Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada
Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada
复制标题
DOI：
10.1503/cmaj.200715
复制
发表时间：
2020-06-15
影响因子：
14.6
通讯作者：
Sander, Beate
中科院分区：
文献类型：
--
作者：
Barrett, Kali;Khan, Yasin A.;Sander, Beate
背景：2019年冠状病毒病(新冠肺炎)的全球传播在多个司法管辖区继续，给医疗保健系统造成巨大压力。我们研究的目的是预测加拿大安大略省新冠肺炎大流行对患者预后和医院资源使用的影响。方法：我们开发了一个个体水平的模拟来模拟新冠肺炎患者在安大略省医院系统中的流动。我们模拟了疫情轨迹和医院卫生保健能力的不同组合情景。我们的结果包括需要住进病房或重症监护病房(ICU)的患者的数量，是否需要机械通气，资源耗尽的天数，等待资源的患者数量和死亡人数。结果：我们发现，只要及早采取有效的公共卫生措施，医院系统的资源不会枯竭。如果实际距离的实施延迟或无效，医院资源会在14至26天内耗尽，而在最坏的情况下，13 321名病人会在等待所需资源的过程中死亡。通过采取积极措施增加ICU、呼吸机和急性护理医院的能力，资源枯竭将被避免或延迟。解读：我们发现，如果没有积极的物理距离措施，安大略省的医院系统将不足以管理预期数量的新冠肺炎患者，尽管容量迅速增加。这种医院资源的缺乏将导致死亡率的增加。通过使用公共卫生措施和增加医院容量来减缓疾病的传播，安大略省可能已经避免了给医院带来灾难性的压力。
BACKGROUND: The global spread of coronavirus disease 2019 (COVID-19) continues in several jurisdictions, causing substantial strain to health care systems. The purpose of our study was to predict the effect of the COVID-19 pandemic on patient outcomes and use of hospital resources in Ontario, Canada. METHODS: We developed an individual-level simulation to model the flow of patients with COVID-19 through the hospital system in Ontario. We simulated different combined scenarios of epidemic trajectory and hospital health care capacity. Our outcomes included the number of patients who needed admission to the ward or to the intensive care unit (ICU) with or without the need for mechanical ventilation, number of days to resource depletion, number of patients awaiting resources and number of deaths. RESULTS: We found that with effective early public health measures, hospital system resources would not be depleted. For scenarios with late or ineffective implementation of physical distancing, hospital resources would be depleted within 14-26 days, and in the worst case scenario, 13 321 patients would die while waiting for needed resources. Resource depletion would be avoided or delayed with aggressive measures to increase ICU, ventilator and acute care hospital capacities. INTERPRETATION: We found that without aggressive physical distancing measures, the Ontario hospital system would have been inadequately equipped to manage the expected number of patients with COVID-19 despite a rapid increase in capacity. This lack of hospital resources would have led to an increase in mortality. By slowing the spread of the disease using public health measures and by increasing hospital capacity, Ontario may have avoided catastrophic stresses to its hospitals.