Critical Care Demand and Intensive Care Supply for Patients in Japan with COVID-19 at the Time of the State of Emergency Declaration in April 2020: A Descriptive Analysis

Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic is overwhelming Japan's intensive care capacity. This study aimed to determine the number of patients with COVID-19 who required intensive care and to compare the numbers with Japan's intensive care capacity. Materials and Methods: Publicly available datasets were used to obtain the number of confirmed patients with COVID-19 undergoing mechanical ventilation and extracorporeal membrane oxygenation (ECMO) between 15 February and 19 July 2020 to determine and compare intensive care unit (ICU) and attending bed needs for patients with COVID-19, and to estimate peak ICU demands in Japan. Results: During the epidemic peak in late April, 11,443 patients (1.03/10,000 adults) had been infected, 373 patients (0.034/10,000 adults) were in ICU, 312 patients (0.028/10,000 adults) were receiving mechanical ventilation, and 62 patients (0.0056/10,000 adults) were under ECMO per day. At the peak of the epidemic, the number of infected patients was 651% of designated beds, and the number of patients requiring intensive care was 6.0% of ICU beds, 19.1% of board-certified intensivists, and 106% of designated medical institutions in Japan. Conclusions: The number of critically ill patients with COVID-19 continued to rise during the pandemic, exceeding the number of designated beds but not exceeding ICU capacity.

Keywords: extracorporeal membrane oxygenation (ECMO); intensive care unit (ICU); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the coronavirus disease 2019 (COVID-19).

Figure 1

Seven regions in Japan defined by the Japanese Society of Intensive Care Medicine. Seven regions are Hokkaido, Tohoku (Aomori, Iwate, Akita, Miyagi, Yamagata, and Fukushima), Kanto-Koshinetsu (Ibaraki, Tochigi, Gumma, Saitama, Chiba, Tokyo, Kanagawa, Niigata, Yamanashi, and Nagano), Tokai-Hokuriku (Toyama, Ishikawa, Fukui, Gifu, Shizuoka, Aichi, and Mie), Kansai (Shiga, Kyoto, Osaka, Hyogo, Nara, and Wakayama), Chugoku-Shikoku (Tottori, Shimane, Okayama, Hiroshima, Yamaguchi, Tokushima, Kagawa, Ehime, and Kochi), and Kyushu-Okinawa (Fukuoka, Saga, Nagasaki, Kumamoto, Oita, Miyazaki, Kagoshima, and Okinawa).

Figure 2

The burden of critical coronavirus disease during the epidemic in Japan. (A) The number of infected and critically ill patients per 1000 adults. Critically ill patients were the sum of the number of patients under mechanical ventilation and ECMO. The Japanese government also declared “The State of Emergency” on 7 April 2020 for major central cities with a cumulative 4257 confirmed cases and 93 deaths among patients with COVID-19 and it spread to all of 47 prefectures on 16 April 2020. (B) The magnified version of (A). Category II: designated medical institutions for Category II infectious diseases, TB: tuberculosis, ECMO: extracorporeal membrane oxygenation.

Figure 3

The burden of critical coronavirus disease during the epidemic in seven regions defined by the Japanese Society of Intensive Care Medicine in Japan. Raw count of COVID-19 patients under critical care (A), mechanical ventilation (B), and ECMO (C), percentage of patients to the number of board-certified intensivists for critical care (D), mechanical ventilation (E), and ECMO (F), and percentage of patients to the number of Category II institutions for critical care (G), mechanical ventilation (H), and ECMO (I), respectively. Category II: designated medical institutions for Category II infectious diseases, ECMO: extracorporeal membrane oxygenation.

Figure 4

The burden of critical coronavirus disease requiring ECMO to the number of ECMO project hospitals during the epidemic in seven regions defined by the Japanese Society of Intensive Care Medicine in Japan. ECMO: extracorporeal membrane oxygenation.