Study Projects Areas Most Vulnerable to COVID-19 Patient Surge

April 8, 2020

Data from a national analysis led by scientists at Columbia University Mailman School of Public Health suggest that, even in parts of the country that are not yet experiencing many cases of COVID-19, aggressive social distancing and medical care preparations are needed to prevent illness and death.

A team led by Columbia researchers, with researchers from Mount Sinai Hospital, Massachusetts Institute of Technology, and federal contractors, have identified U.S. counties that are at risk of exceeding their critical care surge capacity limits within six weeks and estimated the lives that could be saved with enhanced social distancing and ramped up medical care.

Researchers project that as many as 185,000 deaths in the Northeast and 33,000 deaths in the Midwest could be averted by reducing person-to-person contact through actions such as travel restrictions, social distancing, and self-isolation for sick individuals. As many as 100,000 deaths nationally could be averted through an aggressive hospital critical care surge response, with about 55 percent of deaths potentially averted by high clearance and preparation of ICU and non-ICU critical care beds and about 45 percent of deaths averted through extraordinary measures, such as using a single ventilator for multiple patients. The projected estimates and interactive maps of critical care capacity for April 2, 2020, to May 13, 2020, appear as a pre-print on the Columbia University website at

“We hope that these analyses and the online mapping tool are useful for COVID-19 response planning and implementation and reinforce the critical importance of social distancing,” said co-author Andrew Rundle, DrPH, associate professor of epidemiology.

“This type of planning and modeling will be critical to preserving and allocating of scarce resources, further bolstering our efforts to save as many lives as possible,” said co-author Neil Schluger, MD, professor of medicine, epidemiology, and environmental health sciences, and chief of the division of pulmonary, allergy, and critical care medicine at the Columbia University Irving Medical Center.

The researchers’ analysis projected varying levels of hospital surge response capacities and community social distancing over a multi-week period for all U.S. counties, combining numerous national public and private datasets on county-level critical care beds—including the potential for hospitals to repurpose beds outside of ICUs—together with projections of the geographic spread of COVID-19 in the United States.

“It is important to recognize that there is a roughly two-week lag between the implementation of a new control measure and evidence that it has reduced transmission,” said Jeffrey Shaman, PhD, professor, environmental health sciences, who led work to model national projections.

The researchers note that their model does not account for potential shortages of medical staff who become infected, nor does it account for the ingenuity and perseverance of these staff, many of which are trained to work in crisis situations. It also does not account for deaths from other illnesses and injuries that hospitals may not be able to service in the midst of the COVID-19 surge.

“Hospital critical care is perhaps the most important medical system choke point in terms of preventing deaths in a disaster scenario, such as the current COVID-19 pandemic,” said Charles Branas, PhD, professor and chair of epidemiology. “Courageous medical providers are saving lives in dire circumstances and they could better do their jobs and minimize their own risks of COVID-19 if counties across the nation adopt and maintain stringent social distancing policies.”

Co-authors also include Sen Pei, Wan Yang, and James W. Quinn at the Columbia Mailman School; Brendan G. Carr and Alexis Zebrowski at Icahn School of Medicine/Mount Sinai; Sarah Sims at Patient Insight; and Ronan Doorley at the Massachusetts Institute of Technology.