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

The World Health Organization declared the novel coronavirus SARS-CoV2 a public health emergency of international concern on January 30, 2020 and a pandemic on March 12, 2020. 1 Nations around the world are increasingly experiencing case clusters or community transmission. As of March 26, 2020, the United States had the highest number of confirmed cases of COVID-19, the disease caused by SARS-CoV2, of any country in the world. 2 Multiple areas in the US are seeing dramatic increases in cases of COVID-19 and concerns are mounting that local medical system response capacities will be quickly exceeded. Hospital critical care is perhaps the most important medical system choke point in terms of preventing deaths in a disaster scenario such as with the current COVID-19 pandemic. 3, 4 A spectrum of critical care, from intensive care units to other serviceable hospital critical care structures, can be drafted in the event of mass disasters, potentially doubling hospital capacity in a crisis care surge situation. 5, 6, 7, 8 However, whether the nation's potential hospital surge capacity is exactly double, or perhaps more or less than that, in the context of rapidly growing cases of COVID-19 in the US, remains unclear. We therefore brought together previously established disease modeling estimates 9 of the growth of the COVID-19 epidemic in the US under various social distancing contact reduction assumptions, with local estimates of the potential critical care surge response 10 across all US counties. Our objectives in doing this was to highlight US counties that are at risk of exceeding their critical care surge capacity limits within one month, indicate the typical time it would take these counties to exceed their critical care surge capacity limits, and estimate the excess mortality that would potentially result from exceeding critical care surge capacity limits in these counties. These objectives speak to the capabilities of the US medical system under disaster conditions and the usefulness of social distancing and other prevention strategies for slowing the presentation rate of severe COVID-19 cases to a point where the US critical care system can adapt in minimizing preventable mortality. 11, 12