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As the COVID-19 pandemic increases, some communities will be better equipped to treat the sickest patients – especially those who need intensive care units – than others. The capabilities of the intensive care unit not only vary from hospital to hospital, but some parts of the country also have far more intensive care beds by population group than others.
An NPR analysis of data from the Dartmouth Institute for Health Policy and Clinical Practice examined how the country’s 100,000 intensive care beds are distributed across the more than 300 markets that make up the country’s hospital system.
In some areas, such as some in Florida, there are more than 60 intensive care beds for every 100,000 people. In other countries, such as Las Vegas and Nashville, Tennessee, there are fewer than 20. Intensive care beds are now particularly important because they are hospital units that are typically equipped to treat patients with breathing problems who require ventilators.
“The impact of this data is that the pandemic will look very different in different places,” said Eric Toner, a doctor and senior scientist at the Johns Hopkins Center for Health Security.
“Some locations may be able to ration without critical care. Other locations will definitely not be able to,” he says. “The worst scenario would be catastrophic healthcare failure at this facility.”
A report by the Society of Critical Care Medicine found that more than nine out of ten intensive care beds are located in metropolitan areas with more than 50,000 inhabitants at national level. Only 1 percent of American intensive care beds are in rural areas.
David Wallace, a researcher and intensive care physician at the University of Pittsburgh, found that larger hospitals, teaching hospitals and those with intensive care units were more likely to add intensive care beds from 1997 to 2011.
According to Toner, these differences will reveal regional differences in access to critical health care in a pandemic.
“We are seeing the fruits of trying to find a market solution to a national strategic problem,” he says. “We have the number of beds we make because that is the market or where it is required.”
Craig Coopersmith, director of the Emory Critical Care Center in Atlanta, describes the pandemic as a “one-time event”.
“You cannot develop a health system just for times of the pandemic,” he says. “When they did, most beds in the intensive care unit were empty.”
And there is “absolutely no standard” for intensive care beds at the national level.
However, whether it is better to be a COVID-19 patient in a large or a small city depends on how many people are infected in these areas and what skills the local hospital has.
According to Wallace, even his own research on counting intensive care beds is too simplistic, since the intensive care units themselves are so different.
“While I may be able to count the number of beds in Region A and Region B and the underlying populations in these two areas,” he says, “what these beds and intensive care units can actually offer is a whole another question.”
Both Wallace and Toner tell NPR that hospitals will try to cope with the high demand for intensive care beds by relocating some of their facilities, changing staff and moving patients between hospitals. Toner argues that the country should share these costs together.
“It is in the national interest to have hospitals and intensive care units in places that are not profitable,” he says.