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Confronting COVID-19: Surging Critical Care Capacity in Italy

21 Pages Posted: 9 Apr 2020

See all articles by Jose Manuel Rodriguez Llanes

Jose Manuel Rodriguez Llanes

European Commission-Joint Research Centre

Rafael Castro Delgado

Universidad de Oviedo - Unit for Research in Emergency and Disaster

Morten Gram Pedersen

University of Padova - Department of Mathematics "Tullio Levi-Civita"

Pedro Arcos Gonzalez

Universidad de Oviedo - Unit for Research in Emergency and Disaster

Matteo Meneghini

University of Padova - Department of Information Engineering

More...

Multiple version iconThere are 2 versions of this paper

Abstract

Summary: The current spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Europe threats Italian’s capacity and that of other national health systems to effectively respond to the needs of patients who require intensive care, mostly due to pneumonia and derived complications from concomitant disease and age. Predicting the surge in capacity has proved difficult due to the requirement of a subtle combination of diverse expertise and difficult choices to be made on selecting robust measures of critical care utilization, and parsimonious epidemic modelling which account for changing government measures. We modelled the required surge capacity of ICU beds in Italy exclusively for COVID-19 patients at epidemic peak. Because new measures were imposed by the Italian government, suspending nearly all non-essential sectors of the economy, we included the potential impacts of these new measures. The modelling considered those hospitalized and home isolated as quarantined, mimicking conditions on the ground. The percentage of patients in intensive care (out of the daily active confirmed cases) required for our calculations were chosen based on clinical relevance and robustness, and this number was consistently on average 9·9% from February 24 to March 6, 2020. Five different scenarios were produced (two positive and three negative). Under most positive scenarios, in which R0 is reduced below 1 (i.e., 0 ·71), the number of daily active confirmed cases will peak at nearly 89 000 by the early days of April and the total number of intensive care beds exclusively dedicated to COVID-19 patients required in Italy estimated at 8791. Worst scenarios produce unmanageable numbers. Our results suggest that the decisive moment for Italy has come. Jointly reinforcement by the government of the measures approved so far, including home confinement, but even more important the full commitment of the civil society in respecting home confinement, social distancing and hygiene will be key in the next days. Yet, even under the best circumstances, intensive care capacity will need to get closer to 9000 units in the country to avoid preventable mortality. So far, only strong measures were effective in Italy, as shown by our modelling, and this may offer an opportunity to European countries to accelerate their interventions.

Funding Statement: Activity at University of Padova was partly supported by MIUR (Italian Minister for Education) under the initiative "Departments of Excellence" (Law 232/2016).

Declaration of Interests: The authors declare no competing interests.

Keywords: COVID-19; critical care; surge; emergency; policy; intensive care; modelling; ICU; italy; government interventions; reproduction number; planning; disaster response; SARS-CoV-2

Suggested Citation

Rodriguez Llanes, Jose Manuel and Castro Delgado, Rafael and Pedersen, Morten Gram and Arcos Gonzalez, Pedro and Meneghini, Matteo, Confronting COVID-19: Surging Critical Care Capacity in Italy (3/25/2020). Available at SSRN: https://ssrn.com/abstract=3564386 or http://dx.doi.org/10.2139/ssrn.3564386

Jose Manuel Rodriguez Llanes (Contact Author)

European Commission-Joint Research Centre ( email )

Joint Research Centre, European Commission, Rue du
Ispra, Varese 21027
Italy

Rafael Castro Delgado

Universidad de Oviedo - Unit for Research in Emergency and Disaster ( email )

Spain

Morten Gram Pedersen

University of Padova - Department of Mathematics "Tullio Levi-Civita"

Italy

Pedro Arcos Gonzalez

Universidad de Oviedo - Unit for Research in Emergency and Disaster ( email )

Spain

Matteo Meneghini

University of Padova - Department of Information Engineering ( email )

Via Gradenigo 6/a
Padova
Italy

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