Hospitals rely on cooperation to address ventilator demand

Hospitals in the Bay Area are expecting to rely on their own breathing devices when the expected surge in coronavirus cases comes, after President Trump told states that they cannot rely on the federal government to obtain ventilators and other emergency equipment.

The president told governors during a conference call Monday that those who need ventilators should try to obtain them themselves. Then, on Tuesday, Defense Secretary Mark Esper ordered the Pentagon to provide 2,000 specialized ventilators to federal heath authorities for distribution to hospitals.

The conflicting messages came as medical professionals around the country expressed concerns that there are not enough assistedbreathing devices to handle a sudden influx in COVID19 cases.

But local hospitals mostly ignored the chatter and prepared for an uncertain future.

“We could all be surprised by the trajectory of growth of this virus, but right now we feel confident that we have enough of what we need to respond,” said Brent Andrew, spokesman for San Francisco General Hospital, a Level 1 trauma center that is treating two coronavirus cases and has 10 patients on ventilators.

He said the hospital has more than five times that many ventilators on hand, and the staff has made sure every one of them is being maintained and in working order.

“We have an adequate supply. We are nowhere near tapping the boundaries of that supply yet, but we are preparing for a surge,” Andrew said. “Should our supply be taxed, all the hospitals in San Francisco have an agreement to help each other with supplies. In addition to that, the state is sending us supplies of necessary equipment routinely, so that hospitals who need supplies should the demand spike — we will be prepared.”

UCSF Medical Center officials said they are essentially in the same situation, but with fewer ventilators on hand.

Hospital officials in the Bay Area said the question isn’t whether each facility has enough ventilators to get by, but whether there is adequate coordination and collaboration between hospitals so that every patient gets proper care.

That, officials said, means hospitals and state and federal agencies will have to join forces if the worstcase scenario happens and thousands of patients begin rushing to emergency rooms.

Some Bay Area hospitals have already seen increases in patients, but experts believe California is still two to four weeks away from experiencing the worst of the outbreak.

John Balmes, a professor of medicine at UCSF, said there is no shortage now, but there are only about 500 ventilators in San Francisco and what is now a surplus could quickly turn into a deficit if there is a COVID19 surge.

“If we experience a surge like northern Italy, then the capacity of the U.S. health care system to provide adequate care for these severely ill patients will be overwhelmed,” said Balmes, who also teaches environmental health sciences at UC Berkeley. “There are less than 85,000 ventilators in the U.S. Physicians in Italy are having to ration care because of the surge of cases there, so people who could be supported if there were enough ICU beds and ventilators are dying.”

The U.S. surgeon general urged hospitals to delay elective surgeries to preserve medical supplies and ease the burden on health care workers. San Francisco recently banned “nonessential” hospital visits — including by spouses and clergy.

Meanwhile, Stanford hospital officials said they are working with suppliers to triple their supply of ventilators to about 150.

GE Healthcare, a major supplier of hospital equipment, announced recently that it is increasing its manufacturing capacity for ventilators and other equipment to treat COVID19, such as ultrasound devices and monitors.

There are about 1,550 ICU beds across all hospitals in the nine Bay Area counties, according to the California Department of Public Health. The department does not track how many ventilators there are.

“We don’t have a projection yet of how much we would need,” Andrew of S.F. General said. “It’s been difficult to put together an accurate projection because we don’t know where we are on the curve. This is so variable. That’s the thing.”