Assessment of the pandemic phase 3 – mitigation – from the endpoint hospitalization

Abstract

Background: The phase 3—“mitigation”—of the current pandemic by SARS-CoV‑2 is now imminent also in Germany. Given the high complexity many issues have to be taken into account. Simplification is urgently warranted not to loose focus of the important things to be done. Methods: To look at phase 3 from the endpoint—in this case hospital admission—should facilitate the focus on key variables upstream. Based on a simplified model of approximated and plausible parameters for the overall attack rate (AR), the AR(hospitalization) and the AR(ICU admission), the resources needed are compared with the available resources i.e. number of beds available in general and beds in ICU in particular. The calculations are carried out population-based for Ploen County as well as regionally together with the Kiel metropolitan area. Results: Since the ARs in the up do date available cohorts are overestimated, considerably lower AR(hospitalization) and AR(ICU) should be expected. An AR(hospitalization) of 10% could not be materialized in Ploen County; one with 5% could. In the regional analysis together with the University Hospital Kiel (UKSH) an AR(hospitalization) of up to 10% is feasible, as also an AR(ICU) of 3%. The kinetics of hospital admissions is, however, dependent from countermeasures in public health as well as admission habits of the family physicians. The available number of beds is determined by beds made available and by the mean duration of hospitalization. The latter depends from the age and underlying conditions of the patients. Conclusions: System failure has to be averted by clarity in regard to the key parameters and their independent variables. The regional management is crucial and should be coordinated by a so-called bed-coordinator. Close cooperation allover the health care system is needed in alliance with the local health departments.