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Comment by danso | Hacker News Reader

> In the worst hit region in Italy (Lombardy) confirmed covid 19 cases represent enough cases to take up less than 10% of their hospital beds.

Do you have a source for this comment? This WaPo story from 6 hours ago says differently:

https://www.washingtonpost.com/world/europe/italy-coronaviru...

> Giulio Gallera, Lombardy’s health chief, said Thursday that the region would reach its capacity in “five, six or seven days,” even if it tried to add more beds in hospital “cellars.” In an interview with Italy’s La7 channel, Gallera described the possibility of adding 500 intensive-care beds at Milan’s expo center, the kind of rapidly assembled zone that China created in the hard-hit Wuhan area.

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lombardy has 7280 confirmed cases [1] lombary has a population of 10MM (wikipedia) italy has 3.18 hospital beds per 1000 [2]

the math for that adds up to 31,800 hospital beds 7280 confirmed cases is 22% - so my sources were off or wiki is wrong as originally I recall reading lombardy has a 16MM population.

I will say that your article claims they haven't run out of ICU beds yet but that number is surprisingly high for ICU needs to cover covid 19. The article implies 600 ICU cases from covid 19 - that's over 12% ICU from confirmed covid 19 cases, which is more than twice what china reported.

It's also very surprising how few ICU beds they have allocated towards ICU....

The USA has something like 14% of hospital beds as ICU beds [3] but Italy appears to only have have less than 3% of their beds available for covid 19 ICU

[1] https://www.statista.com/statistics/1099375/coronavirus-case... [2] https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp... [3] https://www.sccm.org/Communications/Critical-Care-Statistics

Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season most of those beds are already filled. The hospitals may be extrapolating the growth rate of the disease and realizing how soon they will have problems. Or given the nature of the outbreak it could be that even within Lombardy there are areas with much higher concentrations of cases, like there are more cases, inc. per capita, in Wuhan than other cities in Hubei.

What's not plausible is ICU beds being taken up by people who don't have the disease (maybe miild-to-moderate flus or bad colds) and are just panicking. Emergency room lines, sure. Test shortages, absolutely. But hospitals will not put someone who's just scared and doesn't even need to be admitted at all into the ICU.

> Most hospitals don't have all that much slack in bed capacity; especially at the tail end of flu season

Remember that there's a difference between hospital beds and ICU beds.

In the UK, we maintain 80% utilisation of our ICU beds all year round[0], with very little change in the number of beds available in real number terms. We have ~4100 total ICU beds, which can be expanded to ~5000 if all operating theatres, etc are shut down and used as ICU equivalent instead.

While getting past flu season will help the total number of beds, it does nothing for the ICU.

This is the other reason why it's increasingly important to https://www.FlattenThesCurve.com and employ social distancing techniques. The rate of patients being admitted into ICUs needs to be slowed as much as possible. Once we're out of capacity, every additional patient has a much higher probability of dying than the overall fatality statistics indicate.

[0] https://www.england.nhs.uk/statistics/wp-content/uploads/sit...

There's a typo, it's https://www.flattenthecurve.com/

The NHS regularly has to cancel routine operations in order to free up space for flu patients during the flu season, which might be one reason why the bed usage seems so uniform. Obviously if they're already doing that for flu it leaves less slack in the system if something else comes along.

Italy has about 12.5 ICU beds per 100,000 people. ICU beds are not the same as hospital beds.

https://www.statista.com/chart/21105/number-of-critical-care...

Maybe you shouldn't transfer every confirmed case into hospital since most cases will do just well ... unless they don't. (Not questioning the danger of this virus.)

1. Not every hospital bed is the same as a bed for a highly infectious disease

2. Other things still happen to people and those people need to have their hospital beds.

3. I'm not a hospital planner but I think there may be other things that determine capacity than just hospital beds. I worry that the hospital bed metric is actually a bad metric. Obviously adding hospital beds implies adding people to staff those beds, but also adding people probably also means adding all sorts of other infrastructure to support those people.

As a developer it reminds me of a project that goes way off schedule, you don't bring the project back on track just by adding developers because of the overhead more developers add to your system. Probably most hospital administrators have never actually experienced operating at capacity, so estimations of what would happen could be off and are being corrected now.

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