How many intensive care beds do we need?

As the coronavirus continues to spread in leaps and bounds, we trust that the authorities are pulling out all the stops to enable us to tackle the disease as effectively as we can. Intensive care capacity is clearly a key element, and the only way to save those seriously affected. How many intensive care beds are we likely to need? The authorities have not said, but with a mass of data available on the course of Covid-19 so far, it is possible to make estimates. Russell Hall examines what the statistics are telling us so far, and also prepared the charts.

The prospect of a requirement of 900 beds for the population of Hastings, as suggested recently by Cllr Colin Fitzgerald, is certainly worrying. The aim of East Sussex Healthcare NHS Trust (ESHT) to quintuple capacity in the region to around 100 beds falls a long way short of that number.

But careful analysis and modelling by experts in the field paints a somewhat different picture.

Imperial College Covid-19 Response Team scientists modelling the spread of the disease have estimated that at the peak of the epidemic in the UK 7,836 critical care beds will be required for its nearly 68 million citizens, but the number will be significantly higher if people fail to strictly observe government social distancing instructions.

The modelling estimated that 3,805,866 UK residents are likely to become infected under the most stringent suppression strategy throughout the course of the epidemic, equating to 5.61% of the population.

For the 188,511 residents of Hastings and Rother the modelling suggests that as a proportion of the UK population it is likely around 21 critical care beds will be required during the peak of the virus outbreak at the Conquest Hospital – just within capacity once it has been doubled as promised by ESHT, although since Hastings and Rother have an older demographic than that of the UK as a whole, and the likely severity of the disease increases with age, the number of critical care beds needed in the area is expected to be higher.

Figures from Public Health England show there were 155 confirmed Covid-19 cases reported in East Sussex (see graph above) and 14 deaths due to the outbreak up to 5 April.

Contrasting estimates

Researchers at the University of Cambridge have estimated the case mortality rate for the South East region to be 1.27% with 2.63% of confirmed cases requiring a critical care bed. If the Imperial College modelling estimate of the number of UK residents likely to become infected is realised, then proportionally 10,568 Hastings and Rother residents may become infected through the course of the epidemic, requiring 278 critical care beds over time and resulting in 134 deaths according to the Cambridge estimates. That contrasts with the Imperial model which suggests 61 deaths in the area.

Again the older demographic of the area compared to the UK as a whole would mean these figures would likely be higher; they are central estimates that depend on the public response to the social distancing instructions, and will also be affected by changes in official policy.

It should also be borne in mind that testing capacity constraints mean there are likely many more cases than currently recorded.

From 28 March to 2 April the NHS East Sussex Clinical Commissioning Group reported 2,761 triage calls to the 111 and 999 numbers, along with 12,769 completed online assessments in 111 Online, where it was concluded was that the patient might have Covid-19 out of a population of 554,590. These are people with Covid-19 symptoms, not confirmed cases of the virus.

Cases doubling every three days

While it is too early to say when the rise in the number of new East Sussex confirmed cases each day will peak, the number of cases in East Sussex has recently been doubling roughly every three days, as this log scale presentation of the data shows.

The Imperial College modelling indicates that to control the spread of the virus the current social distancing measures will need to stay in place until the weekly death rate drops below 136 in the UK. In the last week there were 3,706 Covid-19 deaths in the UK.

Plateau approaching

Professor Neil Ferguson of Imperial College said on 5 April, “We think this epidemic in the UK will plateau in the next week to 10 days. What’s critically important then is how quickly case numbers go down though – do we see a kind of long flat peak, or do we, as we hope, see a much faster decline, and that really depends on how effective the current measures are.” On social distancing he added that there “are some signs that it is slowing the epidemic”.

There were 1,712 Covid-19 hospital admissions in the South East on 4 April, an increase of 11% on the previous day and in contrast to a rise of 25% in the North West. Admissions have flattened out in the last few days, but whether they have reached a peak is again too early to say.

Death toll

The number of UK deaths due to Covid-19 reported daily by Public Health England is currently doubling every three days with 4,934 deaths to date. The figures only include Covid-19 deaths in hospitals, omitting those in the community, and are recorded on the day the deaths were reported instead of when they occurred, so the final figures will be higher.

The number of deaths due to the disease in the UK is currently on a similar trajectory to that of other European nations and the United States. South Korea is a notable exception and could provide valuable lessons on how to tackle the coronavirus crisis.

 

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