UT modeling shows COVID-19 demand could put Austin hospitals at capacity in several weeks

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AUSTIN (KXAN) — Modeling data from a University of Texas at Austin researcher shows that without social distancing COVID-19 patients may overwhelm Austin hospitals to the point where these hospitals exceed their capacities by this summer.

UT Austin infectious disease epidemiologist Lauren Ancel Meyers spoke with the media about modeling results from a pandemic tool she and her team developed. Ancel Meyers is also speaking about the preliminary findings from that tool about the potential spread and impact of COVID-19 for the Austin-Round Rock region. Dr. Clay Johnston, dean of the Dell Medical School at UT Austin, will be joining Ancel Meyers to talk about the public health implications of Ancel Meyers’ research.

Figure 1. Projected COVID-19 cases in the Austin-Round Rock MSA under school closures from March 23 to August 17, 2020 coupled with different degrees of social distancing. (Graphic from UT Austin COVID-19 analysis).

Ancel Meyers’ model projects if there’s no social distancing that 1.6 million people will be infected by August in the Austin area. Furthermore, the data showed that a reduction in person-to-person contacts by 50% to 75% may not be enough to mitigate spread of COVID-19 and stop a surge of hospitalizations in the five-county area (Travis, Williamson, Bastrop, Caldwell and Hays). 

In the projections from the UT model, the only scenario which does not result in overwhelming the Austin-area’s current capacity is the one where in-person intersections by residents are reduced by 90% (Graphic Courtesy UT Austin)

Based on the modeling, Ancel Meyers said that when Austin reaches a “peak” of COVID-19 cases will depend on how well the community does at carrying out social distancing measures.

In the projections from the UT model, the only scenario which does not result in overwhelming Austin’s current capacity is one in which in-person interactions by residents are reduced by 90%. In the scenario with “no social distancing” (that means that if no schools were closed and if no stay-at-home measures were implemented) the Austin area is projected to exceed current hospital capacity by April and peak in May, yielding a higher overall number of hospitalizations than the other scenarios.

At a press conference on Tuesday, Austin leaders said they estimate that Austin residents had reduced their daily contacts in the community by only 50%.

“What we can see is that if we are really able to be successful and breaking those contacts through reducing our actions with each other, and depressing and slowing the spread of the disease, we may not see a peak this summer,” explained Ancel Meyers. “However we could have a very very serious and devastating peak  if we don’t take those actions”

As of Thursday at 5 p.m., Austin Public Health said there have been thirteen people in Austin-Travis County hospitalized so far for COVID-19. As of Thursday evening, the city’s website reports that there are 137 confirmed cases in Travis County.

“The takeaway from this analysis is that the extent of social distancing measures and our willingness to adhere to them will directly impact not only the fate of the outbreak but also our capacity to provide life-saving health care for those in need,” said Ancel Meyers.

Ancel Meyers said her team does have a U.S. model which included 217 different cities, but she says her team hasn’t looked at those as closely as they have Austin.

Based on their modeling of other cities, Ancel Meyers believes, “those cities who are more proactive, take earlier measures, will probably see earlier benefits than other cities.

She continued, “but once we begin to relax some of these measures and then there is travel to some of these other cities, then the state of the epidemic in one city will impact other cities as people move back and forth and are infected.”

UT notes that there are uncertainties in this model, including that the research relies upon on assumptions of how quickly the virus spreads, how long people remain sick, how many people will be hospitalized, and how many cases exist in the community.

There is also uncertainty surrounding the virus itself. Ancel Meyers noted on a press call Thursday, “there are a lot of things we don’t know about how quickly it spreads, we don’t know about how severe it is in different ages groups, different groups with underlying health conditions, importantly we don’t know how asymptomatic infection there is or how infectious people are if they are asymptomatically infected.”

Ancel Meyers’ research is funded by the National Institutes of Health. She also holds UT Austin’s Denton A. Cooley Centennial Professorship.

