Flattening the curve before it flattens us: hospital critical care capacity limits and mortality from novel coronavirus (SARS-CoV2) cases in US counties

Charles C Branas; Andrew Rundle; Sen Pei; Wan Yang; Brendan G Carr; Sarah Sims; Alexis Zebrowski; Ronan Doorley; Neil Schluger; James W Quinn; Jeffrey Shaman

Roughly 10,000 to 20,000 excess deaths stemming from inaccessible critical care could be averted within the 4 week study period through greater preventive actions such as travel restrictions, publicly imposed contact precautions, greater availability of rapid testing for COVID-19, social distancing, self-isolation when sick, and similar interventions. Moreover, roughly 4,000 to 11,000 excess deaths stemming from inaccessible critical care could be averted within the 4 week study period through aggressive critical care surge response and preparations, including high clearance of ICU and non-ICU critical care beds and extraordinary measures like using a single ventilator for multiple patients. Adding in the capability of putting two patients on a single ventilator in order to meet demands in a high-volume disaster such as the current pandemic could save the lives of an additional 979 to 4,474 critically ill COVID-19 patients over a month. 34 The highest proportion of excess COVID-19 deaths that could have been averted with access to critical care are shown to occur in the Northeast US and urban counties over the projected month studied, a reflection of the COVID-19 caseload in the New York City region. However, seven other major clusters of potentially preventable deaths due inadequate critical care access were estimated across the US. Assuming a high level of contact reduction and a high level of critical care surge response, these clusters most prominently include counties in New York, Colorado, and Virginia, although relaxations of these high assumptions were shown to add clusters in states such as Louisiana, Michigan, and Virginia.