UPDATED March 24, 2020: As the number of confirmed coronavirus cases continues to grow exponentially, the capacity of the hospital system to treat these cases is becoming a concern. The goal of “flattening the curve” is that testing, isolation, and social distancing will slow the increase of new cases. Hopefully, these efforts reduce the numbers of new patients who require hospitalization to a rate that hospitals can handle.
In this post, I’ll identify the top 10 states in the United States that have the greatest likelihood of experiencing hospital capacity problems if coronavirus cases continue to grow exponentially. To recognize these states, I’ll assess per capita rates for both coronavirus infections and hospital beds. I’m looking for states that have a relatively large number of coronavirus cases given the size of their population and have a relatively low number of hospital beds.
The Exponential Growth of Coronavirus Cases and Hospitals
As you may have heard, most people infected by the coronavirus have mild symptoms. However, 10-15% of the infected require hospitalization. At the moment, U.S. hospitals are experiencing an unusually high usage of their resources, but they’re not currently overwhelmed. However, the CDC is warning hospitals to prepare for shortages.
Unfortunately, given the exponential growth of new cases, the levels we see today can increase to shockingly high numbers in a short timeframe. A study in Lancet suggests that the coronavirus doubles every six days. Some reports indicate a quicker doubling rate, but they likely represent data skewed by insufficient testing.
When I wrote this on March 19, there were 14,250 confirmed cases in the United States. If new cases double every six days for two months, we’ll have 15 million cases in late May!
Exponential growth of coronavirus cases requires the following conditions:
- Regular contact between people.
- Large numbers of uninfected people.
- No effective vaccination or natural immunity.
The goal of quarantines, lockdowns, and social distancing is to reduce the “regular contact” requirement. With these measures, we’ll hopefully be able to slow the growth and not have 15 million cases in 60 days. How many less depends on how well people follow the protocols. Governor Newsom of California expects that 56% of Californians will be infected within that span of time, which equates to 22 million people. However, that seems to be based on a doubling rate of every four days. There are still large uncertainties surrounding the virus and the effectiveness of the efforts to slow it down.
Exponential growth highlights why taking action early, before the number of infections is unmanageably large, is crucial.
Related post: Coronavirus Curves and Different Outcomes
Comparing Coronavirus Cases to Hospital Beds by State
To identify states with the highest potential for hospital shortages, I’ll assess coronavirus cases per capita and hospital beds per capita. We’re looking for states that, given the size of their population, have relatively more coronavirus cases and fewer hospital beds than you’d expect.
Overall, states have a median infection rate of 5.3 confirmed cases per 100,000 people, which is up from 1.9 when I originally wrote this post four days of ago. Of course, that rate will continue to grow with time. States have a median of 250 hospital beds per 100,000. Typically, two-thirds of those hospital beds are occupied. To identify the 10 states with the greatest potential for shortages, I’ll assess the ratio of coronavirus cases to hospital beds. States with potential problems will have higher ratios—in other words, more cases to beds. The list below starts with the worst ratios. The median ratio for all 50 states is 0.0215.
|State||Cases / 100,000||Beds / 100,000||Ratio|
Click here for my full CSV dataset with the complete set of states: Coronavirus_hospitals_03232020
Why Are These States on the List?
This list of states has some obvious candidates that the media has discussed frequently. Washington and New York have both been widely reported as being walloped. Washington has fewer cases of the virus per capita compared to New York, but it has notably fewer hospital beds than NY. In the original post, New York and Washington had virtually equal ratios, but now NY has increased far beyond Washington with this update. New York by far has the largest ratio and has the greatest potential for overwhelming its hospital system.
Washington and New Jersey have nearly equal ratios whereas there was a larger gap between them previously. Notably, the Northeast claims 6 of the 10 spots.
Louisiana is a surprise. It was #4 before and remains in fourth place. When I originally wrote this post, I hadn’t heard much about that state in the media. However, today I just started hearing that it has fastest growth rate for new cases in the United States. While it has an above average number of hospital beds, Louisiana has FIVE times the median infection rate! Colorado was also a surprise. Colorado’s infection rate is more than double the median and it has a relatively low number of hospital beds per 100,000 people.
I expected to see California in the top 10 given how much we’ve heard about it on the news. However, it falls at #21. California’s infection rate equals the median. This state has a large total number of cases (2108), but it also has a very large population at 40 million, which brings the per capita value down.
With this update, Michigan appears on this list. It was previously at #17 but it is now #8. Maine was previously #10 on the list but falls to #17.
We’re not experiencing hospital capacity shortages now. However, it is instructive to look at where more cases are occurring and seeing how hospital beds stack up. Additionally, the hope is that social distancing and quarantines will prevent hospitals from being overwhelmed.
There are several caveats about this analysis. First, we’re looking at the current number of cases by state. Our assumption is that states with more cases per capita now will have higher rates later. Additionally, the number of cases confirmed by testing in the U.S. is underreported due to inadequate testing. So, we don’t have perfect numbers, but they’re the best we have. Finally, hospital beds aren’t a perfect measure either. Hospitals depend on other resources such as masks, gowns, gloves, and ventilators, to name a few. These resources might run out faster than hospital beds. However, the assumption is that states with more hospital beds have a higher capacity overall.
This analysis provides a first take on the states that have a relatively high amount of cases and a low number of hospital beds.