Modelling intensive care unit capacity under different epidemiological scenarios of the COVID-19 pandemic in three Western European countries

Ruth McCabe, Mara D. Kont, Nora Schmit, Charles Whittaker, Alessandra Løchen, Marc Baguelin, Edward Knock, Lilith K. Whittles, John Lees, Nicholas F. Brazeau, Patrick Gt Walker, Azra C. Ghani, Neil M. Ferguson, Peter J. White, Christl A. Donnelly, Katharina Hauck, Oliver J. Watson

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: The coronavirus disease 2019 (COVID-19) pandemic has placed enormous strain on intensive care units (ICUs) in Europe. Ensuring access to care, irrespective of COVID-19 status, in winter 2020-2021 is essential. Methods: An integrated model of hospital capacity planning and epidemiological projections of COVID-19 patients is used to estimate the demand for and resultant spare capacity of ICU beds, staff and ventilators under different epidemic scenarios in France, Germany and Italy across the 2020-2021 winter period. The effect of implementing lockdowns triggered by different numbers of COVID-19 patients in ICUs under varying levels of effectiveness is examined, using a 'dual-demand' (COVID-19 and non-COVID-19) patient model. Results: Without sufficient mitigation, we estimate that COVID-19 ICU patient numbers will exceed those seen in the first peak, resulting in substantial capacity deficits, with beds being consistently found to be the most constrained resource. Reactive lockdowns could lead to large improvements in ICU capacity during the winter season, with pressure being most effectively alleviated when lockdown is triggered early and sustained under a higher level of suppression. The success of such interventions also depends on baseline bed numbers and average non-COVID-19 patient occupancy. Conclusion: Reductions in capacity deficits under different scenarios must be weighed against the feasibility and drawbacks of further lockdowns. Careful, continuous decision-making by national policymakers will be required across the winter period 2020-2021.

Original languageEnglish
Pages (from-to)753-767
Number of pages15
JournalInternational Journal of Epidemiology
Issue number3
Publication statusPublished - 1 Jun 2021

Bibliographical note

Funding Information:
This work was supported by the MRC Centre for Global Infectious Disease Analysis (grant number MR/R015600/1 to A.C.G., N.M.F., P.J.W., C.D. and K.H.), which is jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union (EU); by Community Jameel (to R.M., K.H. and N.M.F.); by the Imperial College Medical Research Council Doctoral Training Partnership (to M.D.K., N.S. and C.W.); by the National Institute for Health Research (NIHR) HPRU in Modelling and Health Economics, a partnership between Public Health England (PHE), Imperial College London and LSHTM (grant number NIHR200908 to N.M.F., P.J.W. and K.H.); by the NIHR HPRU in Emerging and Zoonotic Infections, a partnership between PHE, University of Oxford, University of Liverpool and Liverpool School of Tropical Medicine (grant number NIHR200907 to R.M. and C.A.D.); and by the Wellcome Trust and FCDO (to O.J.W., P.G.T.W., A.C.G. and N.M.F).

Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the International Epidemiological Association.


  • COVID-19
  • epidemiological modelling
  • hospital capacity
  • intensive care
  • non-pharmaceutical interventions


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