Harvard study: COVID-19 could generate demand for hospital services hundreds of times above capacity
Updated: Mar 22
A recent Harvard Global Health Institute study that looks at statewide and regional medical facility capacities - including the Atlanta region that Toccoa/Stephens County is a part of - shows the impact COVID-19 may have on hospitals, and how social distancing can mitigate that impact. Even reducing the study's estimations of hospitalizations by 50 percent still indicates a strong potential for a shortage of medical resources.
Response efforts regarding COVID-19 has faced a wide spectrum of public perception. Some citizens see little need for concern over a disease that carries, at least initially, a low-end mortality rate and a high percentage of individuals who test positive for the virus, but exhibit only mild symptoms.
A review of the Georgia Public Health daily updates on COVID-19 statistics show a limited number of cases in terms of confirmed cases as an overall percentage of Georgia’s population, prompting a proliferation of social media posts expressing concern about the number of citizen rights and freedoms being curtailed by enforced social distancing, government shutdowns or slowdowns, and enforced travel restrictions. Among these in Georgia and the local region are concerns about gun purchase delays, suspension of building permit applications and approvals, business licenses, marriage licenses, wills and probate matters, and civil court matters. Across the state and throughout the nation, even more severe impacts are felt as states counties and municipalities seal borders, demand the closing of specific private businesses, and consider the release of certain classes of inmates.
Many others, however, urge advanced measures to restrict the spread of the disease due to several factors, including its speed of transmission, the fact that individuals are often contagious before they are symptomatic, the fact that there is no vaccine for the virus, and the fact that seemingly targets a vulnerable population sector.
One concern expressed by many health officials, as well as government entities when justifying measures such as closed schools and mandatory curfews, is that the disease, left unchecked, could potentially overwhelm medical facility capacity.
Looking at the statistics from the Georgia Health Department regarding confirmed cases and the breakdown of those figures into age brackets, and using accepted figures for the percentages of confirmed cases that will require hospitalization, and advanced hospitalization (ICU), ConnectLocal researched what the potential existed in Georgia specifically, and the nation in general, for COVID-19 outpacing the resources of our medical system, specifically in the area of staffed hospital beds for the 5 percent of confirmed cases that require hospitalization, and the 2 percent that will require advanced hospitalization (ICU for ventilation).
According to the American Hospital Directory’s statistics Georgia has 22,344 staffed hospital beds. This figure is slightly under the 23,831 statewide number of hospital beds recorded by a recent study published by The Harvard Global Health Institute that estimates the occupancy and availability of hospital beds, based on predictive modeling of COVID-19 contagion rates, over a range of time. According to the Harvard study, the Atlanta Hospital Referral Region (HRR), which includes Toccoa/Stephens County, has 12,800 total hospital beds as of 2018, while the national total is just under 750,000
In the Atlanta region, 74 percent of the 12,800 beds are routinely filled by a combination of elective procedures and emergency care. That figure leaves, at any one time, approximately 3,340 beds open for the care of potential COVID-19 patients. According to the American Hospital Association and the American Hospital Directory, slightly more than 1,600 of that total bed count are assigned to intensive care units where most of the acute COVID-19 cases would need to be placed.
Of the 6.7 million residents of the Atlanta HHR, approximately 12 percent are older than 65 years of age – COVID-19 has proven in studies conducted in China and Italy, to have a higher impact on elderly patients – both in terms of illness severity and in terms of the mortality rate. However, younger patient s are being admitted to hospitals for care of severe cases of COVID-19 across the United States, and Georgia numbers show an almost even split between males and females when it comes to confirmed cases.
Using infection rates provided by Dr. Marc Lipsitch, head of the Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics, the study estimates 40 percent of the adult population will contract some level of COVID-19 in the coming 12 months, and that eight percent of the adult population would require hospital care in that same period, the Atlanta HRR, Georgia as a whole, and the United States in general will experience medical needs due to COVID-19 that will far exceed its capacity. According to the Harvard study, using those estimates, more than 410,000 patients will need to be hospitalized due to COVID-19.
