Coronavirus (COVID-19) Discussion Thread

[SvennoJ]

Analysis of Italy

https://jamanetwork.com/journals/jama/fullarticle/2763188

ICU Admissions Over the First 2 Weeks

There was an immediate sharp increase in ICU admissions from day 1 to day 14. The increase was steady and consistent. Publicly available data indicate that ICU admissions (n = 556) represented 16% of all patients (n = 3420) who tested positive for COVID-19. As of March 7, the current total number of patients with COVID-19 occupying an ICU bed (n = 359) represents 16% of currently hospitalized patients with COVID-19 (n = 2217). All patients who appeared to have severe illness were admitted for hypoxic respiratory failure to the COVID-19 dedicated ICUs.

Within 48 hours, ICU cohorts were formed in 15 hub hospitals totaling 130 COVID-19 ICU beds. By March 7, the total number of dedicated cohorted COVID-19 ICU beds was 482 (about 60% of the total preoutbreak ICU bed capacity), distributed among 55 hospitals. As of March 8, critically ill patients (initially COVID-19–negative patients) have been transferred to receptive ICUs outside the region via a national coordinating emergency office.

During the first 3 days of the outbreak, starting from February 22, the ICU admissions were 11, 15, and 20 in the COVID-19 Lombardy ICU Network. ICU admissions have increased continuously and exponentially over the first 2 weeks. Based on data to March 7, when 556 COVID-19–positive ICU patients had been admitted to hospitals over the previous 15 days, linear and exponential models were created to estimate further ICU demand (eFigure in the Supplement).

The linear model forecasts that approximately 869 ICU admissions could occur by March 20, 2020, whereas the exponential model growth projects that approximately 14 542 ICU admissions could occur by then. Even though these projections are hypothetical and involve various assumptions, any substantial increase in the number of critically ill patients would rapidly exceed total ICU capacity, without even considering other critical admissions, such as for trauma, stroke, and other emergencies.

In practice, the health care system cannot sustain an uncontrolled outbreak, and stronger containment measures are now the only realistic option to avoid the total collapse of the ICU system. For this reason, over the last 2 weeks, clinicians have continuously advised authorities to augment the containment measures.

To our knowledge, this is the first report of the consequences of the COVID-19 outbreak on critical care capacity outside China. Despite prompt response of the local and regional ICU network, health authorities, and the government to try to contain the initial cluster, the surge in patients requiring ICU admission has been overwhelming. The proportion of ICU admissions represents 12% of the total positive cases, and 16% of all hospitalized patients. This rate is higher than what was reported from China, where only 5% of patients who tested positive for COVID-19 required ICU admission.2,4 There could be different explanations. It is possible that criteria for ICU admission were different between the countries, but this seems unlikely. Another explanation is that the Italian population is different from the Chinese population, with predisposing factors such as race, age, and comorbidities.5


They don't put people in ICU for nothing. The admission rate is likely higher since there probably are a lot more undetected cases. Not that it matters since the growth is the same and capacity runs out regardless. Most people are simply told to self isolate at home. Not the best plan since family members will likely get it as well, maybe only mildly, still go out to get food etc and the spread continues.

Containment is the only option. Hopefully the measures in Italy are starting to take effect and the growth will slow down. From Feb 29 to March 11 it was an average of 1.23x, from March 4 to March 15 it was 1.18x, from March 9 to March 15, 1.12x. So averaged out the growth factor is decreasing. However with the incubation period the peak for ICU admissions (and deaths) lags behind.