Currently, Wisconsin is one of the hottest hot spots in the United States. As of last night, per CovidExitStrategy.org, Wisconsin has a 19.6% test positivity rate. This is indicative out of control community spread. The weather is getting colder and indoor concentrations of people are getting more likely.
Uncontrolled community spread with an increasing case count means hospitals will be seeing patients. There are two notes on hospital capacity that I want to highlight. The first is that the governor has ordered the construction of a 450 bed field hospital to provide surge capacity and overflow beds.
Serious situation in Wisconsin, where a field hospital is being set up to care for a big surge in covid patients. https://t.co/Ju26IRpU5t
— Caitlin Rivers, PhD (@cmyeaton) October 9, 2020
The big constraint on most surge plans is staff. A bed needs skilled nurses, aides, and doctors. Short term surges can run staff into the ground with double and triple shifts. Long term surge capacity needs extra resources from either shutting down other aspects of the local healthcare system, bringing in currently underemployed labor (new trainees, skilled retirees) or bringing in out of state personnel.
The New England Journal of Medicine just published the results of a randomized control trial (RCT) on Remisdivir, an anti-viral medication for COVID. There were significant duration effects and non-significant mortality effects:
Those who received remdesivir had a median recovery time of 10 days (95% confidence interval [CI], 9 to 11), as compared with 15 days (95% CI, 13 to 18) among those who received placebo (rate ratio for recovery, 1.29; 95% CI, 1.12 to 1.49; P<0.001, by a log-rank test)... The Kaplan–Meier estimates of mortality were 6.7% with remdesivir and 11.9% with placebo by day 15 and 11.4% with remdesivir and 15.2% with placebo by day 29 (hazard ratio, 0.73; 95% CI, 0.52 to 1.03).
Remisdivir is another way of expanding hospital capacity. A bed and the attached staff can be ~50% more productive by adding a drug to the treatment regimen for some patients.
We saw in the spring that mortality was massively elevated when hospitals were slammed. Expanding capacity by both the construction and staffing of new surge beds and improving the productivity of each current bed will delay if not completely avoid the possibility of local hospital systems getting overwhelmed this fall and winter. Remisdivir should be prioritized for regions that are approaching or over sustainable hospital capacity in order to minimize the total number of deaths. We, as a society, should be willing to pay through the nose for Remisdivir and other drugs that have a good evidence base to reduce mortality and hospital stays when it is used in highly stressed systems and concurrently, we should be willing to pay very little when it is used in regions with thousands of spare hospital beds.