More patients in hospital beds ups COVID-19 deaths

Nurse Karen Hayes uses an oral hygiene tool to administer care to a patient in the acute care COVID unit at Harborview Medical Center on May 7, 2020 in Seattle, Washington. (Credit: Karen Ducey/Getty Images)

Every six additional ICU beds or seven additional non-ICU beds filled by COVID-19 patients leads to one additional COVID-19 death over the following week, new research shows.

“A spike in hospitalization naturally leads to more deaths, but these deaths may not only come from those who are hospitalized, but also from those who should have been hospitalized but were not,” says coauthor Anirban Basu, a professor of health economics at the University of Washington.

Efforts to “flatten the curve” are more important than simply keeping hospitals from becoming overwhelmed.

Results of the study in the Journal of General Internal Medicine show the impact of ICU bed use remains fairly constant as ICU bed availability changes. These effects are also in line with recent literature estimates for the mortality among COVID-19 patients receiving critical care that show mortality rates increase as ICUs fill up.

What was surprising, Basu says, was the effect of non-ICU beds. For additional seven hospitalized patients not in intensive care, one would expect about 0.5 deaths over the next seven days based on general data put out by the Centers for Disease Control. However, this new research finds that the total number of COVID-19 deaths actually occurring is much higher.

“This may indicate that constraints in available capacity of non-ICU beds may have a spillover effect to non-hospitalized patients. In fact, the study found that the effect of non-ICU beds rises steadily as more and more non-ICU beds are occupied by COVID-19 patients,” says Basu, who is also director of the CHOICE Institute at the School of Pharmacy.

For example, when 20% of non-ICU hospital beds are occupied by COVID-19 patients, an additional seven COVID-19 admissions to non-ICU beds will produce two additional COVID-19 deaths over the next seven days.

“Even when, say, 80% of non-ICU beds are still available, a further increase in COVID-19 admissions leads to significantly more numbers of deaths than what we would expect from only the hospitalized patients,” Basu says.

“This may be because the health care delivery within a hospital is not only driven by hospital beds but also personnel and COVID-specific supplies, which may be stretched thin, and affecting COVID-19 admission policies of the hospitals.”

Consequently, Basu says, efforts to “flatten the curve”—that is, reduce or stop the increase of people infected with the novel coronavirus through public health measures such as mask-wearing and physical distancing—are more important than simply keeping hospitals from becoming overwhelmed.

Failure to flatten the curve, even before hospitals reach capacity, is killing more people than just those who end up in hospital beds.

“These results have very important implications as large numbers of students head back to schools and colleges across the nation and resistance to public health measures continues to stymie efforts to reduce the number of infected,” Basu says.

“Our study quantifies the relationship between COVID-19 deaths and COVID-19 hospitalizations using actual data,” write the study authors. “These estimates provide a better understanding of the projections of the COVID-19 pandemic in the USA especially when states are gearing up to restart economic activities and provide important practice insights for hospitals in terms of assessment of hospital bed and ICU bed capacity and preparedness.”

Pinar Karaca-Mandic, professor and academic director of the Medical Industry Leadership Institute at the University of Minnesota is the paper’s lead author. The United Health Foundation and the University of Minnesota Office of Academic Clinical Affairs funded the work.

Source: University of Washington