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Projecting demand for critical care beds during COVID-19 outbreaks in Canada
Affan Shoukat1, Chad R Wells1, Joanne M Langley2
1Center for Infectious Disease Modeling and Analysis (Shoukat, Wells, Galvani), Yale School of Public Health, New Haven, Conn.; Canadian Center for Vaccinology (Langley), Dalhousie University, IWK Health Centre and Nova Scotia Health Authority (Langley), Halifax, NS; Emerging Pathogens Institute (Singer), University of Florida, Gainesville, Fla.; Agent-Based Modelling Laboratory (Moghadas), York University, Toronto, Ont.
Insights
Self-isolation by 40% of mildly ill COVID-19 patients can delay outbreak peaks by up to 8 weeks and reduce intensive care unit (ICU) bed demand by over 50%. However, even with this measure, ICU capacity may still be exceeded during peak demand.
Area of Science:
- Epidemiology
- Public Health
- Health Systems Modeling
Background:
- Rising coronavirus disease 2019 (COVID-19) cases in Canada pose a significant threat to hospital and critical care capacity.
- Evaluating the impact of public health interventions is crucial for managing potential outbreaks.
Purpose of the Study:
- To assess how self-isolation by mildly ill individuals affects COVID-19 outbreak peaks and healthcare demand across Canadian provinces.
- To quantify the reduction in hospital and intensive care unit (ICU) bed requirements under different self-isolation scenarios.
Main Methods:
- Development of a computational model simulating COVID-19 outbreaks in each Canadian province.
- Projection of hospital and ICU bed needs without self-isolation, using an average of 2.5 secondary cases.
- Comparison of scenarios with varying proportions of mildly ill individuals practicing self-isolation within 24 hours of symptom onset.
Main Results:
- Without self-isolation, outbreak peaks are projected for early June, requiring an average of 569 ICU bed days per 10,000 population.
- 20% self-isolation delayed peaks by 2-4 weeks and reduced ICU demand by 23.5%.
- 40% self-isolation delayed peaks by an additional 2-4 weeks and reduced ICU use by 53.6%, though demand could still exceed capacity given high baseline occupancy.
Conclusions:
- Even with 40% self-isolation, peak demand for ICU beds may surpass total available capacity.
- Self-isolation is a vital strategy for mitigating healthcare system strain during COVID-19 outbreaks.
- The study highlights the significant challenges facing Canadian healthcare systems and the potential benefits of public health measures.
Background:
Increasing numbers of coronavirus disease 2019 (COVID-19) cases in Canada may create substantial demand for hospital admission and critical care. We evaluated the extent to which self-isolation of mildly ill people delays the peak of outbreaks and reduces the need for this care in each Canadian province.
Methods:
We developed a computational model and simulated scenarios for COVID-19 outbreaks within each province. Using estimates of COVID-19 characteristics, we projected the hospital and intensive care unit (ICU) bed requirements without self-isolation, assuming an average number of 2.5 secondary cases, and compared scenarios in which different proportions of mildly ill people practised self-isolation 24 hours after symptom onset.
Results:
Without self-isolation, the peak of outbreaks would occur in the first half of June, and an average of 569 ICU bed days per 10 000 population would be needed. When 20% of cases practised self-isolation, the peak was delayed by 2-4 weeks, and ICU bed requirement was reduced by 23.5% compared with no self-isolation. Increasing self-isolation to 40% reduced ICU use by 53.6% and delayed the peak of infection by an additional 2-4 weeks. Assuming current ICU bed occupancy rates above 80% and self-isolation of 40%, demand would still exceed available (unoccupied) ICU bed capacity.
Interpretation:
At the peak of COVID-19 outbreaks, the need for ICU beds will exceed the total number of ICU beds even with self-isolation at 40%. Our results show the coming challenge for the health care system in Canada and the potential role of self-isolation in reducing demand for hospital-based and ICU care.
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