The Importance of ICU/Hospitalization Data

Carter Mecher MD -- Medical Advisor
July 31, 2021

Up-to-date data analysis shows the numbers being hospitalized in states at the leading edge are comparable to the largest wave previously encountered despite affecting a younger demographic.

Early in the Diamond Princess outbreak there was an opportunity to quickly get a bead on COVID. There was a circumscribed population where everyone would be tested. Given those circumstances, you can calculate the attack rate, the percentage of asymptomatic cases, hospitalization rate, ICU admission rate, and infection fatality rate (IFR). In addition, it was important to monitor hospitalization rates, although patients were admitted for isolation. It was quickly realized that this was a bit of an age skewed population, and actually was close in comparison to the Veteran population.

The problem was that the actions taken to mitigate an outbreak needed to be fast, and given the long time lag from illness onset to death, a shortcut had to be taken. That shortcut entailed figuring out the number of Diamond Princess cases needing ICU care and then applying a typical ICU mortality rate for respiratory illness of 15%-50%.  

On the Diamond Princess, the first confirmed case was on Feb 1, 2020. The first death was reported on Feb 19, and 2 deaths were reported that day. The 6th death was reported on Feb 28. The last of the 14 deaths was reported in mid-April. It was crucial to quickly get a sense of the IFR. There were no official channels at the time and instead had to resort to bits and pieces of media reports to roughly estimate the % of COVID + individuals requiring ICU care. With 15-50% ICU mortality, a calculation for   an IFR was made. On Feb 19, a report from Japan provided incredible detail on the demographics of the passengers and crew and cases by age group. As a result, there was a quick way to estimate the severity of this virus in a closed population that was age specific.

For the current wave in the US, the same methodology can be applied. The table below includes two additional columns highlighted in yellow.  For July 30, 2021, added in is the current number of COVID patients in ICUs for each state followed by a calculation for the percent of hospitalized patients in ICUs. On average, about 25% of the hospitalized patients during this wave are in the ICU. An important statistic to consider is that ICU beds account for about 10% of total hospital beds in the US.  

Most states didn't report the number of ICU patients during the early part of the pandemic, especially during other large waves. But Florida did. Florida had a peak number of hospitalized of 12,282 on July 23, 2020. On that day, the number of patients in the ICU was 2,534 -- so 21% of hospitalized patients in the ICU. On July 30, 2021, FL had hospitalized 9,699 patients and patients ICU totaling 1,916 -- so 20% of hospitalized patients in the ICU.

This data would imply that the patients being admitted are as sick as during other major waves and the numbers being hospitalized in states now at the leading edge are comparable to the largest wave previously encountered despite hitting a younger demographic.

This is quite concerning and underestimating the severity of this wave would be devastating. It is extremely important to watch the hospitalizations and especially ICU numbers of patients going forward. There have made advances in ICU care over the course of the pandemic (steroids, prone positioning, high flow O2 via nasal cannula, etc.), but mortality still is significant.

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