• Am J Public Health · May 2021

    Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2.

    • Gonzalo Martínez-Alés, Arce Domingo-Relloso, José R Arribas, Manuel Quintana-Díaz, Miguel A Hernán, and COVID@HULP Group.
    • Gonzalo Martínez-Alés is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Arce Domingo-Relloso is with the National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain, and the Department of Environmental Health Sciences, Columbia University Mailman School of Public Health. José R. Arribas and Manuel Quintana-Díaz are with the Instituto de Investigación Hospital Universitario, La Paz University Hospital, Madrid, Spain. Manuel Quintana-Díaz is also with the Universidad Autónoma de Madrid School of Medicine, Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatics, Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, Boston, MA.
    • Am J Public Health. 2021 May 1; 111 (5): 923-926.

    AbstractObjectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures.Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older.Results. Critical care requirements peaked at 49 beds per 100 000 on April 1-2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000.Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries.Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems.

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