Public health implications

Dr. Clay Johnston, the dean of UT Austin’s Dell Medical School, was also on the call with reporters Thursday. Johnston helped to put the modeling Ancel Meyers presented in context with Travis County’s current status with the spread of COVID-19.

Johnston explained that outside of Travis County, there are fewer cases, so the numbers in Travis County give a good representation of the entire MSA.

COVID-19 cases in Travis County. Data from Austin Public Health, Graph provided by Dell Medical School).

He noted that the county saw its first positive COVID-19 cases on March 13, and the people who tested positive had symptoms prior to that, so Johnston explained that there have been novel coronavirus infections going on in Travis County for about two and a half weeks. Since then, the number of cases in the county has continued to increase exponentially. Johnston reminded the group on the call that the average person infects 2.2 people on average

“That just escalates and creates this very rapid increase which is what you see getting modeled and overwhelming our hospital systems,” he said.

Johnston noted that “many countries have been able to flatten these trajectories, reduce the spread. They’ve been able to do things early on, but mostly they are around social distancing.”

Country-by-country trajectories of coronavirus case trajectories. Source: FT Analysis Johns Hopkins University.)

Johnston explained that this modeling has significant implications for hospitals and healthcare institutions in the Austin area. However, he noted, it’s not clear yet how effective the stay-at-home orders in the Austin area that went into effect Wednesday have been.

“I think we are pretty confident that what we were seeing two days ago was inadequate, ” Johnston said. “Whether what we have today is enough or not? It’s not yet what we’ve seen has been important in other countries to lead to real levels of control.”

Johnston explained that Dell Medical School provided the numbers for this model for local hospitals and their capacity.

The report from UT shows that the estimated, daily total hospital capacity for the Austin Round Rock MSA is around 4,000 beds. That matches the number the City of Austin shared with KXAN on Wednesday. The UT report also estimates that the daily ICU capacity in the area is 750 beds and that the estimated total number of ventilators in the area is 750.

“Right now that is a rough number, we are gathering a better indication of the current total number of hospital beds, and we have to subtract out the beds that are gonna be filled by people who don’t have COVID-19,” Johnston said. “Typically that would be 80% or so capacity, so that would only leave us 20% of total hospital beds available for COVID-19 patients.”

Johnston noted that Austin-area hospitals have already been taking action to reduce the number of hospitalized patients in their care in preparation for the high number of COVID-19 patients they anticipate receiving.

He explained that Austin hospitals are currently assessing what their surge capacity is (doubling up on rooms etc). He says when surge space runs out, that’s when region will have to look at other spaces like Convention Center, Erwin Center, and old hospitals to move patients to.

“We are preparing for the worst and hoping that that’s unnecessary, but it all depends on the behavior today of the public,” he said, echoing Ancel Meyers’ message.

A city of Austin spokesperson explained to KXAN on Wednesday that the city has started to explore buildings that could be used as temporary medical shelters or medical facilities should the region reach the point where their hospitals are over capacity. The spokesperson explained that the city is not looking into erecting new buildings, but rather looking to use buildings that are already standing. The city spokesperson couldn’t say exactly when the tipping point would be when the city would start moving patients to other spaces to make up for over-capacity hospitals, the spokesperson said the city just wants to be ready if and when that point happens.

How the modeling was carried out

The modeling was based on several central numbers and assumptions. The numbers projected based on the assumption that there were 102 cases of COVID-19 in the Austin-Round Rock MSA on March 23, 2020. It also assumed an epidemic doubling time of four days, an average incubation period of 7.1 days, and a case hospitalization rate of 4.6%.

“Our understanding changes every day, we update our inputs, our parameters every single day in our models and that helps us to get a better handle on the situation today in Austin and what might be coming in the weeks and months ahead,” Ancel Meyers said.

“These projections assume, based on the latest data from COVID-19 outbreaks around the globe, that the number of new infections in a community doubles about every four days, and that almost 1 out of every 20 people who contract the virus will need hospitalization,” Ancel Meyers said.

