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Simple math offers alarming answers about Covid-19, health care – STAT

Using the current doubling rate of Covid-19 cases — six days — the U.S. will be facing shortages of hospital beds and face masks by May.

Much of the current discourse on — and dismissal of — the Covid-19 outbreak focuses on comparisons of the total case load and total deaths with those caused by seasonal influenza. But these comparisons can be deceiving, especially in the early stages of an exponential curve as a novel virus tears through an immunologically naïve population.

Perhaps more important is the disproportionate number of severe Covid-19 cases, many requiring hospitalization or weekslong ICU stays. What does an avalanche of uncharacteristically severe respiratory viral illness cases mean for our health care system? How much excess capacity currently exists, and how quickly could Covid-19 cases saturate and overwhelm the number of available hospital beds, face masks, and other resources?

This threat to the health care system as a whole poses the greatest challenge.

As I initially described in a Twitter thread, simple mathematics can derive rough estimates for how this might play out.

This exercise can inform our level of urgency and equip us to anticipate non-obvious, second-order effects, some of which can be mitigated with proper preparation.

As of March 8, about 500 cases of Covid-19 had been diagnosed in the U.S. Given the substantial underdiagnosis at present due to limitations in testing for the coronavirus, let’s say there are 2,000 current cases, a conservative starting bet.

We can expect a doubling of cases every six days, according to several epidemiological studies. Confirmed cases may appear to rise faster (or slower) in the short term as diagnostic capabilities are ramped up (or not), but this is how fast we can expect actual new cases to rise in the absence of substantial mitigation measures.

That means we are looking at about 1 million U.S. cases by the end of April; 2 million by May 7; 4 million by May 13; and so on.

As the health care system becomes saturated with cases, it will become increasingly difficult to detect, track, and contain new transmission chains. In the absence of extreme interventions like those implemented in China, this trend likely won’t slow significantly until hitting at least 1% of the population, or about 3.3 million Americans.

What does a case load of this size mean for health care system? That’s a big question, but just two facets — hospital beds and masks — can gauge how Covid-19 will affect resources.

The U.S. has about 2.8 hospital beds per 1,000 people (South Korea and Japan, two countries that have seemingly thwarted the exponential case growth trajectory, have more than 12 hospital beds per 1,000 people; even China has 4.3 per 1,000). With a population of 330 million, this is about 1 million hospital beds. At any given time, about 68% of them are occupied. That leaves about 300,000 beds available nationwide.

The majority of people with Covid-19 can be managed at home. But among 44,000 cases in China, about 15% required hospitalization and 5% ended up in critical care. In Italy, the statistics so far are even more dismal: More than half of infected individuals require hospitalization and about 10% need treatment in the ICU.

For this exercise, I’m conservatively assuming that only 10% of cases warrant hospitalization, in part because the U.S. population is younger than Italy’s, and has lower rates of smoking — which may compromise lung health and contribute to poorer prognosis — than both Italy and China. Yet the U.S. also has high rates of chronic conditions like cardiovascular disease and diabetes, which are also associated with the severity of Covid-19.

At a 10% hospitalization rate, all hospital beds in the U.S. will be filled by about May 10. And with many patients requiring weeks of care, turnover will slow to a crawl as beds fill with Covid-19 patients.

If I’m wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by six days (one doubling time) in either direction. If 20% of cases require hospitalization, we run out of beds by about May 4. If only 5% of cases require it, we can make it until about May 16, and a 2.5% rate gets us to May 22.

But this presumes there is no uptick in demand for beds from non-Covid-19 causes, a dubious presumption. As the health care system becomes increasingly burdened and prescription medication shortages kick in, people with chronic conditions that are normally well-managed may find themselves slipping into states of medical distress requiring hospitalization and even intensive care. For the sake of this exercise, though, let’s assume that all other causes of hospitalization remain constant.

Let me now turn to masks. The U.S. has a national stockpile of 12 million N95 masks and 30 million surgical masks for a health care workforce of about 18 million. As Covid-19 cases saturate nearly every state and county, virtually all health care workers will be expected to wear masks. If only 6 million of them are working on any given day (certainly an underestimate) they would burn through the national N95 stockpile in two days if each worker only got one mask per day, which is neither sanitary nor pragmatic.

It’s unlikely we’d be able to ramp up domestic production or importation of new masks to keep pace with this level of demand, especially since most countries will be simultaneously experiencing the same crises and shortages.

Shortages of these two resources — beds and masks — don’t stand in isolation but compound each other’s severity. Even with full personal protective equipment, health care workers are becoming infected while treating patients with Covid-19. As masks become a scarce resource, doctors and nurses will start dropping from the workforce for weeks at a time, leading to profound staffing shortages that further compound the challenges.

The same analysis applied to thousands of medical devices, supplies, and services — from complex equipment like ventilators or extracorporeal membrane oxygenation devices to hospital staples like saline drip bags — shows how these limitations compound one another while reducing the number of options available to clinicians.

Importantly — and I cannot stress this enough — even if some of the core assumptions I’m making, like the fraction of severe cases or the number of current cases, are off even by several-fold, it changes the overall timeline only by days or weeks.

https://www.statnews.com/2020/03/10/simple-math-alarming-answers-covid-19/comment-page-6/#comments

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Olivia Kroth
March 12, 2020

TASS: Russia hands over to Iran 500 test systems for detecting novel coronavirus — Test systems were also sent to the countries of the Eurasian Economic Union, North Korea and Mongolia MOSCOW, March 12. /TASS/. Russia has sent 800 test systems for detecting the novel coronavirus to the countries of the Eurasian Economic Union, Iran, North Korea, Mongolia and the Commonwealth of Independent States, the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing said on Thursday. “Test systems developed by Rospotrebnadzor have been handed over to the member-states of the EAEU, Azerbaijan, Uzbekistan, Tajikistan, Turkmenistan, Mongolia, North… Read more »

Olivia Kroth
Reply to  Olivia Kroth
March 12, 2020

TASS: Russia scientists invent 15-minute portable coronavirus test device — The device uses the isothermal polymerase chain reaction MOSCOW, March 11. /TASS/. A Russian company has developed an express coronavirus test device that provides the result in only 15 minutes, the National Technical Initiative announced Wednesday. The new method undergoes final tests and the device might be presented to the public this autumn. The device uses the isothermal polymerase chain reaction. To perform the analysis, a mucous sample from the nose or the throat, says the Initiative, who assisted the Medical Biological Union (MBU) Company in creation of the device.… Read more »

Olivia Kroth
March 13, 2020

PRESS TV IRAN: Could US tourists have introduced the virus to Wuhan? New evidence seems to support that possibility. The US has been very secretive about how it plans to combat the novel coronavirus. Certain meetings in the White House have been deemed top secret and medical professionals who lacked the necessary security clearance were forbidden from attending them. This type of secrecy is unprecedented. The reason given was that the discussions revolved around China. We will never know what was actually being discussed and planned in those meetings. In addition, it’s come to light that the US refused to… Read more »

Olivia Kroth
Reply to  Olivia Kroth
March 13, 2020

PRESS TV IRAN: White House told federal health agency to classify coronavirus deliberations: Report — Friday, 13 March 2020 12:42 AM [ Last Update: Friday, 13 March 2020 12:42 AM ] The White House has ordered meetings where federal health officials discussed the coronavirus to be classified, according to four Trump administration officials. Speaking to Reuters, the officials said dozens of classified discussions about topics ranging from infections, quarantines and travel restrictions had been held in a high-security meeting room at the Department of Health & Human Services (HHS) since mid-January. The officials said the National Security Council (NSC) directed… Read more »

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