Friday 28 February 2020

Australia is "well prepared" for Covid-19 - really?

According to the head of the Biosecurity Program at UNSW's Kirby Institure, Australia might need 650,000 ICU bed's in a worst-case Covid-19 scenario (which considers the 'what if' case of 25%-75% of the population eventually being infected) - although these beds would be needed "over a period of time", such as one year.

However, even if a patient only required IC treatment for two days (which is probably way too low a guesstimate, given the average ICU length of stay is 3.3 days), that corresponds to 3,560 ICU beds in continual use dedicated exclusively to Covid-19 patients. Given that Australia only has approximately 2,000 ICU beds in total (spread across public and private hospital ICU units) that would seem to be a bit of a challenge -- especially as most of the ICU beds are already fully utilized for patients with burns, trauma, heart attacks etc. So, a 'worst case' scenario would imply almost tripling the number of ICU 'beds' (which in reality means a whole load of specialized equipment and infrastructure, specialist medical staff, and associated support staff...)

If one assumes ICU beds only have 90% availability (i.e. allow some 'down time'  for cleaning/disinfection between patients, maintenance, breakdowns etc.) and the LOS for Covid-19 turns out to be at least the same as the average ICU LOS (3.3 days), then the ICU bed requirement in Australia in the 'worst case' could easily hit an additional 6,500 ICU beds (a four-fold increase in the existing number of ICU beds). And its not as if Australia would be able to source additional technical and staff resources from overseas in such a situation (Australia's traditional answer to shortages in nursing staff is to poach them from the UK health system...), as other countries would be trying to boost their capacity at the same time.

BTW, the current fatality rates are skewed towards countries that have quite good health care capability (China, Korea, Japan, Iran) - and in that sample roughly 5% of Covid-19 cases have needed IC, resulting in the current fatality rate of between 1%-3%. If/when Covid-19 spreads to developing countries in Africa etc. the lack of ICUs could mean the fatality rate in those countries approaches 5% (those that 'need' ICU and can't get it would presumably not have good outcomes).

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