COVID death risk nearly doubles when ICU capacity exceeds 75%, study suggests

A critically-ill COVID patient is nearly twice as likely to die when the intensive care unit (ICU) is operating at more than 75% capacity, research suggests.

Officials and doctors alike have long warned lockdowns were essential to preventing the NHS from becoming overwhelmed while the coronavirus vaccines were being developed, with the extreme restrictions still being required as the jabs are rolled out.

Amid England’s dreaded second wave, 10 hospital trusts are said to consistently have no spare critical care beds, with NHS bosses warning capacity may soon “hit the limit”.

Hospital strain has been linked with an increased patient death risk outside of a pandemic.

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To better understand the situation amid the coronavirus outbreak, medics from the US Department of Veterans Affairs (VA) analysed more than 8,500 patients with an average age of 67, who were admitted to 88 VA hospitals between March and November.

Results suggest the patients were 94% more likely to die when the ICU capacity was at 75% to 100%, compared to when the COVID-related demand was no more than 25%.

Ever since the UK’s first lockdown was introduced in March, officials have stressed the “stay at home” measure will help “save lives” and “protect the NHS”.

England’s third lockdown may be beginning to have a positive effect, with 37,535 new cases recorded on 18 January, a 22.2% reduction on the seven days before.

There is a lag time before this translates to decreased hospitalisations, however, with 3,984 patients being admitted to hospital on 14 January – a 6.9% increase on the previous week.

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Speaking on The Andrew Marr Show on 17 January, NHS England’s chief executive Sir Simon Stevens said English hospitals have seen an increase of 15,000 inpatients since Christmas Day.

“That’s the equivalent of filling 30 hospitals full of coronavirus patients and staggeringly every 30 seconds across England another patient is being admitted to hospital with coronavirus,” he added.

Watch: US hospitals overwhelmed after influx of COVID patients

To better understand the impact hospital strain can have on a coronavirus patient’s outcome, the VA medics analysed veterans with a confirmed infection.

The patients, of whom 94% were male, were admitted to an ICU with 10 or more people who also had the coronavirus. COVID-19 is the disease that can be triggered by the coronavirus.

The results, published in the journal JAMA Network Open, revealed the patients who were treated when the ICU demand was between 75% and 100% were 94% more likely to die from any cause.

Deaths were recorded up to 30 days after a patient was discharged.

There was no significantly increased death risk when the ICU demand was less than 75%.

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“Tracking COVID-19 ICU demand may be useful to hospital administrators and health officials as they seek to implement interventions to optimise outcomes for patients with COVID-19,” wrote the medics.

“Facilities can identify the peak surge caseload since the pandemic started, in March 2020, and prospectively monitor COVID-19 ICU demand.

“Facilities within a health care system or within a geographic region could collaborate to triage patients with critical COVID-19 to sites with greater ICU capacity to reduce strain on any one facility.”

‘Extremis’ situation

The pressures being faced by the NHS come despite trusts adding an additional 50% “surge” capacity in the summer and autumn to cope with winter pressures, according to NHS England.

On 12 January, a leaked email seen by the HSJ revealed University Hospitals Birmingham was set to redeploy 200 doctors to its critical care units as the trust faced being “overwhelmed”.

Dr Peter Hewins, consultant at the trust’s Queen Elizabeth Hospital (QEH), wrote: “The trust position is one of extremis.

“We are at significant risk of becoming overwhelmed by COVID-19 patient[s] and specifically our ICUs are under immense pressure.

“We are planning for 280 ICU patients across the trust [230 at QEH] – potentially as soon as the end of this week.”

Across the NHS, critical care beds have reportedly been set up in overspill areas, including those usually reserved for surgery.

Without extra staff to care for these patients, specialist intensive care nurses are being stretched across more individuals, with one looking after three or four critically-ill people in some cases, rather than the typical one-on-one care.

Staff from other areas have also been redeployed to critical care departments, causing some non-urgent treatments to be cancelled.

The VA medics stressed further research is required to uncover how a patient’s disease severity and any staffing shortages contribute to ICU strain.

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