On ventilators, stop bidding wars, remove politics
The nation received the grim news this week that, even under the best efforts to fight the new coronavirus, as many as 100,000 to 200,000 Americans might die.
Beyond that stunning White House revelation lies an even darker reality: The world’s richest and most medically advanced country won’t have enough ventilators to keep alive all the COVID-19 victims struggling to breathe.
In the worst cases, the virus migrates to the lungs, where tiny air sacs called alveoli can be damaged, compromising the ability to take in oxygen. When breathing becomes heavily labored, a tube is forced down the throat — intubation — and a machine, a ventilator, infuses crippled lungs with oxygen, allowing precious days or weeks for a patient to hopefully recover.
Physicians in northern Italy’s most advanced hospitals were weeping in hallways because they ran out of ventilators and had to choose who would live or who would die.
In America, governors are trying to stock up on the machines, but it’s a struggle. New York is America’s epicenter of the outbreak and needs as many as 30,000 ventilators. As of Wednesday morning, the Federal Emergency Management Agency, which handles the national emergency stockpile, provided 4,000. The New York Times reports that Illinois needed 4,000 and got 450; New Jersey sought 2,300 and received 300. Virginia requested 350 and nothing has arrived.
It gets worse.
Thousands of ventilators in the shrinking federal stockpile, and scores sent to states, are broken for lack of maintenance. States are scrambling to buy machines on the open market but are bidding against each other and FEMA. “Look at the bizarre situation,” New York Gov. Andrew Cuomo said Tuesday. “It’s like being on eBay.”
And now the federal government is recommending hospitals split a ventilator between two patients, an option experts say is difficult and desperate, not the least because it requires trying to synchronize the breathing of two desperately ill patients.
This situation ensued despite the Trump administration anticipating shortages nearly six weeks ago, according to Feb. 25 congressional testimony by Health and Human Services Secretary Alex Azar. A month later, President Donald Trump finally invoked the Defense Production Act to pressure car makers to produce ventilators. They hope to have made 50,000 by July, weeks after the anticipated peak of the epidemic.
There will be plenty of time to figure out how this ventilator crisis was
botched as badly as the lack of coronavirus testing. Right now, though, there are three more urgent priorities:
❚ Stop the bidding wars. Trump said states “shouldn’t be doing that. If that happens, they should be calling us.” They shouldn’t have to call. He needs to be proactive and coordinate with the states so that FEMA does all the purchasing and distributes the machines — many of them produced overseas, in China and elsewhere — to states as needed.
❚ Take politics (and incompetence) out of decision-making. The distribution of medical supplies has been a mess. The Washington Post reports that Oklahoma received 120,000 face shields from FEMA, despite asking for only 16,000. North Carolina wanted 500,000 medical coveralls and got 306. Florida, which happens to be a crucial battleground state, has received 100% of what it wants. At some point, the federal government will have to make hard decisions about doling out ventilators to states in crisis. That must be done with careful analysis, dispassionately and without favor or partisanship.
❚ Protect doctors. If the worst happens and there are more suffocating patients than machines to keep them breathing, medical ethicists have already circulated triage guidelines. Those deemed medically most likely to survive the disease would be first on a ventilator — an awful choice to make. But as it stands in this country, clinicians who withhold or withdraw ventilators without the consent of a patient are exposed to criminal charges or civil liability. A 2004 Maryland statute, which other states should adopt, provides immunity if a health care decision was made in good faith and under catastrophic circumstances.
Denying someone life because health systems are overwhelmed is a nightmare no advanced nation should have to contemplate. But there is a very real possibility this could happen in the coming days and weeks, and the time to act is now.