Abstract
As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.
Highlights
The outbreak of COVID-19 [1], the disease caused by the novel coronavirus SARS-CoV-2, detected in China in December 2019 [2], has become pandemic and continues putting national health systems of different countries into significant levels of stress [3,4,5,6]
The clinical need for such a system was evidenced by a spontaneous initiative that took place in Madrid (Spain) in early April 2020 [9], when the Spanish capital was suffering a significant surge of COVID19 cases
Here we build on conceptually similar approaches we focus on a healthcare network where resources to be shared consist of intensive care unit (ICU) beds or ventilators, within the context of the COVID-19 pandemic
Summary
The outbreak of COVID-19 [1], the disease caused by the novel coronavirus SARS-CoV-2, detected in China in December 2019 [2], has become pandemic and continues putting national health systems of different countries into significant levels of stress [3,4,5,6] (see [7] and references therein for a detailed overview). Either during the first or successive epidemic waves, the intensive care unit (ICU) demand of several hospitals might surpass their nominal capacity in particular regions in several countries, as has already happened in Italy or Spain [8]. Epidemic outbreaks can take place in different parts of a country and this can lead to substantial variations of demand both through space and time. Some hospitals may receive substantial numbers of patients early in an outbreak, whilst others may be only mildly affected. This demand heterogeneity opens the possibility of balancing the load of patient admissions such that excessive demand is re-routed to the places which have spare capacity. Without a principled and organic approach to patient transfer it is possible to end up worsening the situation
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