Figure 5. Projected cumulative COVID-19 deaths in the Austin-Round Rock MSA under school closures from March 23 to August 17, 2020 coupled with different degrees of social distancing. (Graphic Courtesy UT Austin COVID-19 Modeling).

UT says that this pandemic-planning tool developed at the university has been used by researchers there and is currently helping public health officials plan for the consequences now of “a deadly and virulent virus.”

The preliminary results of this modeling were shared with Austin-area officials and have been made public in a report Thursday ahead of a scientific peer review. The university says this information was released ahead of a scientific peer review “due to the time-sensitive nature of the subject.”

In a release, UT explained that these models are intended to help guide planning in emergency situations.

KXAN has reported many times before on Ancel Meyers’ work, including her recent research on how quickly the novel coronavirus can spread. For the modeling presented Thursday, Ancel Meyers applied mathematical models while also using computers at UT’s Texas Advanced Computing Center using available data about how quickly a disease spreads.

In partnership with TACC, Ancel Meyers also developed the web-based Texas Pandemic Flu Toolkit.

Table 1. Estimated cumulative COVID-19 cases, hospitalizations, ICU cases, cases requiring mechanical ventilatory therapy, and deaths for the Austin-Round Rock MCA from March 23 through August 17, 2020 (Graphic Courtesy UT Austin COVID-19 modeling).

Public health implications

The public first learned about the significance of the COVID-19 findings from this tool on Tuesday when Austin Public Health Interim Health Authority, Dr. Mark Escott, brought up some powerful statistics he said came from UT modeling.

In talking about the reasons to put a shelter-in-place order into effect for the area, Escott said on Tuesday, “that modeling suggests in the next three to four weeks, our hospitals could reach capacity.”

“If we put schools back in session, if we turn the businesses back on, if we allow people to go back to restaurants and bars and businesses, that by May, we will need to be able to provide more than 20,000 hospital beds per day for our community alone,” Escott continued.

In a press conference with Austin Mayor Steve Adler and Travis County Judge Sarah Eckhardt Thursday, Dr. Mark Escott referenced the new modeling presented by UT on Thursday.

“This is critical information to have because it helps us to frame what we are talking about,” he said.

Escott said that the public health leaders in Austin have been looking at past research to inform how they address COVID-19.

“But sometimes the past evidence, the past information is not enough, and that’s when we look to researchers, like the researchers in our world-class UT Austin,” Escott said. He believes the models from UT show just how important social distancing is in the fight to mitigate COVID-19.

“The data shows us that if we were to go back to school in a week, if we were to turn the restaurants and bars back on in a week, if we were to return to business as normal as a week as some have recommended that we do, by the middle of May, we will be in a catastrophe situation like other jurisdictions are facing right now across the united states and across the world, ” Escott said. “That is not an option.”

He notes that the data in these UT models is not perfect, but he says “it’s as perfect as we can get right now” and is consistent with research from other institutions worldwide.

“What we have to do is delay this as long as we can,” Escott continued. “We have to better prepare our community to answer this challenge, we have to build capacity in our hospitals, we have to build our capacity in our ICU’s, we have to get more equipment — more personal protective equipment for our healthcare workers and our first responders — and more ventilators so we can provide better care to more people.”

Response from local hospitals

KXAN was sent a joint statement from St. David’s HealthCare, Ascension Seton and Baylor Scott & White Health, the three major healthcare systems operating hospitals in the Austin area:

“We are pleased local leaders have issued a ‘shelter in place’ order, as it is the best defense we have for preventing the spread of COVID-19 and protecting our community and healthcare workers during this unprecedented pandemic.

Many people have asked what they can do to ease capacity demands on hospitals and lessen the impact to healthcare workers on the frontlines. The single most important thing the community can do to help is to follow orders from local leaders and stay home, keeping a distance of at least six feet from people outside your household. But in order for it to work, everyone must comply.

Collectively we will do what it takes to meet the needs of this community. The situation continues to evolve each day, and we will adapt, as necessary, but we need your help in order to have a fighting chance at overcoming this pandemic. The sooner we act, the safer our community will be. “

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