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Coronavirus: why a shortage of critical care beds could be deadly

A doctor entering a triage facility in Turin - Stefano Guidi/Getty Images
A doctor entering a triage facility in Turin - Stefano Guidi/Getty Images

Scientists are in no doubt that coronavirus is highly infectious but there remains considerable uncertainty over the case fatality rate - the proportion of infected people it kills.

We do know it has nothing like the 60 per cent lethality of Ebola, a disease which President Trump described as last night as causing people to “disintegrate”. It’s also not as dangerous as its cousins Mers and Sars, which have death rates of 30 per cent and 10 per cent respectively.

Instead, the World Health Organization (WHO) calculates that, in China, coronavirus has killed three per cent in Wuhan and 0.7 per cent in other provinces.

Coronavirus contagion and lethality
Coronavirus contagion and lethality

In many respects this is comforting. President Trump and others have rightly compared it to seasonal flu. But beware the gap between small numbers. A 0.7 per cent fatality rate equates to 70 deaths per 10,000 cases. At three per cent that rises to 300.

At a population level, these numbers start to pile up. The “reasonable worst case scenario” used by the UK government for pandemic planning assumes a 2.5% mortality rate and 750,000 excess deaths, for example.

But the fatality rate of a virus, like it's infection rate, is rarely fixed. It’s lethality will depend on a wide range of variables, not least on how patients are cared for and treated.

Critical care bed capacity in the UK
Critical care bed capacity in the UK

In an expert opinion on coronavirus published in the Lancet last week, the authors suggest the variability in the death rate in China can be explained by differences in local health care capacity. In simple terms, Wuhan ran out of doctors and beds.

“The rapid escalation in the number of infections around the epicentre of the outbreak…  resulted in an insufficiency of health-care resources… negatively affecting patient outcomes,” they said.

So should we be comforted or worried by the data on coronavirus?

Certainly we should all be alert to the speed at which it spreads and take simple measures such as frequent hand washing to protect ourselves and others.

Critical care bed capacity in England
Critical care bed capacity in England

In terms of its lethality, the key determinant in the short term will be the availability of medical care, and in particular the availability of critical care beds.

Unfortunately, the NHS has fewer of these beds by some considerable margin than many other comparable countries - about seven per 100,000 people, compared to 29 in Germany, for example.

There are also significant regional difference within the UK.

This is just one of the reasons why the government’s strategy of “contain, delay, research and mitigate” is so important.

If a sudden spike in case numbers and a rush on critical care beds can be avoided, we will avoid the higher death rates recorded in Wuhan.

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