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. 2020 Jun 15;192(24):E640-E646.
doi: 10.1503/cmaj.200715. Epub 2020 May 14.

Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada

Kali Barrett  1 , Yasin A Khan  1 , Stephen Mac  1 , Raphael Ximenes  1 , David M J Naimark  1 , Beate Sander  2
Affiliations

Estimation of COVID-19-induced depletion of hospital resources in Ontario, Canada

Kali Barrett et al. CMAJ. .

Abstract

Background: The global spread of coronavirus disease 2019 (COVID-19) continues in several jurisdictions, causing substantial strain to health care systems. The purpose of our study was to predict the effect of the COVID-19 pandemic on patient outcomes and use of hospital resources in Ontario, Canada.

Methods: We developed an individual-level simulation to model the flow of patients with COVID-19 through the hospital system in Ontario. We simulated different combined scenarios of epidemic trajectory and hospital health care capacity. Our outcomes included the number of patients who needed admission to the ward or to the intensive care unit (ICU) with or without the need for mechanical ventilation, number of days to resource depletion, number of patients awaiting resources and number of deaths.

Results: We found that with effective early public health measures, hospital system resources would not be depleted. For scenarios with late or ineffective implementation of physical distancing, hospital resources would be depleted within 14-26 days, and in the worst case scenario, 13 321 patients would die while waiting for needed resources. Resource depletion would be avoided or delayed with aggressive measures to increase ICU, ventilator and acute care hospital capacities.

Interpretation: We found that without aggressive physical distancing measures, the Ontario hospital system would have been inadequately equipped to manage the expected number of patients with COVID-19 despite a rapid increase in capacity. This lack of hospital resources would have led to an increase in mortality. By slowing the spread of the disease using public health measures and by increasing hospital capacity, Ontario may have avoided catastrophic stresses to its hospitals.

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Conflict of interest statement

Competing interests: Kali Barrett has received personal fees from Xenios AG, outside of the submitted work. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Model schematic. COVID-19 = coronavirus disease 2019, ED = emergency department, ICU = intensive care unit.
Figure 2:
Figure 2:
Cumulative number of new coronavirus disease 2019 (COVID-19) cases over time in Ontario.
Figure 3:
Figure 3:
Resource depletion for the scenario with expected epidemic trajectory and base-case resources. ICU = intensive care unit.
Figure 4:
Figure 4:
Expected and confirmed ward and intensive care unit (ICU) occupancy for patients with coronavirus disease 2019 (COVID-19) over time in Ontario.
See this image and copyright information in PMC

Comment in

  • CMAJ. 192:E489.
  • CMAJ. 192:E497.

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