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The Center For Disease Dynamics, Economics & Policy

Critical Care Capacity Gaps

Critical Care Capacity Gaps during the COVID-19 Pandemic


Since COVID-19 first appeared in late 2019, there have been over 4 million cumulative confirmed cases and nearly 300,000 deaths reported globally. Many countries have implemented measures to reduce COVID-19 transmission and to prevent health facilities from being overwhelmed by demand for hospital care, intensive care unit (ICU) beds, and ventilator therapies needed to treat severe infections. Despite these interventions, many well-equipped countries have faced shortages in health equipment and trained personnel.


Thus far, African countries have reported lower disease incidence compared to other regions. However, projections of COVID-19 case burden predict that most African countries will experience an uptick in total and severe COVID-19 infections in the next one to three months.


Across Africa, critical care capacity is far below international norms and public health officials have suggested there is a severe lack of ICU beds and ventilators. However, it remains unclear what critical care capacity is available in many countries across the continent as there is no centralized database or capacity reporting mechanism at the local, national, or international levels.


To fill this information gap, CDDEP researchers developed a database on current critical care capacities for 54 African countries which compiled data on number of hospital beds, ICU beds, ventilators, and anesthesia providers. Data were sourced from government and non-governmental reports and statements; published scientific literature; local and international media; in-country informants including public health officials, researchers, and healthcare workers; and existing databases from the United Nations and the World Federation of Societies of Anesthesiologists. Data on number of ICU beds,  ventilators, and  anesthesia providers were available for 47 countries. The full analysis is published on MedRxiv, and the complete database is available here.


In a second analysis, CDDEP researchers combined this data with nation-wise COVID-19 case burden projections to outline needs and gaps in critical care capacities at the peak of each country’s respective outbreaks. Projections of the number of hospital beds, ICU beds, and ventilators needed at outbreak peak were generated for four scenarios – if 30, 50, 70, or 100% of patients with severe COVID-19 symptoms seek health services— assuming that all people with severe infections would require hospitalization, that 4.72% would require ICU admission, and that 2.3% would require mechanical ventilation.


Overall, findings from this analysis suggest that most African countries do not have sufficient critical care capacity to adequately respond to predicted surges in demand due to COVID-19.


Comparing current national capacities to estimated needs at outbreak peak, we found that 31 of 50 countries (62%) do not have a sufficient number of hospital beds per 100,000 people if 100% of patients with severe COVID-19 infections seek out health services and assuming that all hospital beds are empty and available for use by patients with COVID-19. Only four countries (Cabo Verde, Egypt, Gabon, and South Africa) have a sufficient number of ventilators to meet projected national needs assuming all ventilators are functioning and available for COVID-19 patients. Even if only 30% of severely infected patients seek health services at outbreak peak, then 34 of 48 countries (71%) do not have a sufficient number of ICU beds per 100,000 people to handle projected need. Complete findings from this analysis are also available on MedRxiv.


These analyses are intended to inform and assist policymakers and public health officials at the national, regional, and international levels in equipping and preparing African countries to tackle the COVID-19 pandemic.