The response to the Covid-19 coronavirus has raised questions regarding the capability of health systems to deal with an influx of patients requiring intensive care.

It is estimated that one in seven of those who get Covid-19 will require hospital treatment, and out of those one in five will require ICU care. A widespread outbreak of Covid-19 would therefore put an unprecedented strain on intensive care facilities across the world.

The chart above shows the number of ICU beds per 100,000 people in a range of countries around the world, with European countries in blue, countries in the Americas in red, and countries in Asia or Australasia in yellow. The four countries of the UK are shown separately (in purple). The data for China is from 2010 and likely out of date.

Alongside Portugal; Northern Ireland, Scotland and Wales have the fewest intensive care beds per person in the developed world. With 100 beds, Northern Ireland has 5.3 ICU beds per 100,000 people; Wales has 5.4 and Scotland has 5.1. All parts of the UK and Ireland lag far behind countries such as the United States, which has 34 ICU beds per 100,000 people, Germany (29.2), Romania (21.4) or Kazakhstan (21.3).

Compared with countries that have already experienced significant numbers of Covid-19 patients Northern Ireland is much closer to Iran, which has 4.6 ICU beds per 100,000, than Italy which has 12.5.

The facilities available in intensive care units is also an important factor. The low mortality rates in mainland China outside Hubei province (around 1%) have been attributed to widespread use of extracorporeal membrane oxygenation (ECMO) when ventilation doesn’t work. The mortality rate has been observed to be much higher (3.2%) in Italy where this treatment isn’t as widely available, even though the number of ICU beds per 100,000 people in Italy (12.5) is higher than the European average (11.5).

There are no ECMO facilities available in Northern Ireland, Scotland, or Wales. There are currently only 15 beds in all of the UK that offer this treatment across hospitals in London, Cambridge, Manchester and Leicester, although this can be increased in an emergency; there were 30 beds available at the peak of the 2018-19 winter flu season. ECMO is also provided at the Mater Hospital in Dublin; there are seven available beds in that ICU.

The crisis in Northern Ireland’s hospital waiting times is an oft-cited example of the dismal state that the local healthcare system is in. However, the scant provision of intensive care facilities is another area in which standards have fallen far behind other countries.

Sources:

Europe https://link.springer.com/article/10.1007/s00134-012-2627-8

Asia https://www.researchgate.net/publication/338520008_Critical_Care_Bed_Capacity_in_Asian_Countries_and_Regions

United States https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/

Canada https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426537/

Brazil https://healthmanagement.org/uploads/article_attachment/icu-v16-i3-brazil.pdf

Chile https://healthmanagement.org/c/icu/issuearticle/a-glance-at-intensive-care-medicine-in-chile

Latin America https://www.atsjournals.org/doi/full/10.1164/rccm.201207-1333CP

Australasia https://journals.sagepub.com/doi/pdf/10.1177/0310057X1003800124

Northern Ireland https://www.itv.com/news/utv/2020-03-03/100-critical-care-beds-ready-for-coronavirus-in-northern-ireland/

Scotland https://www.sicsag.scot.nhs.uk/publications/_docs/2019/2019-08-13-SICSAG-report.pdf?1

Wales https://www.ficm.ac.uk/sites/default/files/icm-and-cc-facilities-in-wales-md.pdf

England https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/