ICU Bed Availability Monitoring and analysis in the Grand Est region of France during the COVID-19 epidemic
Authors:   ICUBAM Consortium, josse julie 
Published: May 2020

Background: Reliable information is an essential component for responding to the COVID-19 epidemic, especially regarding the availability of critical care beds (CCBs). We propose three contributions: a) ICUBAM (ICU Bed Availability Monitor), a tool which both collects and visualizes information on CCB availability entered directly by intensivists. b) An analysis of CCB availability and ICU admissions and outcomes using collected by \ICUBAM during a 6-week period in the hard-hit Grand Est region of France, and c) Explanatory and predictive models adapted to CCB availability prediction, and fitted to availability information collected by ICUBAM.
Methods: We interact directly with intensivists twice a day, by sending a SMS with a web link to the ICUBAM form where they enter 8 numbers: number of free and occupied CCBs (ventilator-equipped) for both COVID-19 positive and COVID-19- negative patients, the number of COVID-19 related ICU deaths and discharges, the number of ICU refusals, and the number of patients transferred to another region due to bed shortages.
The collected data are described using univariate and multivariate methods such as correspondence analysis and then modeled at different scales: a medium and long term prediction using SEIR models, and a short term statistical model to predict the number of CCBs.

Results: ICUBAM was brought online March 25, and is currently being used in the Grand-Est region by 109 intensivists representing 40 ICUs (95% of ICUs). ICUBAM allows for
the calculation of CCB availability, admission and discharge statistics. Our analysis of data describes the evolution and extent of the COVID-19 health crisis in the Grand-Est region: on April 6th, at maximum bed capacity, 1056 ventilator-equipped CCBs were present, representing 211% of the nominal regional capacity of 501 beds.
From March 19th to March 31st, average daily COVID-19 ICU inflow was 68 patients/day, and 314 critical care patients were transferred out of the Grand-Est region. With French lockdown starting on March 17th, a decrease of the daily inflow was found starting on April 1st: 23 patients/day during the first fortnight of April, and 7 patients/day during the last fortnight. However, treatment time for COVID-19 occupied CCBs is long: 15 days after the peak on March 31st, only 20% of ICU beds have been freed (50% after 1 month). Region-wide COVID-19 related in-ICU mortality is evaluated at 31%. Models trained from ICUBAM data are able to describe and predict the evolution of bed usage for the Grand-Estregion.
Conclusion:
We observe strong uptake of the ICUBAM tool, amongst both physicians and local healthcare stakeholders (health agencies, first responders etc.). We are able to leverage data collected with ICUBAM to better understand the evolution of the COVID-19 epidemic in the Grand Est region.
We also present how data ingested by ICUBAM can be used to anticipate CCB shortages and predict future admissions. Most importantly, we demonstrate the importance of having a cross-functional team involving physicians, statisticians and computer scientists working both with first-line medical responders and local health agencies. This allowed us to quickly implement effective tools to assist in critical decision-making processes.