Interventions
Sensitivity analyses for increases in Capacity-to-Treat.
Various interventions are possible to combat the dissonance between the potential counts of patients in the various risk cohorts requiring treatment and the Capacity-to-Treat that is available today. We want to investigate scenarios that modify Capacity-to-Treat measures. Such as: (i) adding Beds (+10%, 25% and 50%); (ii) adding or “splitting” Ventilators (really adding ICU beds +25%, 50% and 100%); an/or (iii) “unretiring” Physician Intensivists (+15%).
Total Beds:
Total Beds can be increased by converting spaces into temporary hospitals. The Army Corp of Engineers is busy converting convention spaces into temporary hospitals. Estimates indicate that a 50% increase in Total Beds is achievable. Healthcare systems can increase their capacity to respond by increasing the number of beds they have available as well. Hospitals are urged to reschedule elective surgeries to later dates to open up beds[1] and hospitals that have been closed or reduced down to clinics are proving to be potential sources of new beds[2] as well as hotels[3] and dormitories.[4]
Total Beds:
Total Beds can be increased by converting spaces into temporary hospitals. The Army Corp of Engineers is busy converting convention spaces into temporary hospitals. Estimates indicate that a 50% increase in Total Beds is achievable. Healthcare systems can increase their capacity to respond by increasing the number of beds they have available as well. Hospitals are urged to reschedule elective surgeries to later dates to open up beds[1] and hospitals that have been closed or reduced down to clinics are proving to be potential sources of new beds[2] as well as hotels[3] and dormitories.[4]
ICU Beds:
Increasing ICU Beds is really a measure of the number of ventilator assisted patients a ZIP3 region is prepared to accommodate. One option is to acquire ventilators from the government stockpile. This option may not be a realistic option for every ZIP3 region. Another option may be to treat multiple patients with a single ventilator. Current research suggests that one ventilator may be used to temporarily treat two to four patients at once, which if successful represents a 100% to 300% surgein capacity by itself.[5]
Physician Intensivists:
There are two issues at play with respect to this Capacity-to-Treat measure:
• Maintenance of current Physician Intensivist counts: These humans are coming into contact with infected patients and if they get infected, this obviously reduces capacity at the time when Physician Intensivist capacity needs to surge. One critical intervention is to ensure to the degree possible maintenance of current Physician Intensivist capacity by ensuring that physicians and nurses have enough personal protective equipment (PPE) to prevent themselves from getting infected.
• Increasing current Physician Intensivist counts: Reports suggest that bringing back retired doctors to assist in the response to COVID-19 could increase Physician Intensivist capacity by 15%. State governments must assist by reducing red tape to quickly renew licenses or extend licenses that are about to expire.
Physician Intensivists:
There are two issues at play with respect to this Capacity-to-Treat measure:
• Maintenance of current Physician Intensivist counts: These humans are coming into contact with infected patients and if they get infected, this obviously reduces capacity at the time when Physician Intensivist capacity needs to surge. One critical intervention is to ensure to the degree possible maintenance of current Physician Intensivist capacity by ensuring that physicians and nurses have enough personal protective equipment (PPE) to prevent themselves from getting infected.
• Increasing current Physician Intensivist counts: Reports suggest that bringing back retired doctors to assist in the response to COVID-19 could increase Physician Intensivist capacity by 15%. State governments must assist by reducing red tape to quickly renew licenses or extend licenses that are about to expire.
References:
1. Surgeons, A.C.o. Covid-19: Elective Case Triage Guidelines for Surgical Care. 2020; Available from:
https://www.facs.org/covid-19/clinical-guidance/elective-case.
2. Rachel Chason, K.S., With virus cases soaring, closed hospitals become a precious soure of beds, in The Washington Post. 2020.
3. Johanson, M., Today’s hotel is tomorrow’s coronavirus hospital, in CNN Travel. 2020.
4. Campanile, C., CUNY boots students from dorms to make space for coronavirus hospitals, in New York Post. 2020.
5. Neyman, G. and C.B. Irvin, A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge. 2006. 13(11): p. 1246-1249.
