tetano
Editor, Senior Moderator
CMAJ Open
. 2020 Sep 22;8(3):E593-E604.
doi: 10.9778/cmajo.20200093. Print Jul-Sep 2020.
Estimated surge in hospital and intensive care admission because of the coronavirus disease 2019 pandemic in the Greater Toronto Area, Canada: a mathematical modelling study
Sharmistha Mishra[SUP] 1 [/SUP], Linwei Wang[SUP] 2 [/SUP], Huiting Ma[SUP] 2 [/SUP], Kristy C Y Yiu[SUP] 2 [/SUP], J Michael Paterson[SUP] 2 [/SUP], Eliane Kim[SUP] 2 [/SUP], Michael J Schull[SUP] 2 [/SUP], Victoria Pequegnat[SUP] 2 [/SUP], Anthea Lee[SUP] 2 [/SUP], Lisa Ishiguro[SUP] 2 [/SUP], Eric Coomes[SUP] 2 [/SUP], Adrienne Chan[SUP] 2 [/SUP], Mark Downing[SUP] 2 [/SUP], David Landsman[SUP] 2 [/SUP], Sharon Straus[SUP] 2 [/SUP], Matthew Muller[SUP] 2 [/SUP]
Affiliations
Abstract
Background: In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired.
Methods: To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R[SUB]0[/SUB] = 2.4) resembled the early trajectory (to Mar. 25, 2020), and compared the default model projections with observed COVID-19 admissions in each hospital from Mar. 25 to May 6, 2020.
Results: For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity.
Interpretation: Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.
. 2020 Sep 22;8(3):E593-E604.
doi: 10.9778/cmajo.20200093. Print Jul-Sep 2020.
Estimated surge in hospital and intensive care admission because of the coronavirus disease 2019 pandemic in the Greater Toronto Area, Canada: a mathematical modelling study
Sharmistha Mishra[SUP] 1 [/SUP], Linwei Wang[SUP] 2 [/SUP], Huiting Ma[SUP] 2 [/SUP], Kristy C Y Yiu[SUP] 2 [/SUP], J Michael Paterson[SUP] 2 [/SUP], Eliane Kim[SUP] 2 [/SUP], Michael J Schull[SUP] 2 [/SUP], Victoria Pequegnat[SUP] 2 [/SUP], Anthea Lee[SUP] 2 [/SUP], Lisa Ishiguro[SUP] 2 [/SUP], Eric Coomes[SUP] 2 [/SUP], Adrienne Chan[SUP] 2 [/SUP], Mark Downing[SUP] 2 [/SUP], David Landsman[SUP] 2 [/SUP], Sharon Straus[SUP] 2 [/SUP], Matthew Muller[SUP] 2 [/SUP]
Affiliations
- PMID: 32963024
- DOI: 10.9778/cmajo.20200093
Abstract
Background: In pandemics, local hospitals need to anticipate a surge in health care needs. We examined the modelled surge because of the coronavirus disease 2019 (COVID-19) pandemic that was used to inform the early hospital-level response against cases as they transpired.
Methods: To estimate hospital-level surge in March and April 2020, we simulated a range of scenarios of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread in the Greater Toronto Area (GTA), Canada, using the best available data at the time. We applied outputs to hospital-specific data to estimate surge over 6 weeks at 2 hospitals (St. Michael's Hospital and St. Joseph's Health Centre). We examined multiple scenarios, wherein the default (R[SUB]0[/SUB] = 2.4) resembled the early trajectory (to Mar. 25, 2020), and compared the default model projections with observed COVID-19 admissions in each hospital from Mar. 25 to May 6, 2020.
Results: For the hospitals to remain below non-ICU bed capacity, the default pessimistic scenario required a reduction in non-COVID-19 inpatient care by 38% and 28%, respectively, with St. Michael's Hospital requiring 40 new ICU beds and St. Joseph's Health Centre reducing its ICU beds for non-COVID-19 care by 6%. The absolute difference between default-projected and observed census of inpatients with COVID-19 at each hospital was less than 20 from Mar. 25 to Apr. 11; projected and observed cases diverged widely thereafter. Uncertainty in local epidemiological features was more influential than uncertainty in clinical severity.
Interpretation: Scenario-based analyses were reliable in estimating short-term cases, but would require frequent re-analyses. Distribution of the city's surge was expected to vary across hospitals, and community-level strategies were key to mitigating each hospital's surge.