Limited ICU Space Played a Role in COVID-19 Deaths in Wuhan

Jared Kaltwasser

A new analysis of COVID-19 pneumonia deaths shows ICU space was insufficient, and comorbidities were a major factor.

A new analysis of patients who died of pneumonia related to coronavirus disease 2019 (COVID-19) in Wuhan, China, shows most patients were older and had serious comorbidities. However, the report suggests that the availability of intensive care unit (ICU) rooms had a significant impact on how long a patient lived.

The study, which was published in The Annals of the American Thoracic Society, was based on the cases of 109 patients in Wuhan who died between December 25, 2019 and February 24, 2020.

The city became the early epicenter of the COVID-19 crisis, though in recent days local officials have begun loosening disease-containment precautions.

Corresponding author Huan-Zong Shi, MD, PhD, of Beijing Chao-Yang Hospital, Capital Medical University, in China, said the findings of the study have implications for how hospitals prepare resources to deal with COVID-19 patients.

“Our findings should aid in the recognition and clinical management of such infections, especially in ICU resource allocation,” Shi and colleagues wrote.

The patients in the study represented about 10% of the 1017 patients who died of COVID-19 pneumonia at 3 hospitals in Wuhan. The study’s 109 patients had an average age of 70.7 years, and most (85%) had one or more comorbidities, including hypertension (60%), cardiovascular and cerebrovascular disease (34%), and diabetes (31%).

Upon admission to the hospital, Shi said the most common symptom observed in the patients was rapidly worsening dyspnea.

However, fewer than half (47%) were admitted to the ICU, even though Shi said all of the patients required ICU admission. The problem, Shi said, was lack of ICU space. The 3 hospitals in the study had a total of 1379 beds, but only 43 of those beds were ICU beds made available for patients with COVID-19, meaning patients in the study had to wait for other patients to recover or die before a bed was available.

Among those who were able to be admitted to the ICU, the average survival was 15.9 days after hospitalization. Those who did not get an ICU spot lived an average of 12.5 days post-hospitalization.

“Given that the numbers of critical ill patients with COVID-19 pneumonia far exceeded the numbers of ICU beds, and that no specific decision rule risk scores or criteria were available for judging who got ICU admission, our physicians made the decision at sole discretion,” Shi reported. Occasionally, clinicians used age as the decision-maker, assuming that younger patients might have a higher likelihood of survival.

Shi and colleagues said it’s possible some of the 109 patients would have survived if ICU resources had been more readily available, particularly if earlier intubation and invasive ventilation had been implemented.

All patients in the study received antibiotics to treat secondary infections. Most patients received antivirals, and all of the patients in ICU received antifungal drugs, the authors reported.

In addition to maximizing ICU availability, Shi and colleagues said hospitals should also implement an organ protection strategy as soon as possible in patients with severe COVID-19 pneumonia.

“A social distancing policy should also be proposed to slow the rate of cases and prevent health care systems from being overwhelmed by patients for whom they cannot provide ICU care,” Shi and colleagues conclude.