Ventilator Shortage Worries Coronavirus Fighters
The infection often starts with a cough and then a fever, but coronavirus can end with a deadly case of pneumonia when patients cannot get enough oxygen to survive. Hence, the desperate need for ventilators worldwide as the COVID-19 pandemic spreads.
The devices are literal breathing machines that pump air through a tube, inserted in the throat and then down into the lungs. They blow oxygen in. They can also, if need be, blow carbon dioxide out. They are absolutely essential to dealing with acute cases of respiratory viruses, and they are in short supply globally.
The scarcity is enough to frighten elected officials, notably Andrew Cuomo.
“These ventilators are expensive to begin with and they are scarce, and you can’t find available ventilators no matter how much you’re willing to pay right now, because there is literally a global run on ventilators,” the New York governor warned. “You’re going to be thousands short. Thousands.”
The White House is well aware.
“If you don't have enough ventilators, it's obvious people who need it will not be able to get it,” Dr. Anthony Fauci, who has quickly become the face of the coronavirus task force, warned on CNN. And that, continued the director of the National Institute of Allergy and Infectious Diseases, “is when you’re going to have to make some very tough decisions.”
Hospitals around the world regularly work according to triage principles (wheel the elderly patient with extreme chest pain into the operating room; leave the patient complaining about seasonal allergies in the waiting room a little longer). But what happens when hundreds, even thousands, rush an emergency room with the same life-threatening illness?
It’s the nightmare scenario, the one that includes the grim choices described by Fauci. Doctors in China, Iran and Italy are living it already, forced to decide who lives and who dies because of scarce resources in some cases.
In the Chinese city of Wuhan, doctors had more than 1,000 patients who experienced trouble breathing, but only 600 ventilators. Hospitals were also flooded throughout northern Italy, at levels not seen since the end of the World War II. Again, a similar problem: too many patients and not enough resources. Iran was no different, and likely worse, as the government begged the international community to lift sanctions.
If the United States experiences a similar spike, healthcare professionals and patient advocates worry about similar heart-breaking decisions being made in this country. According to the most recent estimate by the John Hopkins Center for Health Security, around 160,000 ventilators are available for patient care. The federal government also has a stockpile of ventilators in reserve.
Is that enough? “It’s a very good question,” said Vice President Mike Pence, who is overseeing the U.S. coronavirus response.
The White House has focused on mitigation, the vice president told reporters during a Sunday briefing — an attempt to flatten the so-called curve, to prevent a spike in coronavirus so that the healthcare system won’t be overwhelmed with a wave of patients. “But the whole issue of personal protective equipment and supplies and the capacity of our healthcare system,” he continued, “is in the forefront of what we're talking about every day.”
Then Health and Human Services Secretary Alex Azar stepped to the podium to acknowledge that “any pandemic like this runs the risk of exceeding our healthcare system capacity.” This is why, he continued, the government has worked to build “flex” into the system to prepare for emergencies. But in addition to mitigation efforts at the current moment, Azar promised “to increase the supplies of personal protective equipment, of ventilators, of field medical unit hospitals that we can deploy.”
Citing national security concerns, Azar wouldn’t disclose the number of ventilators held in reserve. During an interview on CNN shortly afterward, Fauci said there were 12,700 ventilators stockpiled, although details of how they will be distributed were not yet available.
An HHS spokesperson later told RealClearPolitics that, to date, “we have one formal request” from a healthcare provider for some of these ventilators. And yes, the aide continued, “we have ordered more ventilators and are working with the private sector to acquire and produce more.”
One private sector partner involved is ResMed, a California-based medical device company. “Our primary focus is to maximize availability of these devices for the patients that need them most,” a spokesman told RCP. For now, things are going well: “At present we can meet demand.” He cautioned, however, that “our ability to do so could change if demand were to significantly increase, either globally or within certain markets.”
The focus will shift from the availability of testing, if mitigation efforts fail, to the availability of this type of medical equipment. Physicians around the country are already taking close notes on how their international colleagues are treating the disease overseas. Individuals living with progressive illnesses, meanwhile, are watching closer than most.
“What we are really talking about when we talk about the scarcity of ventilators is rationing of healthcare. It’s a terrifying thought,” said Gunnar Esiason, director of patient outreach at the Boomer Esiason Foundation, which supports people with cystic fibrosis. When doctors must prioritize some patients over others, “it begs the question … would we be chosen to be saved if things got out of hand?”
“No one ever wants to make those decisions. Doctors don’t want to have triage care,” Esiason told RCP. “I’m of the opinion that this sort of thing is being talked about as a way to motivate people to take this seriously.”
Those motivated now include the Pentagon. The Department of Defense announced Tuesday evening that it will give 2,000 respirators to HHS in preparation for the pandemic. Governors and patients and medical professionals worry that it may not be enough.