Indications for healthcare surge capacity in European countries facing an exponential increase in COVID19 cases

Frederik Verelst; Elise J. Kuylen; Philippe Beutels

The measures proposed in this paper are an approximation to the current healthcare capacity in Europe. Unfortunately, data on health care capacity is rel atively scarce and we have to rely on data from 2017,2018 or even older. Data availability is even worse for critical care beds, on which we rely on multicountry data from 2010. Remuzzi & Remuzzi report ICU capacity of 5200 beds for Italy as a whole, which is lower than the 7550 critical care beds reported by Rhodes et al. [1, 5] . It is likely that other EU countries have downsized their critical bed capacity too. In terms of curative beds per 100 000 population as reported by Eurostat, for most countries (all except Ireland, Bulgaria, Poland and Romania), we observed a downward trend in the past 10 years. Moreover, hospital capacity strain was recently found to be associated with increased mortality and decreased health outcomes [10] . Note that if we would assume the same extent of downsizing in Italy and other EU countries, our relative comparisons would not change. Note that we compare these countries by their base capacity, while clearly many countries have expanded their base capacity to differing degrees (eg, additional beds, mobilizing volunteers or retired Physicians x critical care beds (Physicians + nurses) x critical care beds health care workers). We therefore will track at which relative pressure individual countries can no langer handle the volume of critical patients and which pressure on their base capacity they experience at the peak. Note also that we do not account for health care workers' incapacitation from COVID-19 or other causes as the epidemic unfolds. Our analysis shows that many European countries are soon to be confronted with a health care pressure that will exceed current healthcare capacity. Based on the intensity-approach and the composite measures, we believe that the healthcare pressure in Spain is already at very high levels. For The Netherlands and France the pressure on healthcare systems will soon reach Italy's levels. Where this is not yet done, policymakers should urgently expand their health care capacities to avoid pressure as experienced in Italy. Our analysis informs policy makers on how far their country is removed from an overloaded healthcare system. As such, this information can be useful to plan ahead in order to relieve pressure on their national healthcare system. Moreover, the evolving healthcare pressure, especially the pressure experienced by each country at the peak, will be useful to plan future outbreaks and a timely expansion of health care capacity.