Using medical and scientific data culled from prior viral epidemics and data from China and Italy’s experience with COVID to determine that each COVID-19 patient will require 12 days of hospital care on average, the Harvard team determined that those 410,000 patients, over that 12 month period, would require 13,700 beds – more than four times the available beds. Exceeding the concerns expressed by the Harvard team about general hospital bed shortages in the Atlanta HRR, the study shows that the 440 available beds at any one time in intensive care units falls almost seven time short of what would be needed for the expected severe cases.
The population of Stephens County is 25,600. A total of 6,554 of those are under the age of 20, leaving an adult population of 19,046, with 6,081 of them being over the age of 60, according to Census Bureau statistics. Using the estimations employed in the Harvard study, 40 percent of the adult population, or 7,618, will contract COVID-19 at some level of severeness over the coming 12-month period. Again using Harvard Study methods, an estimated 1,524 will need hospitalization, 381 of which will need ICU care, over that same 12-month period.
Stephens County Hospital has 96 beds, six of which are in the ICU unit, according to the hospital’s website. Using the Harvard Study’s estimation that 74 percent of beds are in use at any one time, that leaves 25 beds available at any one time to care for COVID-19 patients. If social distancing and other measures can spread out the 1,524 people who will need hospitalization over an 18 month period, and assuming each patient will remain in the hospital for 12 days, the 25 beds available will still fall short of the demand, but by a significantly smaller margin than if all 1,524 of the estimated patient load must be treated within the coming two or three months.
“Though the U.S. health care system is projected to be overwhelmed by an influx of patients infected with the novel coronavirus, the pressure on hospitals will vary dramatically across the country,” states ProPublica, a non-profit investigative journalism organization. “What (the Harvard study) found, shows that, unless we can slow the spread of the pandemic, hospitals could be overwhelmed…and shows why public officials are so intent on ‘flattening the curve’ or slowing the spread of infections over a longer period of time.”
Lipsitch’s infection rate estimations utilized by the study looked at a number of factors, including contagious and hospitalization during the COVID outbreak in China and Italy, as well as the behaviors of previous viruses. For example, No containment or “social distancing” measures instituted in response to the Swine Flu in the United States, and there were approximately 60 million confirmed cases in America over a one-year period, according to CDC figures.
While studies are still being undertaken to understand the dynamics of COVID-19 and its transmission rates, World Health Organization initial figures indicate that it is more contagious than the Swine Flu. Using those figures, the Harvard team estimated 40 percent of the adult population, or nearly 100 million Americans, will be infected with the virus, though a large percentage will have no symptoms, or mild symptoms, and will not be tested. The infection rate scenarios are based on estimates from leading epidemiologist Dr. Marc Lipsitch, head of the Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics
“The way to permanently stop new cases from setting off long chains of transmission is to have each case infect considerably less than one case on average,” Lipsitch said. “The numbers will go down. There will still be little outbreaks, but not big ones.”
Harvard Study Results synopsis:
Total Hospital beds: Atlanta HRR 12,780, Georgia 23,831, National 746,170
Total ICU beds: Atlanta HRR 1,621, Georgia 2,703, National 85,489
Adult Population: Atlanta HRR 5,027,281, Georgia 7,702,432, National 250,140,764
Projected Hospitalized Individuals: Atlanta HRR 206,224, Georgia 952,202, National 31,272,684
Percentage of available beds needed if the infection rate is spread out over a 6-month period: Atlanta HRR 412%, Georgia 880%, National 780%
Percentage of available beds needed if the infection rate is spread out over a 12-month period: Atlanta HRR 206%, Georgia 440%, National 390%
Percentage of available beds needed if the infection rate is spread out over an 18-month period: Atlanta HRR 134%, Georgia 287%, National 255%
Percentage of available ICU beds needed if the infection rate is spread out over a 6 month period: Atlanta HRR 665%, Georgia 1,791%, National 1,467%
Percentage of available ICU beds needed if the infection rate is spread out over a 12 month period: Atlanta HRR 333%, Georgia 896%, National 734%
Percentage of available ICU beds needed if the infection rate is spread out over an 18 month period: Atlanta HRR 217%, Georgia584%, National 479%