The pandemic placed enormous strain on intensive and critical care resources. It was more intense in some regions and periods than others, for example in Lombardy (Italy) during March/April 2020. The pandemic resulted in intensive care demands exceeding the ability of critical care facilities to serve their communities. If critical care is not accessible when required, morbidity and mortality increase. Increasing occupancy of intensive care has been associated with increasing mortality (Bravata et al., 2021[1]).
In 2019, there was a wide variation between countries in the number of intensive care unit (ICU) beds, with an eight‑fold difference between the Czech Republic (43 adult beds per 100 000 population) and Sweden (5.1 adult beds) (Figure 8.7). There was also wide variation in the spare capacity of ICU beds. Occupancy was high in Ireland (90%) and substantially lower in Spain (57%).
The treatment of patients admitted for COVID‑19 early in the pandemic involved a high rate of invasive ventilation and critical care. Those admitted with COVID‑19 pneumonia and organ failure had a relatively long period in ICU, implying a very high demand for critical care and invasive ventilation capacity. Prior to widespread COVID‑19 immunisation, the requirement for ICU beds during periods of acute infection (i.e. waves) typically doubled every two to three days and required four weeks to reach its peak.
In response, many countries increased critical care capacity. The use of temporary facilities, including surge capacity in intensive care delivery, was widespread. Many countries increased the intensity of treatment they could offer, with a greater number of ventilators. Improved use of digital technology led to greater co‑ordination and a better use of critical care resources. However, capacity constraints in physical supplies and workforce hampered the initial response (OECD, forthcoming[2]).
Most countries reported an increase in adult ICU beds per capita (13 out of 15 EU countries) and for some there was a substantial increase in their maximum capacity. Sweden reported a maximum capacity during 2020 of 10.3 beds per 100 000, more than doubling the number available. Due to increased capacity and a decrease in other activity, there was a decrease in average occupancy of adult ICU beds in 2020 compared to 2019 in all reporting EU countries (Figure 8.8). Switzerland was the only country to report a slight increase.
Resilient health systems have the flexibility to increase critical care capacity quickly to match demand. While physical capacity is important, it is essential that trained staff and adequate supplies are also present.
