Projecting hospital utilization during the COVID-19 outbreaks in the United States
Projecting hospital utilization during the COVID-19 outbreaks in the United States
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DOI：
10.1073/pnas.2004064117
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发表时间：
2020-04-21
影响因子：
11.1
通讯作者：
Galvani, Alison P.
中科院分区：
文献类型：
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作者：
Moghadas, Seyed M.;Shoukat, Affan;Galvani, Alison P.
随着2019年冠状病毒病（COVID-19）在美国的社区传播，人们越来越关注治疗感染病例的资源是否充足。医院病床、重症监护室（ICU）和呼吸机对于重症患者的治疗至关重要。为了预测疫情高峰的时间和高峰时所需的ICU床位数量，我们模拟了一场以美国人口统计数据为参数的COVID-19疫情。在情景分析中，我们改变了从症状发作到自我隔离的延迟，有症状的个体进行自我隔离的比例，以及基本繁殖数R-0。如果没有自我隔离，当R-0= 2.5时，在疫情高峰期治疗重症患者将需要比美国现有ICU床位多3.8倍的ICU床位。20%的病例在症状出现后24小时进行自我隔离，将延迟和平坦化疫情轨迹，将高峰期所需的ICU床位数量减少48.4%（四分位数范围46.4-50.3%），但仍超过现有能力。当R-0 = 2时，在没有自我隔离的情况下，疫情高峰期需要增加两倍的ICU床位。在这种情况下，24小时内自我隔离对减少ICU床位峰值的比例影响显著更高，为73.5%（四分位数范围为71.4-75.3%）。我们的估计强调了重症监护能力的不足，以处理迅速爆发。鼓励自我隔离的政策，如带薪病假，可能会推迟疫情高峰，从而提供一个时间窗口，有利于紧急动员扩大医院容量。
In the wake of community coronavirus disease 2019 (COVID-19) transmission in the United States, there is a growing public health concern regarding the adequacy of resources to treat infected cases. Hospital beds, intensive care units (ICUs), and ventilators are vital for the treatment of patients with severe illness. To project the timing of the outbreak peak and the number of ICU beds required at peak, we simulated a COVID-19 outbreak parameterized with the US population demographics. In scenario analyses, we varied the delay from symptom onset to self-isolation, the proportion of symptomatic individuals practicing self-isolation, and the basic reproduction number R-0. Without self-isolation, when R-0= 2.5, treatment of critically ill individuals at the outbreak peak would require 3.8 times more ICU beds than exist in the United States. Self-isolation by 20% of cases 24 h after symptom onset would delay and flatten the outbreak trajectory, reducing the number of ICU beds needed at the peak by 48.4% (interquartile range 46.4-50.3%), although still exceeding existing capacity. When R-0 = 2, twice as many ICU beds would be required at the peak of outbreak in the absence of self-isolation. In this scenario, the proportional impact of self-isolation within 24 h on reducing the peak number of ICU beds is substantially higher at 73.5% (interquartile range 71.4-75.3%). Our estimates underscore the inadequacy of critical care capacity to handle the burgeoning outbreak. Policies that encourage self-isolation, such as paid sick leave, may delay the epidemic peak, giving a window of time that could facilitate emergency mobilization to expand hospital capacity.