Gerontology

Intensive care medicine

2019-20 coronavirus outbreak

Emergency medicine

Health care

Betacoronavirus

Cohort

Virology

Medical emergency

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Stern

Outbreak

Coronavirus disease 2019 (COVID-19)

Political science

Hospital medicine

Ancient history

Family medicine

Infectious disease (medical specialty)

Internal medicine

Medicine

Pandemic

Disease

History

Annals of Internal Medicine

Letters20 October 2020Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 PandemicFREEGary E. Weissman, MD, MSHP, Andrew Crane-Droesch, PhD, Corey Chivers, PhD, Mark E. Mikkelsen, MD, MSCE, and Scott D. Halpern, MD, PhDGary E. Weissman, MD, MSHPUniversity of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.E.M., S.D.H.)Search for more papers by this author, Andrew Crane-Droesch, PhDUniversity of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C.)Search for more papers by this author, Corey Chivers, PhDPenn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C.)Search for more papers by this author, Mark E. Mikkelsen, MD, MSCEUniversity of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.E.M., S.D.H.)Search for more papers by this author, and Scott D. Halpern, MD, PhDUniversity of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.E.M., S.D.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1062 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Stern highlights 2 important limitations of the SIR model that underlie the CHIME planning tool. We agree that the cohort structure—defined by differences in demographic characteristics, disease response, and contact patterns, among others—influences the course and severity of the pandemic. Using an agent-based model with a first-in, first-out process as Dr. Stern suggests would permit the representation of some of these cohort characteristics. However, this approach would come at the cost of increased complexity, with accompanying difficulty in identifying reliable parameter estimates based on limited published data early in the pandemic.The SIR assumption of a constant doubling time does not reflect the effects of rapidly changing physical distancing behaviors and other policies that might alter viral transmission. Thus, we have advised that the CHIME tool be used only for reliable short-term forecasts. We advocate that users of CHIME and any other COVID-19–related pandemic model iteratively review all parameters based on empirical observations of the pandemic course.As our model has been iteratively revised since publication, the subsequent CHIME estimates have also indicated an earlier but not higher peak, as suggested by Dr. Stern's calculations. However, we disagree that the direction of SIR model bias is yet definitely known in the case of COVID-19. The cited article suggests that the SIR model underestimates model peak and timing compared with 1 matrix model (1). At the same time, other work has suggested that SIR models may overestimate total epidemic size compared with contact models that account for social network structure (2). Further work is needed to validate all COVID-19–related pandemic models against both each other and empirically observed counts of infected cases and their subsequent care utilization patterns. As such, our original manuscript included a plan to undertake such an empirical validation.At this time, we again acknowledge the limitations of SIR models and have since extended CHIME to account for more complex dynamics as more data have become available (https://penn-chime.phl.io). The performance of CHIME has improved with updating since publication, and CHIME has so far proved useful to guide planning efforts in our health system. However, we will continue to revise and assess the model in order to apply these lessons to more efficiently and effectively model future epidemics.References1. Grant A. Dynamics of COVID-19 epidemics: SEIR models underestimate peak infection rates and overestimate epidemic duration. medRxiv. Preprint posted online 12 April 2020. doi:10.1101/2020.04.02.20050674 Google Scholar2. Hébert-Dufresne L, Althouse BM, Scarpino SV, et al. Beyond R0 : the importance of contact tracing when predicting epidemics. arXiv. Preprint posted online 10 February 2020. Accessed at http://arxiv.org/abs/2002.04004 on 10 April 2020. Google Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Gary E. Weissman, MD, MSHP; Andrew Crane-Droesch, PhD; Corey Chivers, PhD; Mark E. Mikkelsen, MD, MSCE; Scott D. Halpern, MD, PhDAffiliations: University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W., M.E.M., S.D.H.)University of Pennsylvania and Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (A.C.)Penn Medicine Predictive Healthcare, Philadelphia, Pennsylvania (C.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1260. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLocally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic Gary E. Weissman , Andrew Crane-Droesch , Corey Chivers , ThaiBinh Luong , Asaf Hanish , Michael Z. Levy , Jason Lubken , Michael Becker , Michael E. Draugelis , George L. Anesi , Patrick J. Brennan , Jason D. Christie , C. William Hanson III , Mark E. Mikkelsen , and Scott D. Halpern Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic Ralph H. 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Halpern, MD, PhD and Franklin G. Miller, PhDCOVID-19 Nonessential Surgery Restrictions and Spine SurgeryAn interactive online dashboard for tracking COVID-19 in U.S. counties, cities, and states in real timeCOVID-19 e saúde mental: a emergência do cuidado 20 October 2020Volume 173, Issue 8 Page: 680-681 Keywords Behavior COVID-19 Disclosure Forecasting ePublished: 20 October 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic