A Country Level Analysis Comparing Hospital Capacity and Utilisation During the First COVID-19 Wave Across Europe

Abstract Background: The exponential increase of SARS-CoV-2 infections during the first wave of the pandemic created an extraordinary overload and demand on hospitals, especially on intensive care units (ICUs), across Europe. European countries have taken different measures to surge ICU capacity, but little is known on the extent. A country level analysis was conducted to compare hospitalisation rates of COVID-19 patients in acute and intensive care and the levels of surge capacity for intensive care beds across 16 European countries and Lombardy region during the first wave of the pandemic (28 February to 31 July).Methods: We used data on infection rates and numbers of current and/or cumulative COVID-19 patients in acute and intensive care in 16 countries and Lombardy region to analyse the burden on hospitals during the first wave of the COVID-19 pandemic. Data on COVID-19 hospitalisations was continuously extracted since 20 March, 2020 from publicly available sources. To evaluate whether hospital capacities were exceeded, we retrieved information on hospital and ICU surge capacity. Treatment days and mean length of hospital stay were calculated to assess hospital utilisation by COVID-19 patients during the first wave. Results: Pre-pandemic hospital and ICU capacity varied widely across countries. In no studied country did the utilisation of acute care bed capacity by COVID-19 patients exceed 38.3%. However, the Netherlands, Sweden, and Lombardy would not have been able to treat all COVID-19 patients during the first wave without ICU surge capacity. Indicators of hospital utilisation were not consistently related to the numbers of SARS-CoV-2 infections. The mean number of hospital days associated with one SARS-CoV-2 case ranged from 1.3 (Norway) to 11.8 (France). Conclusion: In many countries, the increase of ICU capacity was important to accommodate the high demand for intensive care during the first COVID-19 wave. Our study indicates that SARS-CoV-2 incidence is not the only aspect when it comes to the burden of hospital care for COVID-19 but rather the utilisation of hospital resources as shown by cumulative hospital days and mean length of stay during the first wave. Indicators presented in this study could inform forecasting models, especially in regard to necessary surge capacity.