A pragmatic method to compare international critical care beds: Implications to pandemic preparedness and non-pandemic planning.

ABSTRACT

BACKGROUND: The current method for assessing critical care (CCU) bed numbers between countries is unreliable. METHODS: A pragmatic method is presented using a logarithmic relationship between CCU beds per 1000 deaths and deaths per 1000 population, both of which are readily available. The method relies on the importance of the nearness to death effect, and on the effect of population size. RESULTS: The method was tested using CCU bed numbers from 65 countries. A series of logarithmic relationships can be seen. High versus low countries can be distinguished by adjusting all countries to a common crude mortality rate. Hence at 9.5 deaths per 1000 population 'high' CCU bed countries average of around 30 CCU beds per 1000 deaths, while 'very low' countries only average 3 CCU beds per 1000 deaths. The United Kingdom falls among countries with low critical care provision with an average of 8 CCU beds per 1000 deaths, and during the COVID-19 epidemic UK industry intervened to rapidly manufacture various types of ventilators to avoid a catastrophe. CCU bed numbers in India are around 8.1 per 1000 deaths, which places it in the low category. However, such beds are inequitably distributed with the poorest states all in the 'very low' category. In India only around 50% of CCU beds have a ventilator. CONCLUSION: A feasible region is defined for the optimum number of CCU beds.