Top 5 Takeaways

1. Hospital Strain and Excess Deaths: Intensive care unit (ICU) bed use at 75% capacity is associated with an estimated additional 12,000 excess deaths two weeks later, while exceeding 100% ICU bed capacity could result in 80,000 excess deaths.
2. Impact of Delta Variant: The study period included the months during which the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant became predominant in the United States.
3. Resource Limitations: Hospital resource limitations led to crisis standards of care, where the focus shifted from individual patient outcomes to the immediate needs of larger patient groups.
4. Public Health Recommendations: Leaders are encouraged to implement interventions to reduce disease prevalence, such as vaccination, and to expand or enhance capacity during high disease prevalence periods.
5. Modeling Findings: The negative binomial regression model used in the study predicted significant increases in excess deaths as ICU bed occupancy increased, highlighting the importance of controlling case growth before severe strain occurs.

Original Article Author and Citation

Corresponding Author

Geoffrey French, Geoffrey.french@cisa.dhs.gov

Suggested Citation

French G, Hulse M, Nguyen D, et al. Impact of Hospital Strain on Excess Deaths During the COVID-19 Pandemic — United States, July 2020–July 2021. MMWR Morb Mortal Wkly Rep 2021;70:1613–1616. DOI: http://dx.doi.org/10.15585/mmwr.mm7046a5

Summary

This report examines the impact of hospital strain on excess deaths during the COVID-19 pandemic in the United States from July 2020 to July 2021. The study found that increased ICU bed occupancy was associated with significant increases in excess deaths, particularly during the period when the Delta variant was predominant. The findings underscore the importance of controlling COVID-19 case growth to prevent severe strain on hospital systems.

Methods

Data on excess deaths from all causes were provided by the CDC, and hospital strain data came from the U.S. Department of Health and Human Services (HHS) hospital utilization timeseries dataset. Excess deaths were defined as the difference between observed and expected deaths during specific periods. Hospital strain was measured by ICU bed occupancy. A negative binomial regression model was used to estimate excess deaths, controlling for state-level differences. Statistical analyses were conducted using R software (version 4.0.2).

Discussion

The study’s findings suggest that ICU bed use is a critical indicator of stress on health care and public health sectors, with excess deaths emerging in the weeks following a surge in COVID-19 hospitalizations. The results support previous analyses on the potential consequences of the COVID-19 pandemic on critical infrastructure and workforce. The study also highlights the need for interventions to reduce disease prevalence and enhance hospital capacity during high disease periods.

Conclusion

Controlling COVID-19 case growth and subsequent hospitalizations is crucial to prevent severe strain on hospital systems. State, local, tribal, and territorial leaders should consider implementing strategies to reduce disease prevalence, such as vaccination, and ways to expand or enhance capacity during times of high disease prevalence.

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