We expect the COVID-19 hospital demand to peak in 2-3 weeks(1), per Governor Cuomo. In the 5 counties referenced earlier, there are a total of 196 cases of COVID-19(2), as of yesterday afternoon (146 in Onondaga, 4 in Cayuga, 8 in Cortland, 29 in Madison, and 9 in Oswego). 20 patients are currently receiving hospital care in Onondaga County(2), and my guess is that anyone who requires hospitalization from the surrounding area is already included in that figure.
The exponential growth in infection rate has seemingly been the same across the globe. The curves in China, Italy, and NYC all look pretty similar … scarily similar. It is easy to look at NYC and see that NYC was at 173 cases on March 10.(3)* If CNY follows the same exact curve, we would be looking at 30,000 cases when this thing peaks in two weeks, more if the peak occurs later. By most accounts, approximately 12% of those afflicted with COVID will require hospitalization.(4) That is more than 3,000 COVID hospitalizations for the 2,400 available beds in CNY. Then consider that most hospitals are running at 80-90% capacity on an ongoing basis (sure, in some instances, up to 30% are for now-cancelled elective procedures) … it gets ugly quick.
That is the most dire, and (frankly) obscenely unlikely scenario. In NYC, hospitalizations are already beginning to level-off a little, possibly due to the impact of social distancing that was being encouraged even before everything was closed; the curve may be flattening (a little). Now, hospitalizations in NYC are only doubling every 4.7 days, down from every 3.4.(4) If CNY remained on a similar trajectory for the next 2 weeks, there would be less than 100-120 hospitalizations, 320-350 if it peaked in the 3rd week.
There is good reason to think that our numbers shouldn’t be severe and that our curve was always going to be less than some of the other places that we read/hear about. NYC was at 173 cases on March 10(3), and the state didn’t really close shit down until March 22. CNY started distancing – statewide – at the same time. NYC had an additional 2 weeks of life-as-usual once they hit the same number of cases that CNY has now – life is now far-from-usual. Meanwhile, CNY schools closed a little earlier. Only a small percentage of residents in Onondaga County use public transport, and the outlying communities (accounting for >50% of the 785,000 population) are in rural communities. There are no high rise buildings. There are very few apartment buildings, far more “garden-style” apartments. The population density in NYC is 66,000 people per square mile. Syracuse’s density is 5,700 per square mile and a typical suburban town(5) has a density of 2,400 people per square mile.
Last week, Onondaga County had discovered 34 cases of COVID-19(6). One week after having 44 cases, NYC had jumped to over 400 cases(3). Again, in contrast, Onondaga County is now at 146 over the same 7-day duration. The curve in CNY is simply flatter. On average, it took Onondaga County approximately 3.5 days to double their cases last week. It took NYC 2 days to double their cases in the week after they had their 40th confirmed case. If CNY continues to confirm cases at the same current rate as Onondaga County (an admittedly unlikely worst-case scenario as density is much less in the areas surrounding Syracuse), the cases will double twice weekly, four times until we hit peak. That is 196 cases jumping to 392, 784, and 1,568 after 2 weeks. In a worst-worst case scenario, CNY peaks another week later at 6,272 cases. If 12% require hospitalization (consistent with the 10% rate that CNY is currently seeing), CNY could have upwards of 750 patients who require COVID-related hospitalization. The better scenario, peaking at 2 weeks, would require hospitalization for only approximately 200 patients for COVID-related illness.
Hopefully, citizens keep doing what they are supposed to be doing. If they do, CNY could be able to peak at a level that doesn’t interrupt most already existing hospital services. By eliminating elective procedures and using operating rooms as inpatient rooms, the local hospitals should be able to free up 20-25%(7) of the approximately 1700 beds, a figure between 340-425 rooms. Depending on which napkin you are writing on, and extrapolating from which dataset, CNY will need anywhere from 200 to 750 beds, probably closer to 500, and not necessarily all at the same time. Then the questions get interesting: does NY start transporting patients from downstate to upstate? Does CNY still expand their hospitals to make room? If they are already at capacity with their own patients, how do they make room for patients that are overflowing from much-more-burdened facilities elsewhere? Which patients do they place in the expanded/overflow sites, COVID patients or other medical cases?
So, what does this mean for me as soon-to-be home care decision influencer? (my boss, the director, is the decision-maker)
I don’t know. I’ll find out tomorrow.
*to be fair, this data is skewed a little, as the numbers are from all of New York, which was mostly downstate at the time, inclusive of Westchester and Rockland counties, but the number should hold mostly-true for the purposes of this post