The Skellam distribution revisited: Estimating the unobserved incoming and outgoing ICU COVID-19 patients on a regional level in Germany

Abstract

With the beginning of the COVID-19 pandemic, we became aware of the need for comprehensive data collection and its provision to scientists and experts for proper data analyses. In Germany, the Robert Koch Institute (RKI) has tried to keep up with this demand for data on COVID-19, but there were (and still are) relevant data missing that are needed to understand the whole picture of the pandemic. In this article, we take a closer look at the severity of the course of COVID-19 in Germany, for which ideal information would be the number of incoming patients to ICU units. This information was (and still is) not available. Instead, the current occupancy of ICU units on the district level was reported daily. We demonstrate how this information can be used to predict the number of incoming as well as released COVID-19 patients using a stochastic version of the Expectation Maximization algorithm (SEM). This, in turn, allows for estimating the influence of district-specific and age-specific infection rates as well as further covariates, including spatial effects, on the number of incoming patients. The article demon-strates that even if relevant data are not recorded or provided officially, statistical modelling allows for reconstructing them. This also includes the quantification of uncertainty which naturally results from the application of the SEM algorithm.