

George Batchelor is a Co-Founder and Director of Edge Health, a firm which specialises in the use of economics and data science science to help the NHS be more productive and effective.

https://www.telegraph.co.uk/global-health/science-and-disease/hospitals-could-need-75-times-number-critical-care-beds-treat/