The question of hospital capacity

A lot of people are arguing for their favorite health care policy in the middle of the national response to the novel coronavirus pandemic. If you have politically engaged friends the left, as we do, then you’ve seen no end of claims that the solution is single-payer healthcare “for all” (Taiwan has it!), never mind that the four countries with the highest per capita infection rate, at least as of this writing, all have universal health care. On the right, people are passing around this article, which points the finger at state “certificate of need” laws.

There is no doubt a legitimate argument to be had about the correct balance between the capacity of the nation’s hospitals and the cost of that capacity. Of course, if we are all in the moment focused on flattening the curve because of capacity constraints, then we are all — in this moment — going to wish we had more of it, never mind the cost during all of those times when there is no global pandemic.

The national numbers do not answer the question of the right balance, but they do suggest that — nationally — we are in good shape compared to most other countries hit with Covid-19. See the chart below, and then multiply the beds per 100,000 by 10 to get the beds per 1,000,000, which aligns it with the column on this table.

Source.

OK, we’ll do the math for you. As of today, Italy and Spain have many more Covid-19 cases than their total critical care capacity (recognizing both that there are many people in hospitals for other reasons, but also that most cases of Covid-19 do not require hospitalization). Germany and the United States are still far below capacity, at least measured against known Covid-19 cases, with the United States in very good shape.

On the national numbers.

The issue for all actual people, of course, is that the local burden on the system might well be far above, or far below, the local capacity to deal with them. If Seattle’s many great hospitals are overwhelmed, it will not matter that there are plenty of beds in Tulsa or Wheeling. Look at this map. The national policy and national capacity barely matters to the discussion.

So, whether or not we have “enough” critical care capacity as a nation, and whether or not there is an obvious public policy solution that would have provided more, it is impossible to know whether any such policy would have allowed for more, or less, in the places that will turn out to need it.