On Monday, a team of epidemiologists, infectious disease specialists, actuaries, data scientists and researchers in North Carolina released a brief on hospital capacity in the state**. They used an ensemble of three different modeling approaches to project hospital need and ICU bed need in the state through June 1. They model two scenarios. The first is maintaining current policies throughout the analysis period. The second lifts social distancing restrictions at the end of April and does not replace those policies with substitutes of equal effectiveness. The forecast is based on the probability that capacity is exceeded.
There is good news in the brief:
Under current policies, our models suggest that the volume of available acute care beds throughout the state will be sufficient to handle growing COVID-19-related case volume in the next few weeks. In the second half of April, estimates for the near-term suggest a substantial increase in confirmed state case volumes, to as many as 5,500-6,500 confirmed cases by April 15, up from approximately 2,402 confirmed cases on April 4.6 The probability that acute care bed demand will outstrip available supply will likely increase by mid-April but remains low (
Policy matters. Social and physical distancing is working to flatten the curve in the state. As long as distancing is maintained, capacity is likely to be sufficienct even as the state peaks. Avoiding current infections and thus avoiding future hospitalizations dominates any capacity response of adding new beds to the hospital systems in the state.
The difference in probabilities of demand exceeding bed supply across the surge levels is approximately 2 to 4 percentage points.
Those few points are very valuable points and are worth pursuing but another few hundred beds will be swamped by half a million avoidable infections.
To put the findings in context, the models’ composite estimates indicate that approximately 750,000 people in North Carolina may be infected with the virus by the end of our forecast period, June 1, 2020. This is if the social distancing policies are fully lifted at the end of April and are not replaced by other policies with equal assumed effectiveness to reduce transmission. On the other hand, if the same policies (or some other policies with similar effect) remain in place, the composite estimates indicate that an estimated 250,000 North Carolinians may be infected by June 1.
Until there is massive, rapid, no barrier access to testing that has few false negatives with accompanying public health contact tracing and mass quarantining in place, opening up a state just guarantees a massive shut down and overwhelmed hospitals in a few doubling cycles again. Even as we may be approaching local peaks, those peaks are only peaks because significant chunks of the nation started to shut down in early to mid-March to avoid millions of infections even as tremendous numbers of people are currently and soon to be infected. Opening back up again will just recreate the infection storm from a much higher base of currently infected individuals at the end of April compared to the base of people who were infected at the start of March.
** Disclosure: Most of the authors of the brief are some combination of co-workers, colleagues, co-authors, friends and beer drinking buddies of mine.