What happens when there are no more hospital beds?

Published in El Pais, 18 July 2020.

Today I had a presentation with colleagues from Turkey on a dynamic COVID-19 model that calculates the cost of an epidemic, both for the health system and for the economy. The numbers are tremendously high. The number of people who do not work, the number of people hospitalized and in intensive care, all are costs. To explain how it is calculated, I showed them a curve with occupied beds within the system during the epidemic and there was silence. They told me that they did not have as many beds and that according to the model more than 1500 beds were missing. The model assumes only a little elasticity in the system because it is not just beds that are required. It is also personnel, infrastructure, equipment, medicines, etc. They asked me what the model does when the capacity is exceeded.

A model is a simplification of reality. We try to make it as real as possible by including variables based on what we observe. For example, the case fatality rate for an infected child is near 0%, but for a person over the age of 80 almost 8%. The model takes all this into account. So what does the model do when demand for beds exceeds capacity? To cover it they would have to double the number of beds and that is almost impossible. So, I ask them: “What happens in reality?” After some discussions everyone knew what the answer was. If the number of beds does not increase in time, the case fatality rate increases dramatically, and the model knows this. The second question is how much does it increase? Some doctors were truly clear about this. If a patient is referred to a hospital and cannot enter due to lack of space, it is highly likely that he would die, even more so, if he required intensive care. Suddenly, this model showed it as an anticipation of reality.

When I see the images of hospitals collapsed on television and in the newspapers, I worry. There are many people who require hospitalization and cannot find space. The high death toll may be higher if we do not control COVID-19, even if we do not want to include them in COVID-19 statistics. We are not talking about a few; we are talking about many. We can increase the capacity, but now it is necessary to enforce the measures to make them work reduce the number of contacts, keep the distance of 1.5 meters, maintain hygiene.