What's the Big Deal?
Last Updated: 14th May 2020
Why all the talk about Hospitals?
There's a curious observation to be made by examining early press briefings from WHO, Italy, America, Australia, and many other countries. There is little discussion of fatality rates. Instead, the gross amount of time goes into discussing two things:
- Spread, and
How easily and quickly COVID-19 spreads makes a lot of sense for discussing an infectious disease, but why all the talk about hospitals? Early data out of China showed that 1 in 5 needed to be hospitalised in order to have a chance at recovery.
The fatality rate in China remained low, only if patients could get a hospital bed. For a disease that had been doubling every 2-4 days, this was a concerning finding. This meant that as cases doubled, so would the need for hospital beds, staff, equipment and supplies. No country in the world was ready for that. Governments don't run health systems to have thousands of spare beds, doctors, nurses, labs and morgues lying around 'just in case'. In fact, it's usually the opposite. For many countries their health systems are already stretched and strained. So then how could governments handle a large influx of new cases, let alone cases that are doubling?
China Quick Response
In China, they put a raft of measures in place, even building 16 shelter hospitals in just three weeks. But even this was a linear solution to an exponential problem.
You can only build hospitals and recruit doctors so fast, and if the disease you're fighting is exponentially doubling every few days, there comes a point where it's impossible to keep up.
If a city reaches a point where it can't keep up, this creates a domino effect of additional consequences. This is because in a health system, each health issue is interconnected with and impacts on other health issues. For example, if one issue overwhelms a system, it can then:
- Take resources away from other issues,
- Worsen the severity of existing issues, and
- Increase the likelihood of new issues occurring
All of this then puts additional pressure on an already over-burdened system, which causes further deaths and complications, which begins a negative feedback loop of increasing pressure. For example.
Whilst governments care about this, their motives are not entirely altruistic. The health of a society can directly correlate to the health of an economy. The extreme actions taken by governments around the world have therefore been focused on protecting both the health of their populations, and the long term functioning of their economies.
Initial modelling and planning was based on the hospitalisation data coming out of China. But different countries have had different experiences.
Across Europe, many cities have been overwhelmed as 32% of cases have been hospitalised, with 2.4% requiring an ICU. In Australia, hospitalisation statistics have been much better than both Europe and China with 12% of Australian cases needing hospitalisation and 1.9% being admitted to ICU. That said, it's important to recognise that these numbers are not static.
Treatment & Hospitals
The reason many COVID-19 patients need a hospital bed to recover is because of how COVID-19 works. As we explain in more detail here, COVID-19 has a few tricks. One of these is to stop the lungs from working properly. This makes it harder for the body to get oxygen into the blood, which in turn makes it harder for organs like the heart to function. As organs struggle, multiple sites throughout the body struggle to fight the disease.
So far, trials on various treatments have not shown any definitive benefit. There are some promising signs from a number of studies, however these are still ongoing. You can track some of the clinical trials here, and other evolving research here.
Until effective treatment methods are discovered, all doctors and nurses can do is support the body and hope to give it the best chance to fight the infection itself. Modern medicine and technologies have given doctors and nurses all sorts of techniques to do this. But for severe cases of COVID-19, this often requires special equipment. For example, Ventilators and ECMO are machines that can help lungs do their job as they become increasingly unable to do so on their own. Because of this, the global demand for specialist equipment has gone through the roof. This alone has magnified health emergencies in some cities as manufacturing and shipping logistics threaten to create higher fatality rates than would be otherwise experienced. The equipment and staffing demands of COVID-19 also combine to make it a more costly disease to treat. This adds to the economic incentive governments have for avoiding its spread.
Whilst the bulk of COVID-19 deaths are from those above the age of 60, it's important to note this doesn't apply the same way to hospitalisations. In both Australia and the US, half of people hospitalised were below the age of 60. Young people may be far more likely to recover - but that doesn't mean some won't need a hospital bed to get there.
Beyond the Short Term
It's also important to consider that the severity of diseases are not as binary as whether it leaves someone dead or alive. We don't yet know what the long term health effects are from COVID-19. A small study from China showed that although patients were returning home, a lot of their biomarkers were still not normal. Another small study showed 96% of survivors were discharged with residual disease remaining in their lungs.
This asks us to consider how we're defining 'recovered'. Do all these biomarkers return to normal over time? How much of the inflammation that remains in the lungs will result in scarring? We don't know. It's taken decades to understand the long term effects of other diseases. Medical professionals refer to this as studying the Sequelae of a disease, and it's an important part of determining how dangerous a disease is. Whilst we don't yet know what the complications and severity of symptoms will be, it's like that a few will exist.
Is it a big deal?
Hospitalisation rates and long term conditions only become a concern if the number of cases a city has, is higher than what it can handle. 10% of cases needing a Ventilator isn't concerning if that means only 100 people need one. This is why there's been so much discussion around 'flattening the curve'. Keeping patient numbers within what a health system can handle allows governments to optimise both health and economic outcomes. How well this is done will help determine whether or not COVID-19 is a big deal for that city or not.
The astute question then becomes - how likely is a health system to be overrun? If that's the point where increased fatalities and severe economic impacts are realised - how likely is this to happen? To understand this more, we can ask: