Forecasting the impact of the first wave of the COVID-19 pandemic on hospital demand and deaths for the USA and European Economic Area countries
Forecasting the impact of the first wave of the COVID-19 pandemic on hospital demand and deaths for the USA and European Economic Area countries
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预测第一波 COVID-19 大流行对美国和欧洲经济区国家的医院需求和死亡人数的影响
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
C. Murray
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文献类型：
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作者：
C. Murray
摘要背景：医院需要计划由于19号大流行而导致的美国和欧洲经济区（EEA）的每个州或欧洲经济区（EEA）的需求激增。计划者需要在接下来的几周内对最可能的轨迹进行预测，并希望计划在这些预测范围内的较高值。迄今为止，美国或EEA的所有国家都无法对未来几周内最有可能发生的事情进行预测。方法：这项研究使用了有关当地和国家政府网站以及谁的日常死亡的确认COVID-19死亡的数据。从某些位置获得了有关医院容量和利用率以及观察到的Covid-19使用数据的数据，是从某些地方政府的数据来源和直接贡献中获得的。我们开发了非线性回归框架的混合效果，以估计累积和每日死亡率的轨迹，这是实施社会疏远措施的函数，并得到了手机数据中的其他证据的支持。在富数据设置中使用了扩展的混合模型，以捕获不对称的每日死亡模式。预测卫生服务需求是使用微模拟模型进行预测的，该模型估计了使用有关COVID-19患者的临床实践的可用数据，可以估计住院，ICU入院，住院时间和呼吸机的需求。我们假设那些尚未实施学校关闭，非必要的业务关闭以及待在家里的司法管辖区将在二十一天内这样做。调查结果：与许可能力和平均年份占用率相比，美国估计的流行高峰期（4月第二周结束）的超量需求预计为9,079（95％UI 253-61,937 ）总床和9,356（3,526-29,714）ICU床。在流行病的峰值上，呼吸机使用的使用率为16,545（8,083-41,991）。 EEA国家 /地区的相应数字为120,080（119,183-121,107），32,291（32,157-32,425）和28,973（28,868-29,085），在4月6日的峰值上。美国和3月27日至5月4日在EEA的国家。我们估计，到7月底，Covid-19美国的60,308（34,063-140,381）死亡，EEA中的143,088（101,131-253,163）死亡。据估计，在5月4日至6月29日，在美国，在5月4日至6月29日之间，在EEA的国家以及5月4日至7月13日之间，估计COVID-19的死亡人数下降到5月29日至6月29日下降。对医院资源需求的高峰需求的时机在美国和整个欧洲地区之间有很大差异。解释：除了19 Covid-19的大量死亡外，该流行病还将为卫生系统资源负载，远远超出了美国和EEA的当前管理能力，尤其是用于ICU护理和通风器的使用。这些估计可以帮助告知制定和实施策略以减轻这一差距，包括减少19日对服务的需求以及暂时增加系统容量。估计对医院系统的过度需求基于在所有尚未这样做的地点的颁布三周内的社会疏远措施以及整个流行病的维护，并强调了实施，执行和维持这些措施的重要性减轻医院系统超负荷并防止死亡。
Summary Background: Hospitals need to plan for the surge in demand in each state or region in the United States and the European Economic Area (EEA) due to the COVID-19 pandemic. Planners need forecasts of the most likely trajectory in the coming weeks and will want to plan for the higher values in the range of those forecasts. To date, forecasts of what is most likely to occur in the weeks ahead are not available for states in the USA or for all countries in the EEA. Methods: This study used data on confirmed COVID-19 deaths by day from local and national government websites and WHO. Data on hospital capacity and utilisation and observed COVID-19 utilisation data from select locations were obtained from publicly available sources and direct contributions of data from select local governments. We develop a mixed effects non-linear regression framework to estimate the trajectory of the cumulative and daily death rate as a function of the implementation of social distancing measures, supported by additional evidence from mobile phone data. An extended mixture model was used in data rich settings to capture asymmetric daily death patterns. Health service needs were forecast using a micro-simulation model that estimates hospital admissions, ICU admissions, length of stay, and ventilator need using available data on clinical practices in COVID-19 patients. We assume that those jurisdictions that have not implemented school closures, non-essential business closures, and stay at home orders will do so within twenty-one days. Findings: Compared to licensed capacity and average annual occupancy rates, excess demand in the USA from COVID-19 at the estimated peak of the epidemic (the end of the second week of April) is predicted to be 9,079 (95% UI 253-61,937) total beds and 9,356 (3,526-29,714) ICU beds. At the peak of the epidemic, ventilator use is predicted to be 16,545 (8,083-41,991). The corresponding numbers for EEA countries are 120,080 (119,183-121,107), 32,291 (32,157-32,425) and 28,973 (28,868-29,085) at a peak of April 6. The date of peak daily deaths varies from March 30 through May 12 by state in the USA and March 27 through May 4 by country in the EEA. We estimate that through the end of July, there will be 60,308 (34,063-140,381) deaths from COVID-19 in the USA and 143,088 (101,131-253,163) deaths in the EEA. Deaths from COVID-19 are estimated to drop below 0.3 per million between May 4 and June 29 by state in the USA and between May 4 and July 13 by country in the EEA. Timing of the peak need for hospital resource requirements varies considerably across states in the USA and across regions of Europe. Interpretation: In addition to a large number of deaths from COVID-19, the epidemic will place a load on health system resources well beyond the current capacity of hospitals in the USA and EEA to manage, especially for ICU care and ventilator use. These estimates can help inform the development and implementation of strategies to mitigate this gap, including reducing non-COVID-19 demand for services and temporarily increasing system capacity. The estimated excess demand on hospital systems is predicated on the enactment of social distancing measures within three weeks in all locations that have not done so already and maintenance of these measures throughout the epidemic, emphasising the importance of implementing, enforcing, and maintaining these measures to mitigate hospital system overload and prevent deaths.
影响因子：
2.2
作者：
Pya, Natalya;Wood, Simon N.
通讯作者：
Wood, Simon N.