As the COVID-19 outbreak worsens, Professor Carri Chan says it is vital that the US hospital system and the public take immediate steps to stave off a crisis-level shortage of ICU beds.
“Hospitals are worried and they recognize they are getting close to their limits,” Chan says.
According to the National Institutes of Health, an average of 85 percent of the nation’s 75,000 ICU beds are occupied, leaving roughly 11,250 available, well below the estimated 67,000 beds that would be needed in a best-case scenario over the next six months to treat COVID-19 patients.
Writing in the New York Daily News, Chan, associate professor in the Decision, Risk, and Operations Division, stressed the importance of testing and early treatment, which can reduce mortality rates by 10 percent while lessening the burden on ICUs.
Below, Chan discusses her research on ICU capacity and hospital delays and offers advice on how people can help stem the pandemic.
How will hospitals address the problem of delays and wait times?
My research demonstrates that delays can result in patients deteriorating. When they eventually do receive care, it takes longer to treat them and return them to a good health state. As a consequence, we need to have more capacity to account for this.
In a resource-limited environment, if you have a large burst of patients coming in, they're going to create waits for each other. But once those patients receive care and are admitted into the hospital, they’re going to need to use more of the resource, and that's going to create delays for more patients. This dynamic is going to end up creating more demand for the limited resource. Things can quickly spiral out of control. With this notion in mind, I started thinking about strategies that might be used to counterbalance this. If we're more proactive and if we bring care to patients before these delay effects come into play, maybe you won't need as many resources to return them to a good level of health.
What exactly do hospitals need to do to be more proactive in treating COVID-19?
We don’t have enough data for the COVID-19 illness specifically to know what the exact benefits of early therapies are. But, if we are able to extrapolate from what we've seen from other coronaviruses in the family— SARS, swine flu, seasonal flu—there's evidence that early treatments do have an impact on reducing mortality risk and length of stay.
If we're able to get people into the ICU earlier, we reduce their mortality risk. And if they don’t need to stay in the bed as long, we can get more patients into the ICU with the same amount of capacity. We can treat more patients and improve overall mortality risk. It can be a win-win situation, as long as you are focused on the most at-risk patients.
What challenges do hospitals face in taking this proactive approach?
You don't want to start giving care to people who don't need it. The ICU is a very expensive resource. There are a limited number of ventilators and a limited number of ICU beds, so you don't want to start admitting lots of patients who could possibly never need ICU care because it could limit access for potentially other, sicker patients. They could get better without ever having to go to the ICU in the first place.
This is the core trade off that we were trying to understand and study. You don't want to start admitting every single person who walks into the hospital into the ICU. On the other hand, if you can identify the most at-risk patients, the ones who are most likely to deteriorate and need to go to the ICU, there are substantial benefits to being able to give that care early.
Is there anything the American hospital system can learn from how China and Italy addressed the outbreak?
If you look at the contrast between the countries, Italy moved slowly. I don't think that they recognized the severity of what could happen. And now, they're in this situation where there are a lot of people who are sick, they don't have enough space, and they're having to make very tough decisions.
I think with Wuhan, it took some time for China to recognize that this was something they needed to take a lot of action on. But if you look outside of Wuhan, the rest of China acted quickly and decisively. You can see from the statistics, this proactive response helped. The mortality rate in Wuhan is much, much higher than in the rest of China.
You’ve researched the benefit of hospitals using step-down units (SDUs), which provide an intermediate level of care between ICUs and general wards. Will SDUs prove effective in treating COVID-19?
I think that is a potential strategy to help mitigate some of the demand on ICUs. Some of the work that I've done with my CBS colleague Linda Green, the Cain Brothers and Company Professor of Healthcare Management, finds evidence that suggests if we can discharge patients from the ICU to a step-down unit, they have a better prognosis than if you send them to a regular ward.
What are steps the public can take to help mitigate the demand on hospital capacity?
Please practice social distancing and good hygiene–wash your hands carefully. Stay away from people as much as possible. There are a lot of carriers who have no idea that they have it. You might have it.
Do not go to the hospital unless you really need to. They are already inundated. They are already busy managing their normal demand of people having heart attacks and various acute episodes on top of the pandemic. If you're not feeling well, but you're able to manage it at home, stay at home because you could get other people sick. If you don't end up having it, but you suspect you might and you go to the hospital, there are going to be people there who do have it and could transmit it to you.
Mitigate your risks and activities to reduce the chance of their having to go to the hospital for any reason. If we all act collectively and we all act responsibly, we will eventually emerge from this. It took China nearly three months to get to the point where there were no more cases of local transmission. We need to act rapidly and intensely to “flatten the curve” and put our healthcare system in the best position possible to handle this pandemic.