Without swift action, parts of the United States will run out of ventilators in the coming weeks. Early signals from New York and Seattle are alarming: both cities are already reporting intensive care unit bed shortages and looming ventilator shortages, weeks before the estimated peak of the projected coronavirus caseload.
On March 15, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN that there are only 12,700 ventilators in the national strategic stockpile. Unfortunately, since that disclosure the president’s response has been to tell each state’s governor to “try getting it yourselves.” Gov. Andrew Cuomo of New York has rightly said that the need for ventilators now is like the need for missiles during World War II. Now imagine the federal government telling governors to try getting their own missiles.
Ventilators are mechanical breathing machines that are the crucial lifesaving tool when a patient’s lungs fill with fluid, making it very difficult for the lungs to oxygenate blood. In one of the first large-scale studies of the characteristics of the coronavirus in Wuhan, 5 percent of patients required the intensive care unit and 2.3 percent required a ventilator. Now imagine 2.3 percent of the perhaps millions of Americans who are expected to become infected with Covid-19 over the next three months. There simply will not be enough of these machines, especially in major cities. (Hospitals in the country have some 160,000 total; New York has 6,000 at most.)
I am a primary care physician at Massachusetts General Hospital and an expert in population health at Harvard Medical School. I am not an I.C.U. doctor, mechanical engineer or logistics expert. Yet, it is painfully obvious that there are three problems we need to solve immediately to avert the ventilator crisis: ventilator production, ventilator distribution and ventilator operation. I believe we can solve all three.
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The first step is a shift in mind-set — one we doctors have already accepted. Several weeks ago our hospital’s physician-in-chief called the first meeting of our emergency command structure and told us that we should assume that our job descriptions no longer applied. We would be asked to do whatever we were best suited to do and would achieve whatever was necessary. This is essential framing for how all of us need to approach this disaster: Do whatever is necessary. Do as much as you can.
In the face of a global shortage, American industries can step up and quickly produce ventilators. All week, I have been receiving text messages and emails that say things like “By the way, my company makes parts for G.E. ventilators. We just got a big order that we are pushing through as fast as we can.” The General Motors chief executive, Mary T. Barra, announced that G.M. was working closely with Ventec Life Systems, one of a few ventilator companies based in the U.S., to rapidly scale up production of their critically important respiratory products. My colleagues at the nation’s top hospitals are getting phone calls from tech leaders asking for ventilator specs.
Such stories give me hope. But we need the federal government, too. The White House has said that the Defense Production Act could be invoked to compel industries to make necessary equipment in a time of crisis. That’s a good step, but there appears to be no firm plan other than repurposing ventilators from surgery centers. And if there is a secret one, the absence of timely and transparent information about it has profoundly undermined trust. Healthcare workers and American citizens deserve better than vague reassurance. We need a plan.
The second problem is ventilator distribution. Once industry rapidly scales ventilator production, where should these ventilators be delivered? Which hospitals need them most? How can we build a nimble logistics operation that can rapidly deploy these machines the moment that a shortage appears imminent?
The truth is: We have no idea. We are currently taking an every-hospital-system-for-themselves approach, in which some hospitals will surely say “we’ll take them all” while others will lack the capital to make such large purchases in advance and therefore will be reliant on FEMA, which will be forced to ration scarce, lifesaving equipment. These already cash-strapped hospitals serving poorer populations will soon be put in even greater jeopardy.
Here, too, we can all drop our job descriptions to solve this problem. Big tech needs to rapidly build and scale a cloud-based national ventilator surveillance platform which will track individual hospital I.C.U. capacity and ventilator supply across the nation in real-time.
Such a platform — which Silicon Valley could build and FEMA could utilize — would allow hospitals nationwide to report their I.C.U. bed status and their ventilator supply daily, in an unprecedented data-sharing initiative. I have no doubt that the tech brain trust now sitting at home on Zoom can mobilize to get this done.
Finally, we need to begin planning for ventilator operation. Just because a hospital has machines doesn’t mean that we have people who know how to use them. Respiratory therapists, I.C.U. nurses, critical care doctors and anesthesiologists will likely be in short supply. But if I could successfully adjust ventilator settings in an I.C.U. as a 28-year-old intern, I’m confident we can train other health care professionals on the basics of deploying this lifesaving equipment.
All of us are watching the horrific news out of Italy and praying that the same doesn’t happen here. The increasingly severe social distancing measures implemented across much of the nation are a collective sacrifice designed to give our hospitals crucial time to prepare. Will we use it properly? And can the government and industry help us save lives?
Source: The New York Times