PT  - JOURNAL ARTICLE
AU  - Shoukat, Affan
AU  - Wells, Chad R.
AU  - Langley, Joanne M.
AU  - Singer, Burton H.
AU  - Galvani, Alison P.
AU  - Moghadas, Seyed M.
TI  - Projecting demand for critical care beds during COVID-19 outbreaks in Canada
AID  - 10.1503/cmaj.200457
DP  - 2020 May 11
TA  - Canadian Medical Association Journal
PG  - E489--E496
VI  - 192
IP  - 19
4099  - http://www.cmaj.ca/content/192/19/E489.short
4100  - http://www.cmaj.ca/content/192/19/E489.full
SO  - CMAJ2020 May 11; 192
AB  - BACKGROUND: Increasing numbers of coronavirus disease 2019 (COVID-19) cases in Canada may create substantial demand for hospital admission and critical care. We evaluated the extent to which self-isolation of mildly ill people delays the peak of outbreaks and reduces the need for this care in each Canadian province.METHODS: We developed a computational model and simulated scenarios for COVID-19 outbreaks within each province. Using estimates of COVID-19 characteristics, we projected the hospital and intensive care unit (ICU) bed requirements without self-isolation, assuming an average number of 2.5 secondary cases, and compared scenarios in which different proportions of mildly ill people practised self-isolation 24 hours after symptom onset.RESULTS: Without self-isolation, the peak of outbreaks would occur in the first half of June, and an average of 569 ICU bed days per 10 000 population would be needed. When 20% of cases practised self-isolation, the peak was delayed by 2–4 weeks, and ICU bed requirement was reduced by 23.5% compared with no self-isolation. Increasing self-isolation to 40% reduced ICU use by 53.6% and delayed the peak of infection by an additional 2–4 weeks. Assuming current ICU bed occupancy rates above 80% and self-isolation of 40%, demand would still exceed available (unoccupied) ICU bed capacity.INTERPRETATION: At the peak of COVID-19 outbreaks, the need for ICU beds will exceed the total number of ICU beds even with self-isolation at 40%. Our results show the coming challenge for the health care system in Canada and the potential role of self-isolation in reducing demand for hospital-based and ICU care.See related editorial at www.cmaj.ca/lookup/doi/10.1503/cmaj.200606