When a coronavirus infection advances through the body in more severe cases, the lungs begin to fill with fluid and breathing becomes difficult. In a hospital intensive care unit, life-saving ventilators can help a patient survive by pumping oxygen into the impaired lungs. But what if thousands more people need hospital beds and ventilators than are available?
That is the nightmare scenario facing the United States and other nations in the pandemic. In Italy, doctors are having to make painful choices about which patients get treatment. President Trump told governors in a conference call on Monday morning, “Respirators, ventilators, all of the equipment – try getting it yourselves. We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”
That was shortsighted. The federal government ought to be doing everything in its power to make sure the worst-case scenario does not happen. Tom Inglesby, director of the Johns Hopkins Center for Health Security, has proposed that the United States “needs a wartime mobilization” to boost the supply of ventilators. We’d settle for even a decent peacetime mobilization.
Whether the worst case will happen is not yet known. But an epidemiological study published Monday by Imperial College, London, focusing on Britain and the United States, makes the point that all the non-pharmaceutical measures now being proposed – social distancing of the entire population, case isolation, household quarantine if one member is sick and school closures, a so-called suppression strategy – will have to be undertaken to reduce the stress on hospitals. If a less intense strategy is followed, the study warns, it would result in an “8-fold higher peak demand on critical care beds over and above the available surge capacity” in both Britain and the United States.
Hospital beds are a major worry. In another study, published in pre-print and not yet peer reviewed, Eric S. Toner of the Bloomberg School of Public Health at Johns Hopkins and colleagues calculated that, using data from the Wuhan, China, outbreak, the demand for critical care treatment at the peak of the pandemic might be 259 people per million. Excluding the Department of Veterans Affairs system, there are 46,500 medical intensive care unit beds in the United States, or 178 per million, with 70 to 80 percent of them already occupied on any given day. Without any changes, that means that in an average metropolitan area of 1 million, there are only 36 to 53 empty, staffed intensive care beds to meet a need that might be 259. To alleviate the shortage, hospitals will have to take drastic rationing action, postpone other treatments, seek additional space, and even then, it is not clear there will be sufficient capacity. In the case of ventilators, too, there are 62,000 immediately available and another 99,000 that could be pulled out in an emergency, according to Forbes. But that might still not be sufficient, depending on the size of the pandemic.
By acting now, we may avert a hospital catastrophe. The government also should be rushing to help add supplies, using whatever means works, even “wartime mobilization” if necessary. “Do it yourself” is not leadership.