Question: How full are ICUs normally (before COVID)? It was my understanding that in order for hospitals to make enough money, they usually kept their beds, including ICU beds, close to full most of the time. While it’s clearly upsetting that they are now mostly COVID patients instead of elective surgeries, is it really abnormal for hospitals to have ICU’s at or near capacity?

Answer: Good question!  ICU capacity typically averages 68%, ranging from 57% to 82%.  We know this with such specificity thanks to rigorous research published a few years ago in Critical Care Medicine, ICU Occupancy and mechanical ventilator use in the United States. The study found that ICU occupancy varied considerably, but on average about 1/3 of ICU admissions were discretionary.  For example, an average of 18% of ICU patients were admitted directly after elective surgery.  Another study published earlier this year, Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis, concluded, “Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State….Suspension of elective surgeries may have a relatively minor impact on ICU capacity.”  Upshot here is that on average (with big variation) ICUs have 7 in 10 beds occupied. Cancelling elective surgeries could free up another bed, giving ICUs a bit more slack (guesstimate average: ~4 open beds out of every 10).  

The problem with ICU capacity is that even if you add beds and other equipment, you need the personnel to care for these very sick patients.  And with the pandemic raging across the country, that slack just isn’t there.  STATNews ran a good article on this issue back in August, ICU capacity is more about the clinicians than the number of beds and the NY Times had an informative article about the current state of affairs earlier this week, “‘There’s No Place for Them to Go’: I.C.U. Beds Near Capacity Across U.S” (Figure 1).  Along with increasing ICU occupancy, another concerning trend has arisen.  As recently reported in The Atlantic and the Washington Post, hospitalization rates are dropping.  As public health expert, Dr. Ashish Jha states in the Atlantic and writes in the Post, “As hospitals fill up, they are admitting fewer and fewer people… as the demand for beds soars, the threshold for admission rises with it.”  In summation, the ICU occupancy we’re seeing and experiencing across large swaths of the country is indeed abnormal. 

Figure 1. Mapping ICU Occupancy (Dec. 9, NY Times)