Hospital bed capacity across in Tunisia hospital during the first 4 waves of the COVID-19 pandemic: A descriptive analysis.

Background: In March 2020, the WHO declared COVID-19 as a pandemic, and Tunisia implemented a containment and targeted screening strategy. The country's public health policy has since focused on managing hospital beds. Methods: The study analyzed the bed occupancy rates in public hospitals in Tunisia during the pandemic. The evolution of daily cases and nonpharmaceutical interventions (NPI) actions undertaken by the Tunisian Government were also analyzed. The study used 3 indices to assess bed flexibility: Ramp duration until the peak, ramp growth until the peak, and ramp rate until the peak. The study also calculated the time shift at the start and peak of each wave to evaluate the government's response efficacy. Results: The study found that the evolution of the epidemic in Tunisia had 2 phases. The first phase saw the pandemic being controlled due to strong NPI actions, while the second phase saw a relaxation of measures and an increase in wave intensity. ICU bed availability followed the demand for beds, but ICU bed occupancy remained high, with a maximum of 97%. The government's response in terms of bed distribution and reallocation was slow. The study found that the most deadly wave by ICU occupied bed was the third wave due to a historical variant, while the fifth wave due to the delta variant was the most deadly in terms of cumulative death. Conclusions: The study concluded that decision-makers could use its findings to assess their response capabilities in the current pandemic and future ones. The study highlighted the importance of flexible and responsive healthcare systems in managing pandemics.