Surges in COVID-19 cases in hospitals can directly and indirectly result in an increase in deaths from all causes 2, 4, and 6 weeks later, according to a report released Thursday.
The modeling study, led by Geoffrey French, MA, with the Cybersecurity and Infrastructure Security Agency (CISA), studied the effect of hospital strain — measured by intensive care unit use — on excess deaths (expected vs observed) from July 2020-July 2021. It was published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.
Researchers found that the conditions of hospital strain in that period, which included the onslaught of the Delta variant, predicted that nationwide ICU bed use at 75% capacity is linked with an estimated additional 12,000 excess deaths in the ensuing 2 weeks (P < .01).
When ICU bed use exceeds 100% capacity, the authors write, 80,000 excess deaths would be expected within the ensuing 2 weeks (P < .01).
As of October 25, the report notes, according to the US Department of Health and Human Services, capacity in adult ICUs nationwide had exceeded 75% for at least 12 weeks. As of Thursday, capacity nationally was at 78%.
“This means that the United States continues to experience the high and sustained levels of hospital strain that, according to the model’s results, are associated with significant subsequent increases in excess deaths,” the authors write.
ICU Capacity a Marker
The CISA COVID Task Force used the data to assess the potential effect of COVID-19 surges on hospital systems and other critical infrastructure sectors and national critical functions. The CDC provided data on deaths from all causes.
The authors write that the data highlight the importance of controlling case growth and hospitalizations for COVID before severe strain.
“State, local, tribal, and territorial leaders could evaluate ways to reduce strain on public health and health care infrastructures, including implementing interventions to reduce overall disease prevalence such as vaccination and other prevention strategies, as well as ways to expand or enhance capacity during times of high disease prevalence,” they write.
Conditions in the pandemic may help explain contributors to the excess deaths. The authors point out that lack of hospital space, staffing, and supplies have pushed some healthcare facilities to adopt crisis standards of care, the most extreme operating condition for hospitals.
Under those standards, decision-making shifts from achieving the best outcome for each patient to addressing the immediate needs of large groups. Additionally, many preventive and elective procedures were suspended, leading to progression of serious diseases.
Emergency department visits for serious conditions also declined. From March to May 2020, ED visits declined by 23% for heart attacks, 20% for strokes, and 10% for diabetic emergencies.
Although pandemic surges in ICU bed use are not a direct cause of excess deaths, the authors write, “high ICU capacity is a marker of broader issues that can contribute to excess deaths, such as curtailed services, stressed operations, and public reluctance to seek services.”
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick
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