key: cord-1033649-i54vrevi
authors: Alkuzweny, Manar; Raj, Anita; Mehta, Sanjay
title: Preparing for a COVID-19 surge: ICUs
date: 2020-08-18
journal: EClinicalMedicine
DOI: 10.1016/j.eclinm.2020.100502
sha: ec0352ec7efdceb59b0eb5fa85dc3757a7bfda3f
doc_id: 1033649
cord_uid: i54vrevi

nan

We previously demonstrated a strong inverse correlation between hospital bed availability for persons aged 65+ and case fatality rate (CFR), suggesting higher mortality in older COVID-19 patients with more limited access to inpatient care [1] . ICU bed availability is also a concern, as CFR of COVID-19 patients in the ICU is >25% [2] .

Spearman's rho was calculated to determine association between ICU beds available per 1000 individuals aged 65+ and CFR across all US counties (Fig. 1) . CFR was higher in the counties with more available ICU beds (p<0.0001), and we suspect this was due to disparities in ICU beds between rural and urban counties; the number of ICU beds per 1000 individuals over 65 is significantly higher (p<0.0001) in urban versus rural counties (1.26 vs. 0.55, respectively) [3, 4] . Therefore, many critically ill rural cases of COVID-19 may be transferred to tertiary care centers in urban counties with greater ICU capacity [5] .

These results highlight urban-rural disparities in ICU bed capacity across the US. There is a clear need to provide support for rural counties that currently lack the capacity to treat severe cases. Transfers to tertiary care centers are possible in well-resourced settings, but when COVID-19 outbreaks strike rural communities in underresourced nations, healthcare providers will be forced to make tough decisions. To prepare for future surges of COVID-19, we will need to increase ICU capacity, ventilator availability, and the human expertise to manage these complex patients in rural settings in both the US and developing nations. Contents lists available at ScienceDirect EClinicalMedicine journal homepage: https://www.journals.elsevier.com/eclinicalmedicine

Preparing for a COVID-19 surge

Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature

NCHS urban-rural classification scheme for counties

Millions of older Americans live in counties with no icu beds as pandemic intensifies

Rural ICU capacity could be strained by COVID-19

USA Fig. 1. a) Map was created using ICU bed data from Kaiser Health News [5] and age demographics from the 2015 American Community Survey [2]. b) Map was created using COVID-19 case and mortality data from USAFacts