Use of hospital resources is expected to peak April 19 in Missouri, and 352 deaths are projected during this wave of the COVID-19 pandemic in the U.S., according to the latest forecast from the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine in Seattle.

That model uses data on confirmed COVID-19 deaths obtained from World Health Organization websites, national and local governments, information on hospital capacity and use, and implementation of social distancing policies in the various states to forecast the challenge that government officials and health care providers can expect the novel coronavirus disease to present in the U.S.

Peak demand for hospital resources nationwide is forecast for April 15 and total deaths in the first four months at 81,766.

The institute released its initial set of estimates March 26, warning that the need for ventilators and intensive care unit beds in U.S. hospitals would exceed capacity by the second week of April. Updated forecasts have been released by IHME every few days since then with the latest issued on Sunday.

A news release accompanying the institute's revised projections on Sunday states that new data received from several states, including New York, Massachusetts, Georgia, Colorado, Pennsylvania, Florida and California, led to downward revisions of the estimated needs to deal with the epidemic in some states.

IHME now projects that all states will have reached their peaks in deaths per day and use of hospital resources by the end of April. The institute had been forecasting that 11 states would not reach their peaks in those two pandemic-related categories until May. Missouri had been projected to be the last state to peak in terms of use of hospital resources.

The peak dates in Missouri as of last Thursday were projected to be May 21 for hospital utilization and May 18 for single-day deaths. Those dates moved up about a month with the input of the latest data on Sunday. The model lowered the projected number of deaths in Missouri attributable to COVID-19 over the first four months of the pandemic from 1,290 to 352.

The institute said in its latest release that new data substantially revised estimates in many of the states.

"Data in the early days of the epidemic in each state can inform the trajectory of the epidemic, whether it will follow a pattern of rapid increase as in New York, or much slower increase as in Washington. Projecting the epidemic in each state depends on projecting the peak," the release said.

Just a week ago, the sole location globally that had peaked was Wuhan City, China. Since then, peaks reached in seven more locations worldwide — two in Spain and five in Italy — have improved the model's projection of the impact of social distancing and strengthened its estimates of the epidemic peaking dates for each state, according to the release.

IHME initially estimated that the U.S. would suffer about 81,000 deaths in the first wave of the pandemic, with fatalities likely to persist into July but dropping to less than 10 per day nationwide by the end of May. Other models have projected the death toll in the U.S. at somewhere between 100,000 and 240,000. The IHME model hiked its projection to 93,765 last week but dropped it back down to 81,766 on Sunday.

The institute warns that their estimates are based on the assumption that states will implement (and residents follow) the recommended social distancing policies of closing schools and nonessential services, issuing stay-at-home orders and limiting travel and that measures will be kept in place through the end of May.

"Our estimated trajectory of COVID-19 deaths assumes continued and uninterrupted vigilance by the general public, hospital and health workers and government agencies," Dr. Charles Murray, the institute's director, said in a news release. "The trajectory of the pandemic will change — and dramatically for the worse — if people ease up on social distancing or relax with other precautions. We encourage everyone to adhere to those precautions to help save lives."

The projected number of deaths in Kansas through Aug. 4 is currently 265. In Oklahoma, the figure is 813, and in Arkansas 297.

The death toll is projected to be more than twice as high in Oklahoma as Missouri despite Missouri ranking 18th in total population (6.17 million residents) and Oklahoma 28th (4 million residents). The projections are favorable for Missouri as a whole with respect to population totals. Thirty-two states are projected to suffer more deaths than Missouri in the first wave of the pandemic.

Globe efforts this past week to discuss the projections with someone from the institute, including why Missouri was initially projected to be the last state to peak in terms of hospital use, have not been successful. But Dan Pekarek, director of the Joplin Health Department, believes geographic location could be a factor.

"It makes sense that the interior of the country is not going to be impacted as quickly as the coasts," Pekarek said.

Proximity to international travel hubs could be another consideration of the model, he said. Not knowing all the factors the model takes into account makes it difficult to interpret some of the projections, he said. Pekarek said last week's projections that had Missouri peaking almost a month after Kansas and Oklahoma were particularly perplexing.

Other states initially not expected to reach peaks in progression of the disease until sometime in May were Florida, Hawaii, Iowa, Kentucky, Oregon, South Dakota, Texas, Virginia, West Virginia and Wyoming, a mix of interior and coastal states. They are now all expected to reach peaks in April.

Another relatively bright spot in the projections for Missouri is that no shortages in hospital beds or intensive care unit beds are anticipated for the state as yet. Similarly, shortages are not currently anticipated in either category for Kansas, Arkansas or Oklahoma, although a shortage of 302 ICU beds had been projected for Oklahoma in the forecast issued last Thursday.

“We hope these forecasts will help leaders of medical systems figure out innovative ways to deliver high-quality care to those who will need their services in the coming weeks,” Murray said.

States and hospitals have been scrambling to find additional medical resources and expand the number of hospital beds available to address the crisis.

New York and adjacent states remain the epicenter of the pandemic in the U.S. The forecast released by IHME on Sunday estimates that the death toll in New York will reach 15,618 by Aug. 4. The state with the next highest toll is projected to be New Jersey at 9,690, followed by Massachusetts at 8,254, Florida at 6,770 and Connecticut at 5,474.

Other states where more than 1,000 deaths are forecast in the first wave are: Illinois (3,629), Georgia (3,413). Michigan (2,963), Maryland (2,326), Texas (2,025), California (1,783), Kentucky (1,750), Indiana (1,681) and Virginia (1,401).

Jeff Lehr is a reporter for The Joplin Globe. 

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