Construction of a demand and capacity model for intensive care and hospital ward beds, and mortality from COVID-19.
Construction of a demand and capacity model for intensive care and hospital ward beds, and mortality from COVID-19.
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DOI：
10.1186/s12911-021-01504-y
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发表时间：
2021-04-27
影响因子：
3.5
通讯作者：
Sarkar R
中科院分区：
文献类型：
--
作者：
Martin C;McDonald S;Bale S;Luteijn M;Sarkar R
本文描述了一个模型，用于估计COVID-19相关的超额死亡，这是医院病房床位和重症监护室（ICU）容量不足的直接后果。使用房室模型估计截至2021年4月下旬在英格兰所需和接受的ICU和病房护理的不同组合下的死亡人数。模型参数来自公开的政府信息和整理COVID-19数据的组织。使用子模型来估计死亡率标量，其表示由于ICU或普通病房床位容量不足而导致的死亡率增加。三个说明性的情况下，招生人数，“乐观”，“中等”和“悲观”，建模和随后的观察到2月3日进行比较。主要产出是所描述的需求和能力模型。在“乐观”情景中，没有因缺乏能力而造成过多死亡。几个“中等”场景应用导致了过量死亡--高达597例死亡（增加0.6%），与最佳估计ICU容量相比减少了20%。所有的“悲观”情景应用都导致了超额死亡，从49，178人（增加17.0%）的病房床位可用性增加20%到103，735人（增加35.8%）的病房床位可用性短缺20%。这些情景没有考虑到新的、更具传播性的、令人担忧的变异体的出现（b.1.1.7）。当医院需求超过现有能力时，死亡率就会增加。在“乐观”情景下，预计不会有过多的死亡人数。“中等”情景可能导致一些额外的死亡-相对于死亡总数增加0.7%。“悲观”情景将导致大量超额死亡。我们的敏感性分析表明，范围在49，178（增加17%）和103，735（增加35.8%）之间。鉴于新的变异，悲观的情况似乎越来越有可能，并可能导致COVID-19死亡人数大幅增加。在这种情况下，似乎在国家一级的任何阶段都没有超过能力，没有过多的死亡。目前尚不清楚，地方能力的轻微不足是否导致了任何少量的额外死亡。在线版本包含补充材料，可通过10.1186/s12911-021-01504-y获得。
This paper describes a model for estimating COVID-19 related excess deaths that are a direct consequence of insufficient hospital ward bed and intensive care unit (ICU) capacity. Compartmental models were used to estimate deaths under different combinations of ICU and ward care required and received in England up to late April 2021. Model parameters were sourced from publicly available government information and organisations collating COVID-19 data. A sub-model was used to estimate the mortality scalars that represent increased mortality due to insufficient ICU or general ward bed capacity. Three illustrative scenarios for admissions numbers, ‘Optimistic’, ‘Middling’ and ‘Pessimistic’, were modelled and compared with the subsequent observations to the 3rd February. The key output was the demand and capacity model described. There were no excess deaths from a lack of capacity in the ‘Optimistic’ scenario. Several of the ‘Middling’ scenario applications resulted in excess deaths—up to 597 deaths (0.6% increase) with a 20% reduction compared to best estimate ICU capacity. All the ‘Pessimistic’ scenario applications resulted in excess deaths, ranging from 49,178 (17.0% increase) for a 20% increase in ward bed availability, to 103,735 (35.8% increase) for a 20% shortfall in ward bed availability. These scenarios took no account of the emergence of the new, more transmissible, variant of concern (b.1.1.7). Mortality is increased when hospital demand exceeds available capacity. No excess deaths from breaching capacity would be expected under the ‘Optimistic’ scenario. The ‘Middling’ scenario could result in some excess deaths—up to a 0.7% increase relative to the total number of deaths. The ‘Pessimistic’ scenario would have resulted in significant excess deaths. Our sensitivity analysis indicated a range between 49,178 (17% increase) and 103,735 (35.8% increase). Given the new variant, the pessimistic scenario appeared increasingly likely and could have resulted in a substantial increase in the number of COVID-19 deaths. In the event, it would appear that capacity was not breached at any stage at a national level with no excess deaths. it will remain unclear if minor local capacity breaches resulted in any small number of excess deaths. The online version contains supplementary material available at 10.1186/s12911-021-01504-y.
DOI：
10.1016/s0140-6736(20)32661-1
发表时间：
2021-01-09
期刊：
Lancet (London, England)
影响因子：
--
作者：
Voysey M;Clemens SAC;Madhi SA;Weckx LY;Folegatti PM;Aley PK;Angus B;Baillie VL;Barnabas SL;Bhorat QE;Bibi S;Briner C;Cicconi P;Collins AM;Colin-Jones R;Cutland CL;Darton TC;Dheda K;Duncan CJA;Emary KRW;Ewer KJ;Fairlie L;Faust SN;Feng S;Ferreira DM;Finn A;Goodman AL;Green CM;Green CA;Heath PT;Hill C;Hill H;Hirsch I;Hodgson SHC;Izu A;Jackson S;Jenkin D;Joe CCD;Kerridge S;Koen A;Kwatra G;Lazarus R;Lawrie AM;Lelliott A;Libri V;Lillie PJ;Mallory R;Mendes AVA;Milan EP;Minassian AM;McGregor A;Morrison H;Mujadidi YF;Nana A;O'Reilly PJ;Padayachee SD;Pittella A;Plested E;Pollock KM;Ramasamy MN;Rhead S;Schwarzbold AV;Singh N;Smith A;Song R;Snape MD;Sprinz E;Sutherland RK;Tarrant R;Thomson EC;Török ME;Toshner M;Turner DPJ;Vekemans J;Villafana TL;Watson MEE;Williams CJ;Douglas AD;Hill AVS;Lambe T;Gilbert SC;Pollard AJ;Oxford COVID Vaccine Trial Group
通讯作者：
Oxford COVID Vaccine Trial Group
影响因子：
9.3
作者：
McCabe R;Schmit N;Christen P;D'Aeth JC;Løchen A;Rizmie D;Nayagam S;Miraldo M;Aylin P;Bottle A;Perez-Guzman PN;Ghani AC;Ferguson NM;White PJ;Hauck K
通讯作者：
Hauck K