Saturday, March 14, 2020

Government preparations for COVID-19

Updated 16 March 2020 with many more references and stats for four countries.

I am not in the business of predicting the future, which is a dangerous activity at the best of times. But governments are now taking actions based on their best predictions, along with other factors. Chief among these is the requirement that they do not panic their citizenry. History has shown the people are caring when the chips are down. But in the transition period there can be panic.

Is our government here in Ireland doing the right thing? Is your government?

The answer depends on evaluating the likely outcomes of the current pandemic. At this point we have a good deal of statistical information on the virus, even if this is still incomplete. (See my previous article for key information about the reproductive factor R.)

Gabriel Leung is the chair of public health medicine at Hong Kong University. He has stated that if R is 2.5, then 60-80% of a given population will catch the virus [Boseley 2020]. Harvard epidemiologist Marc Lipsitch has also given the 60% figure [Schlak 2020]. Other medical sources concur.

Of those people with the virus, many have minor symptoms that do not require special attention. But approximately 20% need hospitalization for oxygen supplementation and other care [WHO 2020]. About 5% need intensive care for up to several weeks. Irish experts agree with this estimate [Clarke 2020]. And this is not even the worst case scenario. In Lombardy 7.7% of the ill are in ICU [Jacobson 2020].

There are five million people in the Republic of Ireland. This means that up to 600,000 will need a bed. About 150,000 will need intensive care. Yes, that number looks incredible. But we are in an unprecedented viral scenario.

As we well know, the capacity of our hospitals is incredibly low. This is why hospitals have been furiously ejecting patients, cancelling treatments, and bringing extra resources online. The HSE (Health Service Executive) is finding 10,000 beds in "existing health facilities, student accommodation, hotel rooms, military and other sites" [Bowers 2020b]. This is being called the "worst-case scenario," but in fact it's highly optimistic. For these are not ICU beds.

How many ICU beds does Ireland have? As of 2019 we have 255. Occupancy of those beds is way over the recommended 80% maximum; in fact it's 96% in some units [Bowers 2020a].

Italy has the best health care systems in Europe. Yet Italian doctors are now making triage decisions to determine who lives and who dies [Monella 2020]. It's a wartime scenario.

Panic is not the answer. The answer is to strictly self-isolate and follow the recommendations already published. This process will "flatten the curve", reducing the peak need for medical services, and giving resources more time to get online [Milman 2020].

Our government in Ireland has acted more promptly than others (the UK for example) and is doing what they can with the pathetic state of our health care system.

It is our job to help wherever possible.

Then, when this crisis is averted, we must build a robust health care system that can deal with both our daily needs and the next health emergency.

Here's a chart showing the data for several countries. Canadian stats come from Fowler et al 2015. UK figures from Ewbank et al. 2017. Italian figures from Jacobson 2020.




References

Boseley, Sarah. 2020. "Coronavirus 'could infect 60% of global population if unchecked'." The Guardian [website], 11 February 2020. Available: https://www.theguardian.com/world/2020/feb/11/coronavirus-expert-warns-infection-could-reach-60-of-worlds-population

Bowers, Fergal. 2020a. "Lack of ICU beds impacting patient care - report." RTÉ [website], 12 February 2020. Available: https://www.rte.ie/news/health/2020/0211/1114690-icu-beds/

Bowers, Fergal. 2020b. "Covid-19: Big rise in testing expected as threshold changes." RTÉ [website], 13 March 2020. Available: https://www.rte.ie/news/coronavirus/2020/0313/1122004-coronavirus-ireland-health/

Clarke, Vivienne. 2020. "Consultant warns not enough ICU beds in event of coronavirus outbreak." Irish Examiner [website], 24 February 2020. Available: https://www.irishexaminer.com/breakingnews/ireland/consultant-warns-not-enough-icu-beds-in-event-of-coronavirus-outbreak-983636.html

Ewbank, Leo; James Thompson; Helen McKenna. 2017. "NHS hospital bed numbers: past, present, future." The King's Fund [website], 29 September 2017. Available: https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers

Fowler, Robert A. et al. 2015. "Critical care capacity in Canada: results of a national cross-sectional study." Critical Care 19.1: 133.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426537/

Jacobson, Don. 2020. "Italy on pace to run out of beds for critically ill coronavirus patients." United Press International [website], 13 March 2020. Available: https://www.upi.com/Top_News/World-News/2020/03/13/Italy-on-pace-to-run-out-of-beds-for-critically-ill-coronavirus-patients/5921584108815/

McCarthy, Niall. 2020. "The countries with the most critical care beds per capita [infographic]." Forbes [website], 12 March 2020. Available: https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/

Milman, Oliver. 2020. "Covid-19 outbreak: what do health experts mean by 'flattening the curve'?" The Guardian [website], 10 March 2020. Available: https://www.theguardian.com/world/2020/mar/10/covid-19-coronavirus-flattening-the-curve

Monella, Lillo Montalto. 2020. "Coronavirus: Italy doctors 'forced to prioritise ICU care for patients with best chance of survival'." Euronews [website], 13 March 2020. Available: https://www.euronews.com/2020/03/12/coronavirus-italy-doctors-forced-to-prioritise-icu-care-for-patients-with-best-chance-of-s

Schlak, Martin. 2020. "'I Don’t Think the Virus Can Be Stopped Anymore'." Der Spiegel [website], 10 March 2020. Available: https://www.spiegel.de/international/world/i-don-t-think-the-virus-can-be-stopped-anymore-a-03d404e6-762b-42fb-ac48-e4a8f03a2f2b

World Health Organisation (WHO). 2020. Report of the WHO - China Joint Mission on Coronavirus Disease 2019. Available: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

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