Beds(Coronavirus) = Beds(Flu) x 3

Yesterday a friend asked a really smart question. She’d seen the data on the 2016-7 flu season. That year there were 80,000 deaths and 900,000 hospitalizations. The question is, why are we in such a state now, but weren’t so during that flu season?

[For background, the seasonal flu vaccine is a very informed bet by WHO, CDC, and others that the strains used to make the vaccine will be similar enough to provide those of us who get the vaccine will have enough of the right antibodies to fight off the flu. (https://www.cdc.gov/flu/prevent/vaccine-selection.htm) Some years’ predictions about what will be circulating are better than others. And sometimes the viruses in circulation change (antigenic drift) during the same flu season. Both of these were at work in 2016-7.]

Most of us know that nCoV-19 is different from the flu. -It spreads more easily -Symptoms, even in those with good health and who will recover, can be severe -It appears to have a higher case fatality ratio -It lingers, even for people who are asymptomatic -No one has immunity to it -The flu has a long-established surveillance program that includes adequate testing &c. -We know who is most at risk for complications of the flu; even though we know that older people and people w certain conditions have a higher mortality risk; we’re still learning who is most likely to be hospitalized w nCoV-19

One of the most important things we’re trying to do is manage the capacity of our hospitals. The US has 2.9 beds per thousand people—as do Lebanon and Albania, ahem. Because of a lapse in regulation (a story for another day), rural hospital closures have surged over the last few years.

Our capacity can be overwhelmed because—even among those that will recover—coronavirus patients are more acutely sick and therefore need more ICU beds and a higher standard of care. This puts a strain on things.

But there’s another complication. In order to make sense of this, we need to look at what hospitals generally refer to as “average length of stay” (LOS)—how long does a person admitted to the hospital stay? Standards for both admission and discharge vary across the globe and even across the US. I’ve been trudging through reports and it appears that LOS for nCoV-19 is somewhere between 2.5 and 3 times the seasonal flu from 2016-7 (LOS_flu = 5.3; LOS_nCov-19 = 12 - 16).

This means that over the same period of time and with the same number of hospitalizations, coronavirus patients need between 2.5 and 3 times as many beds. It’d be like if the 2016-7 flu season had 2.25 to 2.7 million hospitalizations. New York is more or less a live look at the problem of peak capacity requirements. A few days ago they estimated they’d need 110,000 hospital beds. The estimate is now 140,000 beds—7.3 beds per thousand people, two and a half times the national average.

Dave Sundahl *This is not *