Ebola: Impact of hospital's admission policy in an overwhelmed scenario

Abstract

Infectious disease outbreaks sometimes overwhelm healthcare facilities. A recent case occurred in West Africa in 2014 when an Ebola virus outbreak overwhelmed facilities in Sierra Leone, Guinea and Liberia. In such scenarios, how many patients can hospitals admit to minimize disease burden? This study considers what type of hospital admission policy during a hypothetical Ebola outbreak can better serve the community, if overcrowding degrades the hospital setting. Our result shows that which policy minimizes loss to the community depends on the initial estimation of the control reproduction number, R0. When the outbreak grows extremely fast (R01) it is better (in terms of total disease burden) to stop admitting patients after reaching the carrying capacity because overcrowding in the hospital makes the hospital setting ineffective at containing infection, but when the outbreak grows only a little faster than the systems ability to contain it (R0 & 1), it is better to admit patients beyond the carrying capacity because limited overcrowding still reduces infection more in the community. However, when R0 is no more than a little greater than 1 (for our parameter values, 1.012), both policies result the same because the number of patients never exceeds the maximum capacity.