Study evaluates US inpatient, ICU needs should Wuhan-like outbreak occur

An analysis of the need for inpatient and ICU beds during the peak of the COVID-19 pandemic in two Chinese cities indicates that early implementation of strict disease control strategies is needed to prevent overload of local health care systems in U.S. cities.

The comparative effectiveness study, which was recently published in JAMA Network Open, analyzed the need for ICU and inpatient beds for patients with COVID-19 in Wuhan and Guangzhou, China, from Jan. 10 to Feb. 29 to estimate what peak needs would be should a comparable outbreak occur in the United States. Information on estimated confirmed COVID-19 case counts for severe and critical cases was gathered using situation updates from Chinese national and local health commissions. The number of designated COVID-19 beds and hospitalizations was extracted from the Wuhan Municipal Health Commission website.

From Jan. 10 to Feb. 29, 32,486 ICU-days and 176,136 serious inpatient-days were attributable to COVID-19 in Wuhan. During the 51-day study period, there were also a median of 429 patients in the ICU and a median of 1,521 inpatients with serious illness each day. From mid- to late February — during the pandemic’s peak — 19,425 patients (24.5 per 10,000 adults) were hospitalized, with 9,689 in serious condition (12.2 per 10,000 adults) and 2,087 requiring critical care daily (2.6 per 10,000 adults).

In Guangzhou, from Jan. 24 to Feb. 29, 318 ICU-days and 724 serious inpatient days were attributable to COVID-19. During those 37 days, the median number of patients in the ICU was nine and the median number of inpatients with serious illness each day was 17, and during the peak in early February, 15 patients required critical care and 38 were hospitalized in serious condition.

The researchers noted that strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2 in Wuhan, including a citywide lockdown beginning on Jan. 23 that suspended all public transportation within, to and from the city and barred residents from leaving, as well as compulsory wearing of face masks in public and strict social distancing measures. In Guangzhou, however, strict disease control measures were implemented within 1 week of case importation.

There were also several differences between the cities’ handling of patients with COVID-19, according to the researchers. Specifically, in Wuhan, patients with mild disease were isolated in quarantine centers as opposed to designated hospitals, whereas in Guangzhou, all patients were hospitalized until recovery, with a maximum number of hospitalizations of 271 on any day.

At the height of the epidemic, the researchers estimated that the risk for critical care was 1.2 patients per 10,000 adults among those aged 65 years or older and higher among adults with vs. without hypertension (9.5 vs. 1.3 patients per 10,000 adults). Based on the proportion of adults aged 65 years or older (11% to 22.5%) and the crude hypertension prevalence (22% to 46.9%) in the 30 most populous U.S. cities, the projected number of prevalent critically ill patients at the peak of a Wuhan-style outbreak in U.S. cities ranged from 2.2 to 3.2 patients per 10,000 adults after accounting for the difference in age distribution and from 2.8 to 4.4 patients per 10,000 adults after accounting for hypertension prevalence.

“Even after the lockdown of Wuhan on January 23, 2020, the number of patients with serious COVID-19 cases continued to rise, exceeding local hospitalization and ICU capacities for at least a month,” the researchers wrote. “Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on local health care systems in U.S. cities.” – by Melissa Foster

Disclosures: The study was supported by grants from the National Institute of General Medical Sciences, CDC and a gift from the Morris-Singer Fund. Li reports she has received grants from Harvard University. Please see the study for all other authors’ relevant financial disclosures.