Complex dynamics of an SIHR epidemic model with variable hospitalization rate depending on unoccupied hospital beds

In this paper, we propose an susceptible–infectious–hospitalized–recovered (SIHR) epidemic model with a nonlinear hospitalization rate depending on the number of unoccupied hospital beds. Note that the number of all hospital beds is used as a measure of all available medical resources. The basic reproduction number is calculated using the next-generation matrix method. We analyze the existence of endemic equilibria and discuss the global stability of the disease-free equilibrium. Existence and stability of endemic equilibria indicate possible occurrences of bifurcations. We confirm the appearance of backward bifurcation, saddle–node bifurcation, Hopf bifurcation, and Bogdanov–Takens bifurcation using normal form theory and central manifold theory. Numerical simulations show that the dynamic behavior of the model undergoes a transition from forward bifurcation to backward bifurcation and saddle–node bifurcation when the number of total hospital beds is reduced. Our findings suggest that when the number of total hospital beds falls below a threshold, backward bifurcation will occur, meaning that the disease cannot be eliminated even if the basic reproduction number is below unity. Therefore, the number of hospital beds should be increased beyond the bed threshold during an outbreak of a disease, which has important implications for disease control.