Early indicators of intensive care unit bed requirement during the COVID-19 epidemic: A retrospective study in Ile-de-France region, France.

Corstiaan Den Uil

doi:10.1371/journal.pone.0241406

Abstract

The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated (R2 ranging between 0.79 to 0.99, all P<0.001) with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. A qualitative analysis of the onset of the second wave period of the epidemic (August 1 to September 15, 2020) in the same region provided similar results. The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19, or decide additional social measures.

Highlights

The COVID-19 pandemic has a high impact on public health in many countries [1]
The daily number of COVID19-related telephone calls received by the emergency medical service (EMS) and corresponding dispatch ambulances, and the proportion of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests were the earliest indicators of the number of COVID19 patients requiring intensive care unit (ICU) care during the epidemic crisis, rapidly followed by emergency departments (ED) and general practitioner (GP) visits
The daily number of emergency calls received by the EMS, ambulances sent, GP and ED visits, RT-PCR, and hospital admission in all patients and COVID-19 patients during the study period is shown in S1 Table

Summary

Introduction

The COVID-19 pandemic has a high impact on public health in many countries [1]. The medical response has combined all hospital resources, including emergency departments (ED), conventional hospitalization, and intensive care units (ICU). Except for some countries which succeeded in early control of epidemic transmission chains (South Korea, Hong Kong) [3, 4], most countries (China, Italy, France, Spain, UK, USA and Brazil) experienced a rapidly diffusing epidemic pattern. It strucked the health care system with a rare violence and threatened possible ICU bed shortage which would have led to additional mortality [5,6,7]. In France, all patients requiring ICU were admitted in such units, but this result was only obtained by a considerable increase in the number of ICU beds, and inter-regional ICU patient transfers, to avoid overwhelming of local ICUs [10]

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