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As the pandemic of coronavirus infections spreads across the U.S., one figure has become a minor obsession among public health experts and journalists covering the outbreak: the number of mechanical ventilators available to treat patients who are unable to breathe on their own.
A report by the Johns Hopkins Center for Health Security last month put the figure at 160,000, far short of the 740,000 that might be needed in an epidemic on the scale of the 1918 Spanish flu. (The future course of the coronavirus outbreak is still unclear.) So at President Trump’s press briefing Monday afternoon, one question he faced was how many ventilators U.S. hospitals have.
Trump didn’t know, and none of the members of the coronavirus response team with him stepped up to answer.
“We have quite a few,” the president said. “It may not be enough, but if it’s not enough we will have it by the time we need it.”
The forecast demand for ventilators, respirators and other crucial supplies has been a source of concern for health care providers as hospitals and local health departments prepare for an influx of COVID-19 patients. On conference call with governors earlier in the day, Trump advised the state executives: “Respirators, ventilators, all of the equipment — try getting it yourselves.”
“One of the highest points of anxiety for our staff is that they won’t have the supplies not only to keep themselves safe but to keep their other patients safe when it comes to isolation,” said Eileen Searle, the biothreats clinical operations program manager at Massachusetts General Hospital in Boston. Searle told Yahoo News Monday that, while senior hospital officials have been “aggressively taking steps to prepare for a surge of patients related to COVID-19,” the potential for shortages of personal protective equipment, such as respirators, masks and isolation gowns, presents a serious concern as nationwide cases of the virus continue to grow.
“We’re all competing for a small pool of those resources,” Searle said. “Unfortunately, this situation is highlighting how vulnerable our health care system is to disruptions in the supply chain.”
Searle told Yahoo News that Mass General first began making preparations for a coronavirus outbreak in the United States in January, starting with activating the hospital’s incident command system, which “allows us to streamline decision making and communication processes focusing on a specific incident.” They also increased training for staff on the appropriate use of personal protective equipment and began “identifying where we would place suspected and confirmed COVID patients if we exceed capacity.”
Since then, Searle said, the hospital has taken additional measures, including canceling all elective procedures starting this week at the request of Massachusetts Gov. Charlie Baker. It has also begun encouraging staff who do not provide direct care to work from home, “to facilitate social distancing.”
Searle said that Massachusetts General is licensed for just over 1,000 beds, and is usually at almost 100 percent occupancy. Right now, she said, occupancy is slightly below normal and is expected to be reduced over the next few days, as a result of canceling elective procedures. Though the hospital will not comment publicly on how many confirmed or suspected coronavirus cases it is currently treating, Searle said, “Like everywhere else, we are preparing for an expected increase in patients.”
There have been 197 COVID-19 cases diagnosed in Massachusetts, none of them fatal, according to data from Johns Hopkins University.
Searle said that under routine operations, the hospital is equipped with 150 ventilators and ICU beds, as well as critical care staff such as respiratory specialists necessary to care for 150 patients “requiring high-level intensive care.”
The coronavirus preparation process has involved conversations about how to allocate certain equipment in the event that the demand from patients outgrows supply.
“Resource allocation is not something we’re used to talking about here in the United States, but we do allocate resources every day,” Searle said, noting that ECMO (extracorporeal membrane oxygenation) machines, which function as a kind of heart-lung bypass device, are “a very scarce resource, not many facilities can offer it.”
“Even facilities like ours that do have ECMO capability, we want to make sure we target these capabilities to people who will benefit from them.”
In Italy, which has been hit hard by the pandemic, some hospitals reportedly resorted to triage in allocating ICU beds and scarce equipment, reserving them for younger, stronger patients with a better chance of recovering.
Looking at how coronavirus epidemics have been playing out in other countries, Searle said hospital officials have begun consulting a variety of doctors, nurses, even community board members, to develop clear and consistent, evidence-based standards for allocating resources that can be applied to this specific situation.
Searle said they’re also looking to the CDC for more guidance on crisis standards of care as well as dealing with a limited supply of personal protective gear. In the meantime, she said, the hospital has been giving health care providers instructions on how to reuse certain equipment when appropriate.
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