The demand for inpatient and ICU beds for COVID-19 in the US: lessons from Chinese cities

Ruoran Li; Caitlin Rivers; Qi Tan; Megan B Murray; Eric Toner; Marc Lipsitch

Exceeding healthcare capacity may also lead to decreased quality of care, such as not being able to get access to a ventilator, which would lead to an increased case fatality ratio. By the end of February, Wuhan's case fatality ratio was 4.5%, 3.2% for the rest of Hubei province, and for the rest of China, where healthcare capacity was not exceeded due to strong social distancing and contact quarantine measures in the early phase of the epidemic (such as Guangzhou), 0.8%. 13 In both Wuhan and Guangzhou, the lockdowns did not lead to immediate downturns in the demand for hospitalization or the number of serious cases; rather, the peak in these measures occurred approximately a month after the lockdown in Wuhan, and two weeks after the lockdown in Guangzhou. This delay reflects the potentially long time from infection to severe and critical conditions as many COVID-19 patients who eventually require ICU care present initially as having only mild symptoms, 14 and even longer time to discharge or death, 15 resulting in the accumulation of hospitalized cases long after the downturns in the community spread. In Wuhan, the longer delay may also reflect the ongoing transmission after the lockdown described above, which itself resulted from the overloading of the healthcare system. This study has several limitations. We relied on officially reported statistics, which may not represent the change of actual case counts over time, but rather a reflection of testing and hospitalization capacity. The trend in Wuhan of the number of serious cases and hospitalizations is thus not reflective of actual need, but rather the trend in maximum capacity of the Wuhan system in diagnosis and treatment. We are therefore more confident of the hospitalization and serious case counts in Wuhan after mid-February, and in Guangzhou, where excess capacities in diagnosis and treatment were reported based on both official and unofficial sources. In addition, our projection of the ICU bed needs in US cities does not take into account scenarios where local transmission may differ from that of Wuhan.