We previously demonstrated a strong inverse correlation between hospital bed availability for persons aged 65+ and case fatality rate (CFR), suggesting higher mortality in older COVID-19 patients with more limited access to inpatient care [1]. ICU bed availability is also a concern, as CFR of COVID-19 patients in the ICU is >25% [2].
Spearman's rho was calculated to determine association between ICU beds available per 1000 individuals aged 65+ and CFR across all US counties (Fig. 1). CFR was higher in the counties with more available ICU beds (p<0.0001), and we suspect this was due to disparities in ICU beds between rural and urban counties; the number of ICU beds per 1000 individuals over 65 is significantly higher (p<0.0001) in urban versus rural counties (1.26 vs. 0.55, respectively) [3,4]. Therefore, many critically ill rural cases of COVID-19 may be transferred to tertiary care centers in urban counties with greater ICU capacity [5].
Fig. 1.
a) Map was created using ICU bed data from Kaiser Health News [5] and age demographics from the 2015 American Community Survey [2]. b) Map was created using COVID-19 case and mortality data from USAFacts.org [2].
These results highlight urban-rural disparities in ICU bed capacity across the US. There is a clear need to provide support for rural counties that currently lack the capacity to treat severe cases. Transfers to tertiary care centers are possible in well-resourced settings, but when COVID-19 outbreaks strike rural communities in under-resourced nations, healthcare providers will be forced to make tough decisions. To prepare for future surges of COVID-19, we will need to increase ICU capacity, ventilator availability, and the human expertise to manage these complex patients in rural settings in both the US and developing nations.
Declaration of Competing Interest
All authors have no conflicts to disclose
References
- 1.Alkuzweny M., Raj A., Mehta S. Preparing for a COVID-19 surge. EClinicalMedicine. 2020 Jun;23 doi: 10.1016/j.eclinm.2020.100400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Quah P., Li A., Phua J. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Crit Care. 2020 Dec;24(1):285. doi: 10.1186/s13054-020-03006-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Centers for Disease Control and Prevention. NCHS urban-rural classification scheme for counties [internet]. 2017. Available from:https://www.cdc.gov/nchs/data_access/urban_rural.htm.
- 4.Schulte F., Lucas E., Rau J., Szabo L., Hancock J. Millions of older Americans live in counties with no icu beds as pandemic intensifies. Kaiser Health News [Internet] 2020 Mar 20 https://khn.org/news/as-coronavirus-spreads-widely-millions-of-older-americans-live-in-counties-with-no-icu-beds/ Available from: [Google Scholar]
- 5.Franki R. Rural ICU capacity could be strained by COVID-19. Hospitalist. 2020 Apr:27. https://www.the-hospitalist.org/hospitalist/article/221334/coronavirus-updates/rural-icu-capacity-could-be-strained-covid-19 (accessed July 20, 2020) [Google Scholar]