COVID-19 may overwhelm intensive care units in UK within weeks
28 March, 2020
A fresh model has predicted that demand for beds in intensive care units (ICUs) will outstrip supply in two parts of the uk by around April 6, 2020.
Doctors and computer scientists in Cambridge, U.K., have predicted the future option of the country’s intensive care beds through the coronavirus pandemic.
In line with the latest figures from the U.K. government, there were 11,658 confirmed cases of COVID-19, and 578 persons have died.
The brand new model assumes that there will be an exponential upsurge in cases over the coming weeks.
Its predictions are available online, and the team updates the model regularly as its underlying assumptions change and account for new confirmed cases.
During writing, the model suggests that demand for ICU beds will outstrip supply in London and the Midlands as soon as April 6, 2020.
The team, from Addenbrooke’s Hospital and the University of Cambridge, created the working model in under a week, using confirmed cases reported by Public Health England from March 13, 2020 onward.
It takes into consideration the full total number of ICU beds in each of the seven National Health Service (NHS) commissioning regions in England, in addition to the regions’ demographics - including the number of older persons in their populations.
The most extreme cases tend to maintain older people and the ones with underlying health conditions.
Emergency planning
The researchers hope that their model’s predictions will help NHS decision makers within their emergency planning efforts during the pandemic.
However, they emphasize that people should interpret its projections with caution, as a result of limited available data and the countless assumptions they had to make.
For example, the model assumes that the existing exponential growth in confirmed cases will continue, as this is what happened in Italy.
In a preprint of their paper, the researchers remember that demographic and healthcare dissimilarities between the two countries will make a difference factors in deciding when ICU capacity is exceeded.
“However, it is noteworthy that the U.K. compares poorly with other high income countries - including Italy - regarding available ICU bed capacity per capita, and so it is definately not inconceivable a similar pattern may emerge,” they write.
Officials closed all schools in England on March 20, 2020, and the U.K. government introduced stringent lockdown measures on March 23, 2020 to limit the transmission of the virus.
Similar measures taken in China and South Korea have been very successful at reducing the rate of new infections.
Research suggests that social distancing is an efficient technique for containing the spread of the virus.
However, it'll likely take weeks before the U.K. lockdown has any influence on the amount of serious COVID-19 cases admitted to intensive care.
A changing picture
The team’s paper has not yet undergone peer review, however the authors say that they would like to make the regularly updated projections open to healthcare planners as quickly as possible.
As new data have grown to be available and assumptions have changed, the live model’s projections have previously changed since the publication of the preprint on March 23, 2020.
The paper originally predicted that ICU capacity would be exceeded in 5 out of your 7 NHS commissioning regions within 14 days, whereas the live model currently predicts that ICUs in only two U.K. regions - London and the Midlands - will be overwhelmed.
Speaking on The Naked Scientists podcast, lead researcher Dr. Ari Ercole emphasized that a large proportion of individuals with COVID-19 is only going to experience mild symptoms.
“I believe it’s very vital that you understand that the coronavirus in most of the people causes a significant mild disease - and it’s still important because these persons are infectious, hence the plans for social distancing - but many people are expected to progress from this disease without any ill effects.”
- Dr. Ari Ercole, consultant in anesthesia and intensive care at Addenbrooke’s Hospital
“However, some people do go on to develop a viral pneumonia - that’s an inflammation of the lungs - and when it’s really severe, that may prevent the [people] from getting oxygen from the exterior world to their bloodstream,” he said.
“And in sincere about cases,” he added, “that may mean that they have to visit the [ICU] to be mechanically ventilated on a life support machine.”
Hospitals over the U.K. have already been taking emergency measures to boost the option of ICU beds.
One way to release beds is to cancel some elective, or planned, surgical operations. Hospitals may also transfer ventilators currently used in operating theatres and redeploy staff from other departments.
Early warning
However, medical service needs early warning of the likely demands on ICUs, since it does take time to create additional capacity.
“So for example, if you wish to take ventilators from operating theatres, you have to move them, you need to train the staff, you need to make sure all of the consumables are available,” said Dr. Ercole.
“It’s no instant thing at all. So really, what we need is an early warning of accurately when it's that the pandemic will probably take hold in intensive care, and that’s what we tried to do with some of the early data.”
The U.K. government happens to be in negotiations with manufacturers to intensify the production of ventilators. Also, they are agreeing on new contracts with others. However, health regulators should approve these new machines, so they will not become available for weeks.
Maintaining staffing levels presents another major problem for ICUs, since doctors, nurses, and other essential personnel should self-isolate if they or an associate of their household develops COVID-19.
Model assumptions
Within their paper, the researchers acknowledge that their model makes several assumptions that risk turning out to be incorrect.
Their early modeling used a figure for the total number of ICU beds which were available in December 2019, for instance. That total will likely be higher now, as emergency measures could have offered extra capacity.
In addition, data from Public Health England may have underestimated the quantity of COVID-19 cases in the wider population, because to date, most diagnostic testing has occurred in hospitals.
However, for the reason that model focuses only on the most extreme cases, the researchers say that this will probably not affect its projections.
Source: www.medicalnewstoday.com
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