US Pandemic related medical resource shortages

[jim mcnamara]

US health care services under severe strain from pandemic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399859/
Would the United States Have Had Too Few Beds for Universal Emergency Care in the Event of a More Widespread Covid-19 Epidemic?
R Jones, Int J Environ Res Public Health. 2020 Jul; 17(14): 5210.

Of interest in the paper in terms of ICU bed hours now versus assessments of July 2020:

Conclusions: Many U.S. states had too few beds to cope with a major Covid-19 epidemic, but this was averted by low population density in many states, which seemed to limit the spread of the virus.

This no longer appears to be true in those same rural states.

North Dakota, low density state, now has the highest Covid-19 case rate, per JHU dashboard 11/29/2020 14:28:27 MST
Incidence rate: 10,321.73 per 100,000 people

19 available ICU beds in North Dakota as of Oct 20, 2020:
https://www.kxnet.com/news/state-news/19-icu-beds-226-non-icu-beds-available-in-nd-as-of-october-20/

Dr A Fauci interview yesterday NBC News :
'We are facing health care staff shortages'
https://www.nbcnews.com/meet-the-press/meet-press-november-29-2020-n1249279

July paper was correct back then, but, as expected, we have health care population problems that started in the Fall.

Note that hospital ICU staff and facilities treat many Non-Covid patients. This impacts very sick people in general

 

[gleem]

Here is a study of ICU bed occupancy from 2005 to 2017.

Objectives
Detailed data on occupancy and use of mechanical ventilators in United States intensive care units (ICU) over time and across unit types, are lacking. We sought to describe the hourly bed occupancy and use of ventilators in US ICUs to improve future planning of both the routine and disaster provision of intensive care.

This study concerns itself with the adequacy of ICU capacity for disasters. My take is it probably looking at regional disaster situations due to airplane crashes, industrial explosions, extreme weather, or terrorist attacks and not a pandemic. ICU units are very expensive to build/equip and staff so one does not wish to have an oversupply.
The study notes that there were about 66,000 ICU beds in the US and at anyone time, about 66% were in use with a third of these are on ventilators. Thus about 22,000 were available on average suggesting adequate surge capacity. It was noted that this excess in occupancy is greater than the total ICU beds in many developed countries ( however, the US is the third most populous country behind China and India).

The study also recognizes that all though the gross statistics indicate the adequacy of the number of ICU beds there are problems. The study found unexpected issues for example small ICUs (rural hospitals) typically had higher occupancy than larger facilities. Thus the current problem we are seeing in the lesser populated regions.

If you are a person with medical issues it behooves you to stay close to larger metropolitan areas or places with medical schools. Typically rural hospitals are not equipped to handle unusual cases and sometimes even relatively common situations as blood in urine cannot be handled since the medical expertise is not routinely available. They will treat the symptoms or stabilize the patient and transfer or refer them to larger nearby facilities.

In recent decades with increased competition and the consolidation of health care facilities into regional networks with the desire to reduce costs and increase efficiency, redundancy is not something that is desired. Additionally, hospitals are always trying to reduce the total bed count to reduce surplus beds since they cost money to maintain. Thus the explosion of one-day surgery procedures. My wife had a knee replacement and was in the hospital for less than 24 hours. Fewer beds less staff needed for more "routine" procedures. We are less prepared for rare events as pandemics.

COVID must provide the impetus to devise a new paradigm for addressing the impact of potential pandemics.
We cannot wait to see how bad it will get before decisive action is taken.