Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China
Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China
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DOI：
10.1001/jamanetworkopen.2020.8297
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发表时间：
2020-05-06
影响因子：
13.8
通讯作者：
Lipsitch, Marc
中科院分区：
文献类型：
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作者：
Li, Ruoran;Rivers, Caitlin;Lipsitch, Marc
这项比较有效性研究描述并比较了中国两个城市的重症监护病房和住院病床需求，以估计如果爆发相当于武汉的疫情，美国城市需要的重症监护病房床位的峰值。美国主要城市已经发生严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的持续传播。中国城市的能力需求可以为当地医疗资源的规划提供信息。目的描述和比较中国2个城市2019年冠状病毒感染者(新冠肺炎)对重症监护病房(ICU)和住院病床的需求，以估计美国城市在发生与武汉相当的疫情时对ICU床位的高峰需求。设计、设置和对象这项比较有效性研究分析了2020年1月10日至2月29日在武汉和广州确诊的新冠肺炎病例中国。疾病控制措施的暴露时间相对于SARS-CoV-2社区传播的时间。主要结果和衡量指标在研究期间危重和危重病人日数和危重病人高峰数。结果武汉市在SARS-CoV-2持续局部传播6周后，采取了严格的疾病控制措施。在2020年1月10日至2月29日期间，新冠肺炎患者在ICU的中位数(四分位数范围)为429例(25-1143例)，住院大病患者的中位数为1521(111-7202例)。在疫情高峰期，每天有425名患者(每万人24.5人)住院，9689人(每万人12.2人)病情严重，2087人(每万人2.6人)每天需要重症护理。在广州，在病例输入后1周内实施了严格的疾病控制措施。在1月24日至2月29日期间，新冠肺炎每天在ICU中的中位数(四分位数范围)为9(7-12)人，在重症患者中为17(15-26)人。在疫情高峰期，15名患者情况危急，38名患者被归类为重病。根据年龄分布和共病(即高血压)患病率的不同，预计美国城市在类似武汉的疫情高峰期流行的危重患者数量在每1万名成年人中从2.2到4.4人不等。结论和相关性即使在1月23日武汉被封锁后，患有严重新冠肺炎疾病的患者数量仍在继续上升，至少在一个月内超过了当地住院和ICU的能力。迫切需要制定计划来减轻新冠肺炎爆发对美国城市当地医疗体系的影响。问题是，需要多大的医院能力来应对2019年美国城市爆发的严重冠状病毒病，这与干预时机有何关联？在这项有效性比较研究中，武汉的住院和重症监护病房利用率较高，而广州的利用率较低，广州比武汉更早实施严格的社会距离措施以及接触者追踪和隔离方案。根据年龄分布和共病(即高血压)患病率的不同，预计美国城市在类似武汉的疫情高峰期流行的危重患者数量在每1万名成年人中从2.2到4.4人不等。这项研究的结果表明，应及早实施严格的疾病控制战略，以减少2019年冠状病毒疾病爆发期间对住院和重症监护病房床位的需求。
This comparative effectiveness study describes and compares the intensive care unit and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak number of intensive care unit beds needed in US cities if an outbreak equivalent to that in Wuhan occurs.Importance Sustained spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has happened in major US cities. Capacity needs in cities in China could inform the planning of local health care resources. Objectives To describe and compare the intensive care unit (ICU) and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak ICU bed needs in US cities if an outbreak equivalent to that in Wuhan occurs. Design, Setting, and Participants This comparative effectiveness study analyzed the confirmed cases of COVID-19 in Wuhan and Guangzhou, China, from January 10 to February 29, 2020. Exposures Timing of disease control measures relative to timing of SARS-CoV-2 community spread. Main Outcomes and Measures Number of critical and severe patient-days and peak number of patients with critical and severe illness during the study period. Results In Wuhan, strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, 2020, patients with COVID-19 accounted for a median (interquartile range) of 429 (25-1143) patients in the ICU and 1521 (111-7202) inpatients with serious illness each day. During the epidemic peak, 19 & x202f;425 patients (24.5 per 10 & x202f;000 adults) were hospitalized, 9689 (12.2 per 10 & x202f;000 adults) were considered in serious condition, and 2087 (2.6 per 10 & x202f;000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within 1 week of case importation. Between January 24 and February 29, COVID-19 accounted for a median (interquartile range) of 9 (7-12) patients in the ICU and 17 (15-26) inpatients with serious illness each day. During the epidemic peak, 15 patients were in critical condition and 38 were classified as having serious illness. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 & x202f;000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence. Conclusions and Relevance Even after the lockdown of Wuhan on January 23, the number of patients with serious COVID-19 illness continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on the local health care systems in US cities.Question What level of hospital capacity is needed to respond to outbreaks of severe coronavirus disease 2019 in US cities, and how is this associated with intervention timing? Findings In this comparative effectiveness study, higher inpatient and intensive care unit utilization in Wuhan was compared with lower utilization in Guangzhou, which implemented strict social distancing measures as well as contact tracing and quarantine protocols earlier than Wuhan. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 & x202f;000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence. Meaning The findings of this study suggest that strict disease control strategies should be implemented early to mitigate the demand for inpatient and intensive care unit beds during a coronavirus disease 2019 outbreak.