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Most Brazilian states are expected to reach maximum ICU bed occupancy in the Unified Health System (SUS) this month due to the new coronavirus epidemic.
In the private system, a smaller number will reach the limit of their Intensive Care Units in May. However, by the end of June, most states are expected to have full private and public beds.
During the period of maximum occupancy, the lack of ICU in the public system can reach about 20 states and last, in many cases, approximately two months.
In the private system, with proportionally more beds, the vacancy will be approximately one month.
In both systems, the length of stay in the ICU of patients with Covid-19 can vary from 21 to 35 days, which prolongs the lack of beds.
Maintaining the current trend of going up the curve, Brazil can register more than 40,000 infections a day after the first week of June and an ICU bed deficit of over 20,000 by the end of next month.
In São Paulo, cases would exceed 9,000 per day and the ICU bed deficit would reach almost 5,000.
The projections were made with a tool created by researchers from the Federal University of Minas Gerais (UFMG) and were regularly fed, in collaboration with Sheet, with official data on the evolution of the epidemic.
Based on previous information on the total number of infections and the actual parameters regarding the number of beds, their occupancy rate and the average time observed during hospitalizations, the model estimates how long the system can be saturated.
The tool also takes into account the adjusted profile, by state, of people aged 65 years and over and the observed average speed of virus transmission, among other parameters that influence the total number of hospitalizations.
The model also estimates the filling of general hospital beds, used by less severe patients. In such cases, the risk of system collapse is much less.
Infections already registered by the tool project a future curve, whose “reflection” shows the decrease in available beds.
New day-to-day information fuels the mathematical model, increasing its ability to forecast over time.
For ease of reference, the Sheet It provides a synthesis of the data that allows observing the trend of the curve of cases and the occupation of beds in the ICU and the general ones by state and in the capitals, where the curves may differ from those of the states because they are more specific projections.
In general, the expectation is that the lack of beds in the ICU begins to occur two weeks earlier in SUS than in the private system.
The reason for this is that, in addition to serving approximately 75% of Brazilians, SUS has only 1.4 ICU beds, on average, per 10,000 inhabitants. In the private system, there are 4.9 beds for every 10,000 insured.
In some northern and northeastern states, where the supply of public beds is lowest, May will be marked by the maximum occupancy of SUS and private beds.
In the Southeast, SUS ICU vacancies may end this month in São Paulo and Rio de Janeiro. However, these predictions can be changed in the event that states and municipalities begin to integrate private beds into SUS, as the city of São Paulo already does.
In the current scenario, it is also necessary to consider that, if, on the one hand, the under-registration of existing cases anticipates the arrival of the collapse, the new general beds and ICUs of the field hospitals incorporated into the system have been postponed at this time.
Therefore, the breakdown date of the public and private health systems may fluctuate in relation to that indicated by the tool.
The estimate can also be changed according to the measures taken in relation to social distance. In the past few days, there has been a decrease in insulation, which tends to hasten the arrival of collapse.
The tool also allows state and hospital health managers involved in the fight against Covid-19 to do their own simulations on the speed with which general beds and ICUs will be occupied.
Among the pre-established parameters, it is considered that 1% of the population will present more severe symptoms of infection at the peak of the epidemic, cases that will be confirmed by PCR-type tests, a standard adopted by the Ministry of Health in the states and municipalities. .
Among them, around 14% of reported cases will require hospitalization, based on international experience. Of those hospitalized, 25% will occupy beds in the ICU and 75%, general beds.
This parameter of the tool can be updated when the Ministry of Health begins to publish consolidated data on the occupation of general beds and ICU, as promised a few weeks ago.
According to the folder notice, this hospital census is still in the implementation phase.
The forecast model also considered an initial occupancy of 70% of beds in the period before the pandemic, when vacancies were opened with the cancellation of elective surgeries and the reduction of many events, such as serious accidents.
This value can also be adjusted for each state individually by health system administrators who want to make their own projections with the data they have.
In addition to the query model provided by Sheet, the complete tool is available on the website of the Health Decision Support Technologies Laboratory (Labdec) and contains all the technical notes and criteria adopted by the Department of Production Engineering and the Center for Collective Health Education ( Nescon), teaching and research at the UFMG Faculty of Medicine.
To consult and make projections with the tool, health administrators or anyone can access it at labdec.nescon.medicina.ufmg.br.
