Too Many Coronavirus Patients, Too Few Ventilators: Outlook In U.S. Could Get Bad, Quickly

Overrun by critically ill coronavirus patients, Italy’s hospitals are choosing who gets lifesaving breathing machines and who does not.

​

It’s a scenario that could soon repeat in the United States, experts warn.

“The capacity in northern Italy hospitals is a preview of a movie that is about to play in the United States,” said Marty Makary, a Johns Hopkins University surgeon and health policy expert. “The best two indicators of what things will be like in the U.S. are the number of COVID-related deaths in Italy and the number of ICU beds.”

U.S. hospitals are on the cusp of too many severely ill patients without enough intensive care unit beds and ventilators to keep those patients breathing. It’s why states, municipalities and businesses are desperately trying to delay new infections through social distancing measures such as school closings and work-from-home mandates.

The federal government has not publicly released estimates on demands COVID-19 might place on hospitals. In an earlier report on a moderate flu pandemic, the U.S. projected 200,000 Americans would need the most extreme level of care: a bed in a hospital intensive care unit. If the pandemic worsens to levels of the 1918 Spanish flu pandemic, 2.9 million would need ICU care, according to the report.

However, there are fewer than 100,000 ICU beds in the United States, according to a recent analysis by Johns Hopkins Center for Health Security.

The center recommended hospitals be able to convert a full 30% of available beds to COVID-19 patients within a week's notice. It recommend expediting discharges, converting single rooms to doubles and converting lobby waiting rooms and classrooms.

Hospitals also might struggle to keep up with demand for ventilators – mechanical breathing machines needed to keep people with severe pneumonia and respiratory failure alive. During a pandemic, the demand for ventilators "could quickly overwhelm" the nation's stockpile of ventilators, the Johns Hopkins Center reported last month.

A 2010 survey reported U.S. hospitals had 62,188 full-featured mechanical ventilators on hand, but the numbers varied widely by state. Hospitals in Washington, the state hit hardest by the epidemic, had 12.8 ventilators per 100,000 people, the second-lowest per-capita supply, ahead of only Idaho.

Washington, D.C., had the largest supply based on population, followed by West Virginia, which this week became the last state to report a coronavirus case.

Although the survey is a decade old and hospitals have added ventilators to their stockpile, "we figure that supply is less than 100,000 in this country," said Timothy Myers, a respiratory therapist and chief business officer of the American Association for Respiratory Care, which contributed to the survey.

"The number of ventilators pretty much mirrors the number of ICU beds in this country," Myers said. "The problem is a lot of these patients are being ventilated for numerous days. Some are off in three to four days. Others are on for several weeks. That is where you get the supply-demand issue."

The American Hospital Association estimates 960,000 Americans could need mechanical help to breathe during the coronavirus pandemic.

But even if hospitals pull out-of-date ventilators from storage and repurpose other machines to pitch in, there would only be enough devices and trained experts to treat 135,000 patients at a time, according to a paper the Society of Critical Care Medicine released Friday.

“We are being creative,” said Dr. Lewis Kaplan, the society’s president and a doctor at the University of Pennsylvania. The alternative, Kaplan said, is making decisions about who is assigned a machine. “We would like not to be in that space.”

Those who distribute and manufacture ventilators also are scrambling.

Chinese parts suppliers are coming back online, said Cheston Turbyville, a vice president for Vyaire Medical, which manufactures ventilators in Palm Springs, California. Vyaire has sped up its hiring to meet demand, he said, and gives priority to shipments directly to hospitals that need them.

Demand from hospitals has drained the supplies of several large companies that rent ventilators, said Robert Preville, the CEO of KWIPPED.com, which matches businesses to equipment-rental companies. His company received more than 20 requests for ventilator-rental quotes last week for up to 200 ventilators per quote.

Source