On Monday, a team of epidemiologists, infectious disease specialists, actuaries, data scientists and researchers in North Carolina released a brief on hospital capacity in the state**. They used an ensemble of three different modeling approaches to project hospital need and ICU bed need in the state through June 1. They model two scenarios. The first is maintaining current policies throughout the analysis period. The second lifts social distancing restrictions at the end of April and does not replace those policies with substitutes of equal effectiveness. The forecast is based on the probability that capacity is exceeded.
There is good news in the brief:
Under current policies, our models suggest that the volume of available acute care beds throughout the state will be sufficient to handle growing COVID-19-related case volume in the next few weeks. In the second half of April, estimates for the near-term suggest a substantial increase in confirmed state case volumes, to as many as 5,500-6,500 confirmed cases by April 15, up from approximately 2,402 confirmed cases on April 4.6 The probability that acute care bed demand will outstrip available supply will likely increase by mid-April but remains low (<10%) as the available capacity is likely sufficient.
Policy matters. Social and physical distancing is working to flatten the curve in the state. As long as distancing is maintained, capacity is likely to be sufficienct even as the state peaks. Avoiding current infections and thus avoiding future hospitalizations dominates any capacity response of adding new beds to the hospital systems in the state.
The difference in probabilities of demand exceeding bed supply across the surge levels is approximately 2 to 4 percentage points.
Those few points are very valuable points and are worth pursuing but another few hundred beds will be swamped by half a million avoidable infections.
To put the findings in context, the models’ composite estimates indicate that approximately 750,000 people in North Carolina may be infected with the virus by the end of our forecast period, June 1, 2020. This is if the social distancing policies are fully lifted at the end of April and are not replaced by other policies with equal assumed effectiveness to reduce transmission. On the other hand, if the same policies (or some other policies with similar effect) remain in place, the composite estimates indicate that an estimated 250,000 North Carolinians may be infected by June 1.
Until there is massive, rapid, no barrier access to testing that has few false negatives with accompanying public health contact tracing and mass quarantining in place, opening up a state just guarantees a massive shut down and overwhelmed hospitals in a few doubling cycles again. Even as we may be approaching local peaks, those peaks are only peaks because significant chunks of the nation started to shut down in early to mid-March to avoid millions of infections even as tremendous numbers of people are currently and soon to be infected. Opening back up again will just recreate the infection storm from a much higher base of currently infected individuals at the end of April compared to the base of people who were infected at the start of March.
** Disclosure: Most of the authors of the brief are some combination of co-workers, colleagues, co-authors, friends and beer drinking buddies of mine.
Baud
Doesn’t sound socially distant.
Geminid
It sounds like you may live in North Carolina. Any on-the-ground observations on the efficacy of current social distancing practice? In my rural/suburban part of Virginia it seems effective, but I think we are less restrictive in respect to travel to and from work and what work is not ruled out than are other states like California.
Amir Khalid
@Baud:
David and his professional peers are not getting together for a brewski these days. At least, that’s my hope.
debbie
Off-campus (OSU) housing has been non-stop parties. They keep saying they’ll do something about it, but haven’t done a friggin’ thing yet.
DAVID ANDERSON
@Amir Khalid: correct. I have been a participant in a regular Zoom Happy Hour but that is it.
Leto
So close to that Green Day song title (missed it byyyyy that much!)
Mary G
So by the title, you expect the states will have to be shut down until September? Is there any data yet on how accurate the tests being used are?
mad citizen
I drink whenever I hear “the new normal” or “we’re all in this together” (which has anyone noticed the irony to Hillary’s “stronger together” campaign motto? It truly does take a village.) Crazy times indeed.
We’re truly in a war.
(I was going for a very high platitudes to word count. This says it well: https://www.theguardian.com/commentisfree/2020/apr/07/horror-coronavirus-real-imaginary-war-britain)
WereBear
Considering the extraordinary impact individual decision making has on our continued health: it’s almost like a targeted virus which is more virulent among stupid people.
David Anderson
@Geminid: I live in Chapel Hill which is in no ways representative of the rest of the state or hell even 15 miles south of the house. The population is extremely connected to either DUKE or UNC or the Research Triangle, has money to burn, professional jobs where work from home is quite plausible and leans heavily blue which matters a lot for early social distancing.
With that said, yeah, this place is empty. The gas station which is the turn around point to my morning walk normally would have 2 or 3 cars filling up and 4 or 5 cars parked as their drivers got coffee etc pre-COVID. This morning it has 1 car filling up and the store is empty. The movie theatres in town are closed, the parks are empty, the schools are locked down.
Redshift
The correct lyric is “Wake me up when September ends.” #GreenDayFan #Pedant
David Anderson
@Redshift: I am well aware of that… there is a chance that sufficient diagnostics and therapeutics will be available in July/August to make September plausible.
StringOnAStick
My husband and I agreed yesterday that I should quit my job (dental hygienist) because without a vaccine, going back to work whenever that happens is a bad idea. He’s in the very early stages of CLL and his immune system is doing well now but the last thing he needs is for me to bring this thing home. We’re both 62 and planning on retiring in 9 months, and the various repetitive strain injuries from my job have nearly gone away since the office closed, so that’s another good reason. Time to go write a resignation letter.
I’m still pissed at my boss over the fight we got into about even being open, and I know he’s going to rush to reopen the office asap. 6 hours after that fight the state told all dental offices to close except for emergencies, which was what I was advocating for. I figure that every day since has proven I was right and his ego just isn’t going to be able to stand that, so aside from being dangerous it will also be a complete PITA.
David Anderson
@StringOnAStick: Go talk to your boss and see if you can get laid-off or furloughed instead.
ziggy
@StringOnAStick: I bet a lot of people your age are going to be making a similar calculation. Simply no good enough reason to go back to work if you are older, if you don’t absolutely have to financially. This could have big repercussions on the economy.
I’m sure your boss will find that people are not banging on the door to get teeth cleanings if he opens up. I had one scheduled, that was canceled, and I’m not excited about going back for quite a while (even though my hygienist is excellent). I’m simply going to have to eat better and clean more.