“Beyond containment”: sobering predictions for coronavirus spread

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Intensive Care (ICU), Pandemic, Ventilators • Leave a comment

https://mailchi.mp/325cd862d7a7/the-weekly-gist-march-13-2020?e=d1e747d2d8

 

As of today, over 132K cases of coronavirus, or COVID-19, have been diagnosed worldwide, with nearly 1,300 cases confirmed in the United States. As the number of American cases begins to grow, the New York Times detailed sobering “worst case” projections from the Centers of Disease Control (CDC). CDC scientists evaluated four different scenarios of how the virus could progress, based on virus characteristics, transmissibility and severity of illness, finding that between 160M and 214M Americans could be infected, and as many as 200K to 1.7M could die. The analysis also highlighted a potentially devastating gap in needed hospital capacity, estimating that 2.4M to 21M people could require hospitalization. If these patients were to surge into emergency departments over a short period of time, the nation’s hospitals, which operate only 925,000 staffed beds, could be overwhelmed.

News from Italy, now with over 15K coronavirus patients, shows that intensive care capacity is even more important than free hospital beds. Reports from the country’s epicenter in Milan and surrounding regions paint a picture of “wartime” medicine, with exhibition centers turned into ICUs and doctors, facing a shortage of ventilators, forced to decide who lives and who dies. (Read these two Twitter feeds from Italian clinicians to understand the dire situation and stress on providers in their hospitals.) As we show in the graphic below, while the US has more ICU beds per capita than Italy and many other countries, we still fall short of the number of ventilators that could be needed at peak coronavirus infection rates, or even a severe flu pandemic.
As conditions worsened in Italy, the number of new cases diagnosed in China and South Korea dropped dramatically, suggesting that both have figured out a way to stop the spread of the virus (China’s new infection rate has slowed to just a few dozen cases diagnosed daily). Both countries have mounted a similar response to contain spread. In addition to essentially shutting down all gatherings and movement of people in affected areas, both implemented widespread testing of anyone with symptoms, and aggressive tracing and screening of anyone who may have had contact with an infected patient. (This week, South Korea was testing 15,000 patients per day, while the US had performed fewer than half that number of tests in total.) China’s and South Korea’s processes of managing patients have likely been even more critical to their success in curbing spread.

Both have established dedicated “fever centers” separate from hospitals to screen patients. Once patients are determined to have a fever, they are quarantined in mass units and separated from family, which continues if a patient is confirmed to have the virus. This is in stark contrast to Italy’s directive that infected patients and their contacts quarantine at home, which has been much less effective.

According to infectious disease and public health experts, the United States is at a turning point in working to stop the virus, with the country now past the hope of containing the virus, and the goal shifting to slowing spread. The US has been very slow to increase availability to testing, due to a host of reasons ranging from regulatory red tape and political indecision, to supply chain challenges. Efforts announced by the Trump administration today to ramp up testing, and establish dedicated testing centers separate from doctors’ offices and hospitals, are a step in the right direction. So are moves this week to cancel large gatherings, close schools, and encourage telework.

While government-enforced quarantine measures of the level proven effective in China and South Korea are unlikely to be palatable here, we must all embrace the difficult work of strict social distancing and changing how we work and interact with each other. This may be the key to ensuring we can control spread and slow the rate of infection so we can continue to provide the best care to all severely ill patients.

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