ICU Capacity Rates as a Metric for Covid-19
California has just entered into another strict lockdown, bringing to close a year
everyone wishes to forget. In an effort to curb the spread of the virus and in an attempt to keep
the hospitals from being overburdened, the State’s Governor, Gavin Newsom, has declared a
stay-at-home order for five different regions of the state. This ‘lockdown’ is intimately tied to the
metric of hospital ICU capacity.
What is ICU Capacity?
When the ICU capacity drops below 15%, as determined by thestate’s health department, regions are forced to enter a lockdown that closes business and
severely limits travel. Once that metric is raised above 15% availability and a minimum of three weeks has passed, the state health department can decide to end its recommendation to the Governor to issue stay-at-home orders.
With the power to both save lives and disrupt them, stay-at-home orders are a big deal.
They are responsible, in theory, for the slow-down or the speed-up of the virus’ spread, the
continual functioning of the local (and larger) economy, and the very normalcy of people’s lives.
The United States has chosen the path of allowing each state to dictate its own orders on
lockdowns and local policies to stop the spread of Covid-19 - a decision that has brought the
merits and demerits of federalism into the twenty-first century. Whether you can go to the
movies, workout in a gym or worship indoors currently depends more on your zip-code and local government than it does on the President. Local governments make these grueling decisions based on information and data from both local and national agencies, departments, and groups such as the National Institutes of Health (NIH) , the Centers for Disease Control (CDC) and their state health departments.
What is Hospital Capacity Rate?
A leading metric analyzed by state governments and experts is the overall hospital
capacity rate and the ICU’s rate in particular. Taken together with other figures this data point
provides a picture of how well (or not) a hospital can withstand an influx of sick patients. This
number is the amount of space, often calculated as the number of specific types of beds
available, to treat patients. Rural hospitals tend to have less beds but lower occupation rates
while the reverse is true for urban hospitals.
In early December the Department of Health and Human Services (HHS) released nationwide data on the capacity rates and bed use of individual hospitals in relation to Covid-19. This publication of data on a facility basis was a stark change from previously released data by the CDC up until July 2020, which aggregated data ona state-by-state basis making it impossible to narrow down hot spots and local areas with struggling hospitals. Now state leaders have the ability to analyze this much more detailed data and craft tailored-specific recommendations for localities.
But what should their targets include? And what goals are realistic and definitive? The
ever moving goal posts of lockdown orders being lifted is unsustainable and socially unpopular.
A populace does not happily obey stringent orders that are rooted in false statistics or shaky
logic. The metric of hospital capacity is something everyone can understand and this
information is becoming more and more public. A closer look at recent hospital capacity rates
and current targets unveils a picture of inconsistent, varying, and unique problems that likely
have just as unique solutions.
According to data collected and published by the CMS Healthcare Cost Report
Information System (HCRIS) in 2019, the average hospital in the U.S. has a 65% occupancy
rate for ICUs. Nevada has the highest occupancy rate at 78% leaving only 22% of beds open onaverage. Colorado has the lowest occupancy rate with about 61% of ICU beds available. This data does not reflect the hospital’s abilities to add surge beds or rearrange operations to
account for an increased occupancy rate, such as suspending elective surgeries, but is still a
reliable indicator of a state’s ability to either perform well during an increased ICU patient surge or buckle under the pressure.
Is it good to restart Covid restriction?
While average national occupancy rates are helpful to paint a larger picture of the overall
situation of hospitals in the country, it is this new state and facility specific data that could help to flatten the curve and save lives. While hospitals in urban areas may be under severe strain,
rural hospitals with empty beds could potentially help share the burden and even provide
healthcare workers to struggling facilities. The lifting and reimposing of restrictions can turn into something resembling a game of whack-a-mole for local leaders, but with more specific data this unpredictable game can possibly be played with better outcomes and less headaches.
Taking a closer look at California, we find the average ICU occupation rate was 58% in
recent years with the current state-wide ICU occupancy rate at 86.6% as of December 25th.
The target goal of California’s department of health is 85% occupation to allow for a relaxing oflockdown rules. That’s a positive increase of 27% more than the state’s pre-pandemic average.
Now whether this threshold is too low or too high is a decision for the experts to make - and a
critical one at that. But I do believe it is fair to say that this percent increase from the former
average occupancy rate of 58% to the new accepted rate of 85% is not insignificant or
impossible for the state to meet. On the contrary, I think the state has set a realistic goal that is
somewhere between the former annual capacity rate and the new benchmark of 85%, which
allows for a greater occupancy rate due to the stress of Covid-19.
As mentioned earlier, each state is different and sets different metrics for their re-
opening or sh utting down. Florida’s Republican Governor Ron DeSantis lifted state-wide
restrictions in late September, a move that was widely criticized at the time and still provides
fodder for much debate. While there are many variables that go into determining how well the
state is handling the pandemic and which variables helped or hurt, the state’s average ICU
occupancy rate is at 79% according to the most recent data released by the HHS. That’s
compared to the state’s prior years’ ICU occupancy rate of 68%. That’s a difference of 11% or
roughly 777 ICU beds. Is this cause for concern? Or is this a normal surge that happens
seasonally that hospitals are prepared to handle?
How Good is Covid Data?
Those are questions for medical experts and policy analysts to decide. The real-life
application of federalism to the crisis of Covid-19 in the United States is forcing local leaders to make specific, custom, and impactful decisions. With the data available to analyze local hot spots and regional flare-ups, the guidance to follow should be just as targeted and narrow.
There has been and will continue to be discussions about what the optimal occupation rate of a hospital should be. I predict and hope that after the pandemic recedes, much needed resources and funding will be put to use increasing hospitals and their staff for just such scenarios as Covid-19. However, in the meantime, the data is becoming more public and more readable by the lay person, making tough decisions like the one to enforce a statewide lockdown order or to remove it - all the more open to citizen input and over watch. And that’s a good thing.
Josh Gardner is a full time woodworker who enjoys reading and thinking about geopolitics,
technology, and social issues.
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