Peak Health Care Burden During the First Three COVID-19 Waves in the Republic of Croatia

Introduction: One of the main concerns during the COVID-19 pandemic was the overload of health care sector capacities. The objective of this paper was to show peak numbers of selected indicators during the three COVID-19 waves in Croatia and ensure information that will enable revision of preparedness plan and potential hospitals` (re)organization. Methods: Retrospective analysis of COVID-19 testing, infections, hospitalizations, ICU admissions, mechanical ventilation support and deceased data collected via capacity surveillance in the Republic of Croatia during the first three waves. Results: Peak hospital bed occupancy rates observed in the 2nd and 3rd waves were 70.19% and 54.60%, compared to maximum capacity during the COVID-19 wave, and 168.90% and 131.38%, compared to maximum capacity between waves, while ICU beds occupancy rates were 75.51% and 70.73%, and 170.51% and 160.37%, respectively. Peak daily numbers were as follows (first/ second/third wave); positive persons: 53/4827/3198; tested persons: 1984/13325/11622; total hospitalized persons: 372/2976/2315; total mechanical ventilation needed: 31/306/278; total ICU hospitalized: unknown/370/348; deceased: 8/92/52. Conclusion: During pandemic waves, the requirements for hospital and ICU beds significantly exceeded standard available health sector capacities. The system has acutely adjusted by increasing the number of beds available for COVID-19 patients. However, given the peaks observed so far, a permanent additional increase or reorganization of hospital capacity is needed to ensure that during the upcoming waves non-COVID-19 and COVID-19 patients won’t be endangered or part of the staff overloaded.