COVID-19: Analyzing the Potential Healthcare Shortage in Your Neighborhood [Opinion]

As of Monday, March 23, there were approximately 380,000 global cases of COVID-19 infections reported online and over 16,500 deaths. Earlier last week, the US government recommended hand-washing and social distancing to help prevent the spread of the virus. Over the last few days, efforts have been ramped up quickly across many states to put more recommendations in place regarding sheltering in place, closing non-essential businesses, and blocking borders of the most infected states, like New York. With over 500,000 tests arriving in Memphis from Italy, the FedEx distribution center there has been employed to get those tests all around the country to drive-thrus and other testing centers.

The potential number of infections across the United States

The rise in cases in the US is increasing at a steep incline now that more people are being tested. It has been suspected all along by analysts that the number of cases reported in the US has been woefully low based on statistical evidence and comparisons to growth charts of other countries. On February 27 when the global cases were reported to be around 82,500, Dr. James Lawler and colleagues gave a presentation hosted by the American Hospital Association, Overview of COVID-19 – Projections and Modeling, that projected the United States to be on a path of having 96 million cases resulting in 4.8 million hospital admissions, 1.9 million in ICU, and 480,000 deaths. The values projected are a shocking realization that the coronavirus outbreak is a much larger threat than the US is prepared for. With a population of over 331 million people in the US, this study estimates that 30% of the US population will become infected.

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Read Also: COVID-19: In-depth analysis of what the world is doing

Screenshot from Dr. James Lawler’s slide deck.
Screenshot from Dr. James Lawler’s slide deck.

The distribution of COVID-19 infections in every state and county

With New York, Washington, and California’s reported cases and deaths rising much faster than the rest of the US, the reality of the situation still feels far-fetched to people living in other states, like Florida or Tennessee. Carrot Health created a risk dashboard for COVID-19 that makes it much easier to estimate the potential threat all the way down to the county level within each state. “Carrot Health maintains demographic and behavior data on every adult in the US – approximately 260 million people.” This level of detail gives a compelling allocation of the number of cases we could expect. Their dashboard takes into account “Tobacco use, Diabetes, COPD, and Hypertension rate data” as reported by the Behavioral Risk Factor Surveillance System (BRFSS), a product of the Centers for Disease Control and Prevention.

The default settings when looking at Carrot Health’s COVID-19 distribution assume that 10% of the US adult population will be infected with the virus. This results in over 26 million adult infections, a much smaller number than what Dr. Lawler presented. Regardless which projection is the most likely to occur, we can create a range of results around these values to give a picture more easily understood by people living anywhere in the United States.

The range of estimated cases, hospitalizations, and mortalities

Screenshot from Carrot Health’s Risk Dashboard using default settings.
Screenshot from Carrot Health’s Risk Dashboard using default settings.

Assuming that 7.5% of infections are occurring in children using Tennessee’s reported distribution, Dr. Lawler’s projection of 96 million infections would include 89 million adults and 7 million age 20 or younger. We are going to assume that 34% of the adult population is infected to calculate the upper end of the range.

Screenshot from Carrot Health’s Risk Dashboard using a 34% infection rate.
Screenshot from Carrot Health’s Risk Dashboard using a 34% infection rate.
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Now that the simulator shows the 89 million adult infections projected, let’s view what the projections would be for Florida and Tennessee with a range of 10% to 34% infections of the adult population.

Florida’s low-end projection

Based on a 10% adult population infection rate, Florida could expect over 2.1 million infections, 140,000 critical cases, and over 28,000 deaths.

Screenshot from Carrot Health’s Risk Dashboard for Florida using a 10% infection rate.
Screenshot from Carrot Health’s Risk Dashboard for Florida using a 10% infection rate.

Florida’s high-end projection

Based on a 34% adult population infection rate, Florida could expect over 7.2 million infections, 476,000 critical cases, and 95,000 deaths.

Screenshot from Carrot Health’s Risk Dashboard for Florida using a 34% infection rate.
Screenshot from Carrot Health’s Risk Dashboard for Florida using a 34% infection rate.

Tennessee’s low-end projection

Based on a 10% adult population infection rate, Tennessee could expect nearly 530,000 infections, 27,500 critical cases, and over 5,500 deaths.

Screenshot from Carrot Health’s Risk Dashboard for Tennessee using a 10% infection rate.
Screenshot from Carrot Health’s Risk Dashboard for Tennessee using a 10% infection rate.

Tennessee’s high-end projection

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Based on a 34% adult population infection rate, Tennessee could expect over 1.8 million infections, 93,700 critical cases, and 18,700 deaths.

Screenshot from Carrot Health’s Risk Dashboard for Tennessee using a 34% infection rate.
Screenshot from Carrot Health’s Risk Dashboard for Tennessee using a 34% infection rate.

Can our hospital systems handle the volume of hospitalizations projected?

Based on the number of hospitalizations projected for Florida and Tennessee, are there enough hospital beds available to treat patients? The following charts represent the potential growth curves in hospitalizations with varying levels of action taken by each states’ residents. Without action, Florida could potentially see 500,000 hospitalizations. With social-distancing, the figures are closer to 200,000. Notice that the black line in the chart represents the number of available hospital beds in Florida. Using the range of estimates we’ve seen from Carrot Health, Dr. James Lawler, and the charts below from Coronavirus Act Now, we will surpass the number of available beds by the third week of April and be short by nearly 140,000 beds by mid-May in Florida alone.

Screenshot from Coronavirus Act Now website based on March 19 data.
Screenshot from Coronavirus Act Now website based on March 19 data.

According to Shout Your Cause, all 50 states will have hospital bed shortages, including Tennessee, if their state governments and residents do not act quickly to stem the spread of COVID-19. Shout Your Cause is an organization that is using Facebook and Instagram advertising to send state-specific information to each state’s residents to encourage them to tell their elected officials they want action taken immediately.

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