A new model has predicted that demand for beds in intensive care units (ICUs) will outstrip supply in two regions of the United Kingdom by around April 6, 2020.
Doctors and computer scientists in Cambridge, U.K., have predicted the future availability of the country’s intensive care beds during the coronavirus pandemic.
According to the latest figures from the U.K. government, there have been 11,658 confirmed cases of COVID-19, and 578 people have died.
The new model assumes that there will be an exponential increase in cases over the coming weeks.
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Its predictions are available online, and the team updates the model regularly as its underlying assumptions change and to account for new confirmed cases.
At the time of 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 account the total number of ICU beds in each of the seven National Health Service (NHS) commissioning regions in England, as well as the regions’ demographics — including the number of older people in their populations.
The most severe cases tend to be in older people and those with underlying health conditions.
The researchers hope that their model’s predictions will assist NHS decision makers in their emergency planning efforts during the pandemic.
However, they emphasize that people should interpret its projections with caution, due to the limited available data and the many assumptions they had to make.
For example, the model assumes that the current exponential growth in confirmed cases will continue, as this is what happened in Italy.
In a preprint of their paper, the researchers note that demographic and healthcare differences between the two countries will be important factors in determining when ICU capacity is exceeded.
“However, it is noteworthy that the U.K. compares poorly with other high income countries — including Italy — in terms of available ICU bed capacity per capita, and so it is far from inconceivable that 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 effective strategy for containing the spread of the virus.
However, it will likely take several weeks before the U.K. lockdown has any effect on the number of serious COVID-19 cases admitted to intensive care.
A changing picture
The team’s paper has not yet undergone peer review, but the authors say that they want to make the regularly updated projections available to healthcare planners as soon as possible.
As new data have become available and assumptions have changed, the live model’s projections have already 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 the 7 NHS commissioning regions within 2 weeks, 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 the vast majority of people with COVID-19 will only experience mild symptoms.
“I think it’s very important to realize that the coronavirus in most people causes quite a mild disease — and it’s still important because these people are infectious, hence the plans for social distancing — but most people are expected to get better 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 can prevent the [people] from getting oxygen from the outside world into their bloodstream,” he said.
“And in really serious cases,” he added, “that might mean that they need to go to the [ICU] to be mechanically ventilated on a life support machine.”
Hospitals across the U.K. have been taking emergency measures to increase the availability of ICU beds.
One way to free up beds is to cancel some elective, or planned, surgical operations. Hospitals can also transfer ventilators currently in use in operating theatres and redeploy staff from other departments.
However, the health service needs early warning of the likely demands on ICUs, because it takes time to create additional capacity.
“So for example, if you want to take ventilators from operating theatres, you need to move them, you need to train the staff, you need to make sure all the consumables are available,” said Dr. Ercole.
“It’s not an instant thing at all. So really, what we need is an early warning of exactly when it is that the pandemic is likely to take hold in intensive care, and that’s what we tried to do with some of the early data.”
The U.K. government is currently in negotiations with manufacturers to step up the production of ventilators. They are also agreeing on new contracts with other companies. However, health regulators will need to approve these new machines, so they will not become available for several weeks.
Maintaining staffing levels presents another major problem for ICUs, since doctors, nurses, and other essential personnel will need to self-isolate if they or a member of their household develops COVID-19.
In their paper, the researchers acknowledge that their model makes a number of assumptions that may turn out to be incorrect.
Their early modeling used a figure for the total number of ICU beds that were available in December 2019, for example. That total will almost certainly be higher now, as emergency measures will have made available extra capacity.
In addition, data from Public Health England may have underestimated the number of COVID-19 cases in the wider population, because to date, most diagnostic testing has taken place in hospitals.
However, because the model focuses only on the most severe cases, the researchers say that this will probably not affect its projections.
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