COVID-19: How Many ICU Beds and Ventilators Do We Really Have?
Here is the most recent data from the Society of Critical Care Medicine
There has been much written in the news media about the capacity of the U.S. healthcare system. A frequently cited number is that the U.S. has 2.8 hospital beds per 1,000 people. Yet, do we know exactly how many ICU beds we really have? The Society of Critical Care Medicine — the professional society of critical care physicians like me — has just published a report.
How many ICU beds are there?
Based on a proprietary database maintained by the American Hospital Association, the data indicate that there are 5256 AHA-registered community hospitals in the United States. Of these, 2704 (51.4%) deliver ICU services and have at least 10 acute care beds and at least one ICU bed. They have 534,964 acute care beds, including 96,596 ICU beds. There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds. Additionally, there are 25,157 step-down beds, and 1183 burn beds.
In a crisis, these stepdown and burn beds can theoretically be converted to ICU beds if absolutely necessary. The problem with this idea is that there are not enough ICU nurses to staff these beds, and the stepdown beds will need to be used for those COVID-19 patients who are sick, but not critically ill.
Still, if a “moderate pandemic” will produce 1,000,000 people needing hospitalization and 200,000 requiring critical care, this is still way more than the capacity of the ICUs of the entire country.
How many ventilators are there?
According to the report, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators. Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply. The CDC has a Strategic National Stockpile (SNS) of emergency ventilators that perform basic functions. This will add another 8,900 ventilators. So, all in all, there are approximately 169,638 ventilators for use in the country. In a severe pandemic, it is likely that elective surgeries will be canceled, and the anesthesia machines can be used for mechanical ventilation as well.
Again, the problem is many of these ventilators may not be sophisticated enough to deal with the severe respiratory failure that can result from COVID-19. And, there are not enough staff, i.e., respiratory therapists, to work all of these ventilators all at once. What’s more, the report stated: “A recent AHA estimate for COVID-19 projected that 4.8 million patients would be hospitalized, 1.9 million of these would be admitted to the ICU, and 960,000 would require ventilatory support.”
This data is why critical care clinicians like me are worried.
Remember this graph?
This is why mitigation efforts are of critical importance. The more effort we exert in limiting the spread of the SARS CoV-2, the more likely we can hopefully “flatten the curve” [the blue part of the graph] and protect the healthcare system from being overwhelmed.
We doctors, nurses, and other healthcare professionals are getting prepared as we speak. The rest of the country — including me as a member of my community — must do its part to help limit the spread of COVID-19. We can do it, and it will take all of us working together.