MRC Centre for Global Infectious Disease Analysis & WHO Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, St Mary's Campus, Norfolk Place, London, UK.
Department of Statistics, University of Oxford, Oxford, UK.
Int J Epidemiol. 2021 Jul 9;50(3):753-767. doi: 10.1093/ije/dyab034.
The coronavirus disease 2019 (COVID-19) pandemic has placed enormous strain on intensive care units (ICUs) in Europe. Ensuring access to care, irrespective of COVID-19 status, in winter 2020-2021 is essential.
An integrated model of hospital capacity planning and epidemiological projections of COVID-19 patients is used to estimate the demand for and resultant spare capacity of ICU beds, staff and ventilators under different epidemic scenarios in France, Germany and Italy across the 2020-2021 winter period. The effect of implementing lockdowns triggered by different numbers of COVID-19 patients in ICUs under varying levels of effectiveness is examined, using a 'dual-demand' (COVID-19 and non-COVID-19) patient model.
Without sufficient mitigation, we estimate that COVID-19 ICU patient numbers will exceed those seen in the first peak, resulting in substantial capacity deficits, with beds being consistently found to be the most constrained resource. Reactive lockdowns could lead to large improvements in ICU capacity during the winter season, with pressure being most effectively alleviated when lockdown is triggered early and sustained under a higher level of suppression. The success of such interventions also depends on baseline bed numbers and average non-COVID-19 patient occupancy.
Reductions in capacity deficits under different scenarios must be weighed against the feasibility and drawbacks of further lockdowns. Careful, continuous decision-making by national policymakers will be required across the winter period 2020-2021.
2019 年冠状病毒病（COVID-19）大流行给欧洲的重症监护病房（ICU）带来了巨大压力。确保在 2020-2021 年冬季能够获得医疗服务，无论 COVID-19 状况如何，这一点至关重要。
使用一种综合的医院容量规划模型和 COVID-19 患者的流行病学预测模型，来估计在法国、德国和意大利不同流行情景下，ICU 床位、人员和呼吸机在 2020-2021 年冬季的需求和剩余容量。通过使用“双重需求（COVID-19 和非 COVID-19）患者模型”，研究了在不同 ICU 中 COVID-19 患者数量达到不同有效水平时实施封锁的效果。
如果没有足够的缓解措施，我们估计 COVID-19 ICU 患者数量将超过第一波高峰时的数量，从而导致大量的容量短缺，床位始终是最受限制的资源。反应性封锁可以在冬季期间显著改善 ICU 容量，当封锁在早期触发并在更高的抑制水平下持续时，压力可以得到最有效的缓解。这些干预措施的成功还取决于基线床位数量和非 COVID-19 患者的平均入住率。
必须权衡在不同情景下减少容量短缺与进一步实施封锁的可行性和缺点。在 2020-2021 年冬季期间，各国政策制定者需要进行仔细、持续的决策。
