The stark national differences in the mortality rates of Covid-19 patients has become a source of politically charged debate.
Demand for ICU beds tends to surge within Covid-19 hotspots. Yet increasing the number of hospital beds within hotspots can increase the rate of patient mortality when ICU workload reaches a critical threshold, finds new research co-authored by Matthias Holweg, Professor of Operations Management at Saïd Business School, University of Oxford. Rather than building local ICU capacity, Covid-19 patients should be moved out of hotspots and into regions with fewer cases.
We need to relocate ICU patients out of Covid-19 hotspots, published in Harvard Business Review, explores why Germany’s mortality rate of 4.7% is much lower than Italy’s rate of 14.5% despite similar rates of infection.
The researchers found the answer lies, in part, in the management of ICU beds. Germany’s ICU bed registry prevented local overloading by allowing doctors to relocate patients swiftly in order to share the burden on ICU wards, and the country’s worst affected region, Bavaria, reached a maximum ICU capacity of just 61%.
In contrast, Italy’s worst affected regions suffered from overloaded ICU wards. Lombardy, for example, showed a rapid increase in death rate once ICU beds had reached 50% of capacity, hitting a peak at over 80% capacity.
Overloaded ICU wards lead to increased levels of infection among medical personnel causing staff shortages and fatigue, which in turn leads to higher a mortality rate among patients.
The researchers warn that we should expect recurring waves of Covid-19 soon and these will result in further hot spots of the disease. They state that health care leaders ‘must look beyond their local outbreak and address rapidly rising ICU demand in hotspots before the ensuing workload leads to potentially preventable increased mortality.’
They suggest countries adopt the use of online registers to track ICU capacity across their regions, concluding: ‘the early transfer of Covid-19 patients out of hotspot areas may be the most effective measure to curbing excess Covid-19 mortality yet.’Photo by Camilo Jimenez.