The aftermath of acute surge events: Quantifying the “bystander effect” during the COVID-19 pandemic

During acute surge events and public health emergencies, organizations naturally reflex to focus efforts on caring for the influx of affected patients, such as those with a variant respiratory virus or from a mass casualty event. For example, during the COVID-19 pandemic, monumental efforts were appropriately newly directed at caring for patients with COVID-19 pneumonia. This is “healthcare adaptation”—the ability to improve primarily affected patient care and outcomes by implementing new care processes and real-time learning. In parallel, and often at odds, is “healthcare resiliency”—the ability to continue to deliver high-quality care to all patients despite the presence of a surge event. For example, during the COVID-19 pandemic, countless other patients without COVID-19—so-called “bystander” patients—needed both acute and preventative care.

In this issue of Critical Care Medicine, Sakuraya et al sought to address an important component of this critical, yet understudied, bystander effect phenomenon during the COVID-19 pandemic: the impact of COVID-19-related ICU capacity strain on outcomes among non-COVID-19 patients who nonetheless required ICU care during the pandemic. The authors performed a retrospective cohort study evaluating the association of ICU “capacity limitation” with standardized mortality ratios (SMRs) of in-hospital mortality compared with the pre-pandemic period, as well as additional clinical outcomes, among 70,636 patients without COVID-19 who were admitted to 23 ICUs across Japan from January 2019 to February 2023.

George L Anesi, Rachel Kohn