Critical Care Requirements Under Uncontrolled Transmission of SARS-CoV-2

Am J Public Health. 2021 May;111(5):923-926. doi: 10.2105/AJPH.2020.306151. Epub 2021 Mar 18.


Objectives. To estimate the critical care bed capacity that would be required to admit all critical COVID-19 cases in a setting of unchecked SARS-CoV-2 transmission, both with and without elderly-specific protection measures.Methods. Using electronic health records of all 2432 COVID-19 patients hospitalized in a large hospital in Madrid, Spain, between February 28 and April 23, 2020, we estimated the number of critical care beds needed to admit all critical care patients. To mimic a hypothetical intervention that halves SARS-CoV-2 infections among the elderly, we randomly excluded 50% of patients aged 65 years and older.Results. Critical care requirements peaked at 49 beds per 100 000 on April 1-2 weeks after the start of a national lockdown. After randomly excluding 50% of elderly patients, the estimated peak was 39 beds per 100 000.Conclusions. Under unchecked SARS-CoV-2 transmission, peak critical care requirements in Madrid were at least fivefold higher than prepandemic capacity. Under a hypothetical intervention that halves infections among the elderly, critical care peak requirements would have exceeded the prepandemic capacity of most high-income countries.Public Health Implications. Pandemic control strategies that rely exclusively on protecting the elderly are likely to overwhelm health care systems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • COVID-19* / epidemiology
  • COVID-19* / transmission
  • Communicable Disease Control*
  • Critical Care*
  • Electronic Health Records
  • Female
  • Hospital Bed Capacity / statistics & numerical data*
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Spain / epidemiology
  • Young Adult