Nationwide Ventilator Shortage Imperils Hospitals’ Response to COVID-19 Pandemic
The prospect is a daunting one, as the number of COVID-19 cases explodes across the U.S. As of March 17 at 11 P.M. eastern time, 6,353 cases of the novel coronavirus had been documented in the United States, with 108 deaths documented, according to National Public Radio’s live tracker, with both the overall number of documented cases and the number of deaths rising by the hour. But experts in epidemiology and public health have been warning for weeks now that the United States should be prepared to experience the exponential growth that has been taking place in Italy, whose healthcare system is being overwhelmed by the pandemic.
Meanwhile, a report published on Tuesday by the Associated Press’s Lindsey Tanner and Linda A. Johnson under the Headline, “Hospitals fear shortage of ventilators for virus patients,” begins with this statement: “U.S. hospitals bracing for a possible onslaught of coronavirus patients with pneumonia and other breathing difficulties could face a critical shortage of mechanical ventilators and health care workers to operate them. The Society of Critical Care Medicine has projected that 960,000 coronavirus patients in the U.S. may need to be put on ventilators at one point or another during the outbreak. But the nation has only about 200,000 of the machines, by the organization’s estimate, and around half are older models that may not be ideal for the most critically ill patients,” Tanner and Johnson wrote Tuesday. “Also, many ventilators are already being used by other patients with severe, non-coronavirus ailments.”
The AP reporters note that “U.S. hospitals bracing for a possible onslaught of coronavirus patients with pneumonia and other breathing difficulties could face a critical shortage of mechanical ventilators and health care workers to operate them. The Society of Critical Care Medicine [SCCM] has projected that 960,000 coronavirus patients in the U.S. may need to be put on ventilators at one point or another during the outbreak. But the nation has only about 200,000 of the machines, by the organization’s estimate, and around half are older models that may not be ideal for the most critically ill patients. Also, many ventilators are already being used by other patients with severe, non-coronavirus ailments.”
The AP journalists make reference to the informational resources that the SCCM has been updating on its website, with the association indicating a significant potential deficit of ventilators to meet the anticipated need. “Based on a 2009 survey of AHA [American Hospital Association] hospitals,” the SCCM notes on its website, “U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators. Approximately 46 percent of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply. The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 continuous positive airway pressure (CPAP) units.”
As the SCCM notes on its website, there remain several thousand ventilators in the CDC’s Strategic National Stockpile (SNS) and other sources. The medical society states that “The SNS has an estimated 8,900 ventilators for emergency deployment. These devices are not full featured but offer basic ventilatory modes. Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy them.8,9 States may have their own ventilator stockpiles as well. Respiratory therapy departments also rent ventilators from local companies, further expanding the supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals’ surge capacity.”
And, the SCCM notes, “The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units. Many of the additional and older ventilators, however, may not be capable of adequately supporting patients with severe acute respiratory failure. Supplies for these ventilators may also not be available due to interruptions in the international supply chain. Moreover, an analysis of the literature suggests that U.S. hospitals could absorb between 26,000 and 56,000 additional ventilators at the peak of a national pandemic, as safe use of ventilators requires trained personnel.”
The AP’s Tanner and Johnson quoted Lewis Kaplan, M.D., the SCCM’s president, as stating that, while hospitals are rushing to rent more ventilators from medical-equipment suppliers, and manufacturers are ramping up production, “The real issue is how to rapidly increase ventilator production when your need exceeds the supply. For that I don’t have a very good answer.”
The AP’s reporters noted that on Tuesday, U.S. Defense Secretary Mark Esper said the Pentagon will provide 2,000 specialized ventilators to federal health authorities to help handle the outbreak. Secretary Esper said the machines are designed for use by troops, and the military will need to train civilians how to use them. And President Donald Trump said Monday that the government is seeking to acquire more ventilators. “But he angered some when he said governors should feel free to take matters into their own hands if they can obtain the equipment more quickly elsewhere,” the AP reporters wrote. And Michigan Gov. Gretchen Whitmer, a Democrat, said on MSNBC that, “To hear the leader of the federal government tell us to work around the federal government because it’s too slow is kind of mind-boggling.”
All of these issues are causing great alarm in the state of New York, which this week outpaced Washington as the state with the largest number of COVID-10 cases. As the New York Times’s Brian M. Rosenthal and Joseph Goldstein wrote on Tuesday, “As the coronavirus has swept across New York, officials have become increasingly alarmed about a bleak reality: The state may not have enough ventilators for everybody who could need one. It is still possible that the state could slow down the spread of the virus enough to curb the demand for ventilators, the machines that help the sickest patients to breathe. But a panel convened a few years ago by the state found that in the worst-case scenario of a flulike pandemic, New York could be short by as many as 15,783 ventilators a week at the peak of the crisis.”
The Times reporters also noted that “Most of the New York’s major health systems have declined to provide details about their ventilators or what they will do if they run out. Some hospital administrators have said they believe new measures, such as closures of schools and restaurants, can slow the spread of the virus and keep the number of critically ill people below levels that could overwhelm hospitals. they wrote. “But officials have repeatedly said that a ventilator shortage is one of their top concerns.” And it quoted Gov. Andrew Cuomo as stating on Sunday that “These ventilators are expensive to begin with, and they are scarce. You’re going to be thousands short. Thousands.” “I’m nervous,” Akshay Ganju, M.D., an emergency room physician at Montefiore New Rochelle Hospital, in Westchester County, told the Times. “I’m steeling myself for the possibility that at some point I’m going to have to look a daughter in the eye and tell her that I don’t have a ventilator for her father.”
And, writing in POLITICO on March 14, Joanne Kenen noted that, “As they prepare for an expected influx of patients, local public health officials painted a picture of a system with only a limited ‘surge’ capacity, and stressed the importance of social distancing as a crucial way to keep the numbers of patients at a level the system can handle.” And she quoted Amy Acton, M.D., head of the Ohio Department of Health, as saying that "It's about our supply of ventilators, our supply of beds, and of course we have to worry about our health care workers and the general stress on our health care system," said Dr. Amy Acton, the head of the Ohio Department of Health. "If we stay below a certain threshold, we can try not to overwhelm our health care system. So we need to take aggressive measures now." Dr. Acton also
Healthcare industry leaders have been working on the ventilator shortage issue, attempting to coordinate a response to the ventilator shortage, following the national emergency declaration made by President Trump on March 13. “Ventilators are challenging,” Soumi Saha, PharmD, senior director at the Charlotte, N.C.-based Premier Inc. told Healthcare Innovation this week. “There’s currently an eight-week lead time to purchase ventilators from the largest manufacturers. We’re also hearing different numbers about the stockpile; we’re hearing numbers varying anywhere from 4,000 to 12,000, in terms of ventilators sitting in the strategic national stockpile. We’re trying to assess that situation,” she added.
And, experts are saying, it will be important for everyone to understand that the fight against the COVID-19 virus will not be a brief one. “I think people think that if we get through a couple of weeks with this, we’ll be OK; but it’s going to be several months. The Chinese are still dealing with it more than four and a half months later,” Michael Osterman, Ph.D., M.P.H., director of policy at the Center for Infectious Disease Research and Policy at the University of Minnesota, in Minneapolis, told MSNBC’s Rachel Maddow on Tuesday evening. “This is an incredibly important point.”
Indeed, Dr. Osterman added, “This is going to be a rolling set of outbreaks across the country. What we want to do is to make sure we have a national response, not one just driven by the first cities” affected.
