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ICU Beds in Contra Costa
#1
Maybe someone can help me out with the data.

According to the Contra Costa County Covid site, the county currently has 177 ICU beds, with 158 occupied. The total number of beds is up from early November with 156 beds. Interesting though, on August 4th, the county had 199 ICU beds (though the timeline has recently been truncated on the site).

Currently, the county has 10% unoccupied ICU beds, however, if there were still 199 ICU beds as there were in early August, there'd be over 20% unoccupied capacity. I've been trying to understand what happened to the extra beds, but have had no luck. Any thoughts? Anything similar occur in other counties?
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#2
The counting of beds gets very confusing, and especially ICU beds.  I've seen it done differently at Texas Medical Center (tmc.org) than in California.

My guess is that CoCo is more likely to be counting like Santa Clara County (SCC), with which I'm more familiar. (I'm not in the medical field; I've just been watching their numbers.)

I think the situation is similar for ICU beds and for overall beds.  Don't think of "bed" as a physical object.  Think of it more as the capacity to treat a patient. 

There is a standard maximum number of ICU beds for the facilities.  Beds beyond that point are called surge beds.  They generally have more physical beds, so that isn't a limitation.  They also likely have more places to put the beds (rooms, esp. with O2, monitoring equipment) so that isn't a limit on the standard maximum.

Santa Clara County standard capacity is essentially static
Santa Clara County current capacity changes daily as staff are available and called in.  It may be less than or more than standard capacity.

The usual limiting resource for the standard maximum number of beds is the hospital's staffing level, which is based on how much business it normally has so it can operate efficiently/profitably.  If you had a 10,000 bed hospital in the middle of nowhere, it might have a standard maximum of, say, 10 beds because that's all the patients they hire staff to treat.  Those 10 are basically guaranteed a good level of care.

So, along comes a pandemic and a big surge of patients.  Extra staff, if available, are hired.  Working hours are stretched.  
Normal hospital beds are used as ICU beds.   Beyond some point, care diminishes somewhat for any individual patient as total care increases.  

As we've seen, hospitals quit doing non-critical operations to conserve beds for those suffering from the pandemic.  If you look at the load for SCC ICU, you'll see that the number of COVID ICU patients now is far greater than their spare capacity in June.  This is a direct result of reducing the number of non-COVID ICU patients, primarily by reducing non-critical operations.

I suspect the California "less than 15% ICU beds" metric was set up by someone who didn't know how elastic the capacity is.

While it wasn't a facility that has ICU beds, a relative was in a skilled nursing facility a few weeks ago.  The for-profit company that runs it brought in staff from their facilities in other states to help with the load.  That doesn't work well if every area is being hit hard, but it can help to extend capacity for short-term regional shortages.
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