Estimated surge in hospital and intensive care admission because of the coronavirus disease 2019 pandemic in the Greater Toronto Area, Canada: a mathematical modelling study.
COVID-19
/ diagnosis
Canada
/ epidemiology
Forecasting
/ methods
Health Services Needs and Demand
/ trends
Hospitalization
/ statistics & numerical data
Hospitals
/ statistics & numerical data
Humans
Inpatients
/ statistics & numerical data
Intensive Care Units
/ statistics & numerical data
Models, Theoretical
SARS-CoV-2
/ genetics
Surge Capacity
/ statistics & numerical data
Journal
CMAJ open
ISSN: 2291-0026
Titre abrégé: CMAJ Open
Pays: Canada
ID NLM: 101620603
Informations de publication
Date de publication:
Historique:
entrez:
23
9
2020
pubmed:
24
9
2020
medline:
24
9
2020
Statut:
epublish
Résumé
In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired. To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity. Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.
Sections du résumé
BACKGROUND
In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired.
METHODS
To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R
RESULTS
For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity.
INTERPRETATION
Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.
Identifiants
pubmed: 32963024
pii: 8/3/E593
doi: 10.9778/cmajo.20200093
pmc: PMC7641231
doi:
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
E593-E604Informations de copyright
Copyright 2020, Joule Inc. or its licensors.
Déclaration de conflit d'intérêts
Competing interests: Eric Coomes is the co–principal investigator on a randomized controlled trial of chemoprophylaxis for COVID-19. This trial is funded by the Toronto COVID-19 Action Initiative and Thistledown Foundation. No other competing interests were declared.
Références
Int J Infect Dis. 2020 May;94:154-155
pubmed: 32179137
N Engl J Med. 2020 Mar 26;382(13):1199-1207
pubmed: 31995857
Int J Infect Dis. 2020 Apr;93:201-204
pubmed: 32097725
Lancet Infect Dis. 2020 Jul;20(7):803-808
pubmed: 32246905
Science. 2020 May 8;368(6491):
pubmed: 32234805
BMJ. 2020 Feb 19;368:m606
pubmed: 32075786
Immunity. 2020 May 19;52(5):737-741
pubmed: 32433946
J Travel Med. 2020 Mar 13;27(2):
pubmed: 32052846
Acad Emerg Med. 2006 Nov;13(11):1228-31
pubmed: 16807399
Eur Respir J. 2020 May 14;55(5):
pubmed: 32217650
Lancet Respir Med. 2020 May;8(5):475-481
pubmed: 32105632
J Clin Med. 2020 Feb 14;9(2):
pubmed: 32075152
Emerg Infect Dis. 2020 Jun;26(6):1339-1441
pubmed: 32168463
JAMA. 2020 Apr 7;323(13):1239-1242
pubmed: 32091533
Euro Surveill. 2020 Feb;25(5):
pubmed: 32046819
Int J Hyg Environ Health. 2020 Jul;228:113555
pubmed: 32460229
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Euro Surveill. 2020 Mar;25(9):
pubmed: 32156327
J Clin Virol. 2020 Jun;127:104364
pubmed: 32311650
Nature. 2020 Apr;580(7803):316-318
pubmed: 32242115
Innovation (Camb). 2020 Nov 25;1(3):100048
pubmed: 33521762
Can Commun Dis Rep. 2020 May 07;46(5):150-154
pubmed: 32558821
Ann Intern Med. 2020 May 5;172(9):621-622
pubmed: 32160273
CMAJ. 2020 Mar 23;192(12):E314-E318
pubmed: 32144097
Nature. 2020 Mar 20;:
pubmed: 32203376
Int J Infect Dis. 2020 Apr;93:284-286
pubmed: 32145466
Int J Infect Dis. 2020 Apr;93:211-216
pubmed: 32145465
Euro Surveill. 2020 Mar;25(12):
pubmed: 32234121
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Signal Transduct Target Ther. 2020 Feb 21;5(1):18
pubmed: 32296012
J Infect. 2020 Apr;80(4):401-406
pubmed: 32112886
Clin Gastroenterol Hepatol. 2020 Jun;18(7):1561-1566
pubmed: 32283325
Ann Intern Med. 2020 May 05;172(9):577-582
pubmed: 32150748