A pragmatic method to compare international critical care beds: Implications to pandemic preparedness and non‐pandemic planning

Background The current method for assessing critical care (CCU) bed numbers between countries is unreliable. Methods A pragmatic method is presented using a logarithmic relationship between CCU beds per 1000 deaths and deaths per 1000 population, both of which are readily available. The method relies on the importance of the nearness to death effect, and on the effect of population size. Results The method was tested using CCU bed numbers from 65 countries. A series of logarithmic relationships can be seen. High versus low countries can be distinguished by adjusting all countries to a common crude mortality rate. Hence at 9.5 deaths per 1000 population ‘high’ CCU bed countries average of around 30 CCU beds per 1000 deaths, while ‘very low’ countries only average 3 CCU beds per 1000 deaths. The United Kingdom falls among countries with low critical care provision with an average of 8 CCU beds per 1000 deaths, and during the COVID‐19 epidemic UK industry intervened to rapidly manufacture various types of ventilators to avoid a catastrophe. CCU bed numbers in India are around 8.1 per 1000 deaths, which places it in the low category. However, such beds are inequitably distributed with the poorest states all in the ‘very low’ category. In India only around 50% of CCU beds have a ventilator. Conclusion A feasible region is defined for the optimum number of CCU beds. Highlights International critical care bed numbers can be better compared using a method which is sensitive to both nearness to death and population size and age structure. A feasible region is suggested in which the optimum number of critical care beds is likely to be found. The upper limit for the feasible region is likely to decline over time as better algorithms are developed to support the decision to admit to critical care. It is suggested that further studies on this topic include both occupied and available beds, which can be linked at local level via the occupancy margin which is a function of the size of the critical care unit.