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"On small numbers and large problems"
Imagine that in a given country every day, every 100000 people we admit to an ICU bed 1 patient with pneumonia requiring invasive mechanical ventilation. 1 per 100000 seems a small number, right?
Imagine that in a given country every day, every 100000 people we admit to an ICU bed 1 patient with pneumonia requiring invasive mechanical ventilation. 1 per 100000 seems a small number, right?
Ok, now imagine that the average stay for this patient (taking into account who survives and who unfortunately does not) is 10 days. It means that we need roughly 1 x 10 = 10 beds in order to be able to admit 1 patient and discharge another one each day.
Now let's divide the population of country with 10 millions people by 100000. That is = 100 and assume 100 patients with pneumonia per day requiring ICU admission.
Beds needed? 100 patients per day x 10 days lenght of stay = 1000 beds, which is again 10 beds every 100000 people
Beds needed? 100 patients per day x 10 days lenght of stay = 1000 beds, which is again 10 beds every 100000 people
In Europe we have roughly between 4 and 27 ICU beds (yes, high variability) per 100000 people. Those beds are not normally empty, they are used to look after high risk surgical patients, trauma, cardiac, medical emergency etc.
Why do we need to surge so much ICU capacity during an oubreak? Because it takes just 1 patient with pneumonia requiring ICU every day every 100000 people every day to stress any healthcare system and because we want to give a bed to whoever benefits from it, COVID and non COVID
In order to create this extra capacity we have to use human resources normally employed elsewhere in the hospital. The activities are paused until the outbreak is controlled again. That can be necessary but is unfair for all other patients.
In reality it takes much less than 1 ICU admission per 100000 per day, which is indeed a huge absolute number, to stress healthcare systems because ICU capacity is not 100 % free normally.
The bottom line is that public health measures are a much better way to deal with the pandemic than surging ICU beds.
