Harvard T.H. Chan School of Public Health, Center for Communicable Disease Dynamics, Department of Epidemiology, Boston, Massachusetts.
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Health Security and the Department of Environmental Health and Engineering, Baltimore, Maryland.
JAMA Netw Open. 2020 May 1;3(5):e208297. doi: 10.1001/jamanetworkopen.2020.8297.
Sustained spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has happened in major US cities. Capacity needs in cities in China could inform the planning of local health care resources.
To describe and compare the intensive care unit (ICU) and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak ICU bed needs in US cities if an outbreak equivalent to that in Wuhan occurs.
DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study analyzed the confirmed cases of COVID-19 in Wuhan and Guangzhou, China, from January 10 to February 29, 2020.
Timing of disease control measures relative to timing of SARS-CoV-2 community spread.
Number of critical and severe patient-days and peak number of patients with critical and severe illness during the study period.
In Wuhan, strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, 2020, patients with COVID-19 accounted for a median (interquartile range) of 429 (25-1143) patients in the ICU and 1521 (111-7202) inpatients with serious illness each day. During the epidemic peak, 19 425 patients (24.5 per 10 000 adults) were hospitalized, 9689 (12.2 per 10 000 adults) were considered in serious condition, and 2087 (2.6 per 10 000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within 1 week of case importation. Between January 24 and February 29, COVID-19 accounted for a median (interquartile range) of 9 (7-12) patients in the ICU and 17 (15-26) inpatients with serious illness each day. During the epidemic peak, 15 patients were in critical condition and 38 were classified as having serious illness. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence.
Even after the lockdown of Wuhan on January 23, the number of patients with serious COVID-19 illness continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on the local health care systems in US cities.
严重急性呼吸系统综合症冠状病毒 2 型（SARS-CoV-2）在美国主要城市持续传播。中国城市的重症监护病房（ICU）和住院病床需求可为当地医疗资源规划提供信息。
描述和比较中国 2 个城市的 2019 年冠状病毒病（COVID-19）患者的 ICU 和住院病床需求，以估计如果发生类似于武汉的疫情，美国城市 ICU 病床的需求峰值。
设计、地点和参与者：这项比较有效性研究分析了 2020 年 1 月 10 日至 2 月 29 日期间中国武汉和广州的 COVID-19 确诊病例。
疾病控制措施与 SARS-CoV-2 社区传播时间的关系。
研究期间危重症患者和严重患者的天数以及危重症患者的人数峰值。
在武汉，当地 SARS-CoV-2 持续传播 6 周后，才实施了严格的疾病控制措施。2020 年 1 月 10 日至 2 月 29 日期间，ICU 中 COVID-19 患者中位数（四分位间距）为 429（25-1143）例，严重疾病住院患者中位数（四分位间距）为 1521（111-7202）例。在疫情高峰期，有 19425 名（每 10000 名成年人中 24.5 名）成年人住院，9689 名（每 10000 名成年人中 12.2 名）成年人病情严重，每天有 2087 名（每 10000 名成年人中 2.6 名）需要重症监护。在广州，在病例输入后 1 周内实施了严格的疾病控制措施。2020 年 1 月 24 日至 2 月 29 日期间，ICU 中 COVID-19 患者中位数（四分位间距）为 9（7-12）例，严重疾病住院患者中位数（四分位间距）为 17（15-26）例。在疫情高峰期，有 15 名患者处于危急状态，38 名患者被归类为严重疾病。根据年龄分布和合并症（即高血压）流行率的差异，预计美国城市类似武汉疫情高峰期 ICU 中普遍存在的危重病患者人数为 2.2 至 4.4 例/每 10000 名成年人。
即使在 1 月 23 日武汉实施封锁后，COVID-19 严重疾病患者的数量仍继续上升，至少持续了一个月，超过了当地的住院和 ICU 能力。迫切需要制定计划，以减轻 COVID-19 疫情对美国城市当地医疗保健系统的影响。
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