healthcare system will manage the influx of COVID-19 patients. The mantra of #flattenthecurve tells us that we need t

How can we avoid being the next Italy?
Among the many fears surrounding COVID-19, the one most critical to our future in the United States is the question of how our healthcare system will manage the influx of COVID-19 patients. The mantra of #flattenthecurve tells us that we need to minimize the surge of patients so as to “not overwhelm” the healthcare system. What exactly does it mean for a healthcare system to be overwhelmed and how does it happen?
First, I want to address the question of just how dangerous is this virus? While I will not speculate on where the final mortality rate will be (we won’t know for years), there are a few patterns to point out

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from the data so far. Specifically, we can look at the mortality rate across different countries and try to learn from their experience. (All data as of 3/22/20 12 PM EST). On one end of the spectrum, Italy is reporting a raw mortality rate of 9.3% (5,476 deaths out of 59,138 cases). At the other end, South Korea has diagnosed 8,897 cases with 104 deaths (1.2%). Germany is doing even better with 24,714 cases and only 92 deaths (0.4%). China fell somewhere in the middle at with 3,261 deaths out of 81,054 cases (4.0%).
Why is there such a wide variation between countries? I hope to explain how the ability of the local healthcare infrastructure to handle a surge of critically ill patients will influence the mortality rate. One way to explain this is to look closely at the China data (charts 13 and 14 in the linked medium.com article). Roughly 68,000 out of 81,000 cases (84%) in China was in Hubei Province. The case mortality rate in Hubei was 4.5%. The case mortality rate in the rest of the country was 0.9% (121 deaths in 13,597 cases).
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Source: Tomas Pueyo,
A simple way to understand this is this: when the healthcare system is overwhelmed, outcomes decline significantly (Hubei Province, Italy). When the cases are spread out across a wider area and the healthcare system is adequately prepared, the true mortality may be less than 1% (rest of China, South Korea, Germany).
What happens when a lot of cases are diagnosed at the same time in a small geographic region? You got a glimpse of this if you followed the outbreak in China. The Chinese government was forced to respond by building two temporary COVID-19 hospitals from scratch in less than 10 days. Now you’re seeing day-by-day how an advanced healthcare system in northern Italy (one of the most developed areas of Europe) is being taken to its knees.
There are three critical components of the healthcare response to COVID-19. First, you need physical space and equipment to care for patients: ICU rooms, negative pressure rooms, and ventilators. Second, you need personal protective equipment (PPE) to protect the medical providers. Lastly, you need the staff themselves.
Physical space and ventilators
Health care is a limited resource. Much more limited than you might expect. For 330 million Americans, there are approximately 90,000 ICU beds across the country (half medical, half surgical). At any given time, most hospitals run 80–90% full, so we’ll round that up to 20,000 available ICU beds. But that number isn’t evenly distributed across the country. Even a major academic center such as New York Presbyterian Hospital in NYC only has approximately 80 adult ICU beds. In a city with an active outbreak, the number of cases will quickly overwhelm the available ICU capacity — remember these beds are already mostly filled from the flu, trauma, cardiac arrests, strokes etc. Ideally, patients would be treated in negative pressure rooms in which air inside the room is pulled out through the ventilation system to prevent spread of infectious particles to the rest of the hospital. ICU rooms are generally negative pressure rooms, but few other rooms in a hospital fit the bill. Generally you would prefer not to put COVID-19 patients in regular floor rooms