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Tracking ICU beds reveals potential holes in treatment

The national inventory of ICU beds is not evenly distributed around the country. There are enormous holes in the coverage.
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WASHINGTON — So far New York City has been the focus of the COVID-19 outbreak in the United States, as the cases and casualties pile up in the five boroughs. But a look at some crucial numbers in the hospitals there raises serious concerns at what could be coming for the rest of the country, particularly rural areas.

An analysis from Kaiser Health News finds that huge swaths of the country may end up short of the ICU beds they need in the coming weeks, with challenges just as bad or worse than those faced in New York.

New York City has about 38 hospitals and nearly 1,600 ICU beds. The city needs them because of its massive size. There are about 1.6 million people over the age of 60 (the age most severely affected by COVID-19) in five boroughs. That works out to about one ICU bed for every 1,000 people in that age group.

That's slightly higher than overall U.S. average in the analysis, which shows there are about 74,000 ICU beds across the nation, one for every 900 people ages 60 or older. (That doesn’t include the roughly 1,800 ICU beds in the VA system.)

But that doesn't tell the full story because that national inventory of ICU beds is not evenly distributed around the country. There are enormous holes in the coverage.

Only 47 percent of U.S. counties have even one ICU bed and only 29 percent of U.S. counties have more than nine ICU beds.

Why are ICU beds so important? They serve as health monitoring stations that let medical staffs track how a patient is doing, looking at measures such as heart rate and oxygen level in the blood. Many also have ventilators. They are crucial parts of fighting any major health challenge such as the COVID-19 pandemic.

And the ICU shortage is even more of a concern in counties with larger populations of those 60 or older.

There are about 540 counties where 30 percent or more of the population is in the 60-or-older group and only 124 of those counties have even one ICU bed. The counties in that situation (high-risk group/no ICU beds) span the country. There are 20 such counties in Virginia. There are 40 in Nebraska. Texas has 43 of them.

A lack of ICU beds doesn’t mean people in those places don’t have any access to high-end care. But it likely means that any patient who gets a severe case of COVID-19 is going to have to travel somewhere else for treatment. That, in turn, will put a further strain on urban, small-town and university hospitals that will likely be trying to handle their own caseloads.

And there are some people who will likely face a lot of travel. We combined the Kaiser Health News data with the data from the American Communities Project at George Washington University and looked at the most remote counties in the country, the ones called Aging Farmlands. The numbers drew a troubling picture.

There are 161 of those rural agricultural counties in the United States and only two of them have even a single ICU. And there are a total of six ICU beds overall in those 161 counties. There are 23 of those aging farmlands counties in Kansas, none with an ICU bed, according to the data.

To be fair, those counties are sparsely populated; in total, they only hold about 570,000 people. But they also hold large numbers of older residents, people more susceptible to the virus. In 114 of the counties, 30 percent or more of the population is 60 or older.

In some of those remote locales, social distancing might be inherently easier than it is in big urban environments. There’s usually no mass transit system or bustling downtown to aid the virus’s spread. But many of those aging farmland communities are close-knit in other ways. There are often local gatherings at stores, cafés and churches.

In short, we don’t yet know how COVID-19 spreads in those very rural environments. But we’re likely going to find out what that spread looks like in the new few weeks.

Even as most eyes have been on New York City recently, the virus has been spreading outside of that metro area. Two weeks ago there were fewer than 800 counties with a confirmed case of the virus. This week, there were 2,300 counties with at least one case.