The number of US coronavirus cases has topped 1,800. More than half of US states have declared a state of emergency as the healthcare system prepares for an onslaught of patients.
But research reveals US hospitals may not be prepared for an influx of severely ill coronavirus patients. Respiratory failure can be a severe side effect of COVID-19, the disease caused by the coronavirus. When people go into respiratory failure, and either can't breathe or have trouble breathing, they need a ventilator.
If the coronavirus pandemic worsens, these life-saving machines, which move breathable air into and out of a patient's lungs, could be in short supply.
A February report from the Center for Health Security at Johns Hopkins revealed the US has about 160,000 ventilators ready for use in hospitals, with another 8,900 held in a national reserve. The report doesn't say how many are typically in use, but notes that demand could increase by at least 25% during an influenza pandemic.
"The need for ventilation services during a severe pandemic could quickly overwhelm these day-today operational capabilities," the report says.
About 1 million Americans might need a ventilator throughout the course of the outbreak, according to projections from Dr. James Lawler, an infectious diseases specialist and public health expert at the University of Nebraska Medical Center. Lawler's projections didn't include a time frame, and all of those people might not need a ventilator at the same time.
In February, Lawler presented his projections for how many people in the US might get infected with the coronavirus during a webinar convened by the American Hospital Association: about 96 million.
He said up to 1.9 million of those 96 million could require a stay in a hospital's intensive care unit (ICU), and approximately half of them would need a ventilator.
This potential scarcity shouldn't come as a surprise. In a 2005 report by the US Department of Health and Human Services, experts discussed a possible plan to combat pandemic influenza, a type of respiratory illness similar to COVID-19.
In the report, the authors said: "In a severe pandemic it is possible that shortages, for example of mechanical ventilators, will occur and medical care standards may need to be adjusted to most effectively provide care and save as many lives as possible."
That same report estimated that, if the US were struck by a severe influenza pandemic akin to the 1918 Spanish flu, we would need more than 740,000 ventilators, The Washington Post reported.
A 2015 study discussed another potential problem: during a pandemic, the number of respiratory therapists trained to operate ventilators may not be sufficient.
"Successful ventilation also depends on sufficient numbers of suitably trained staff," the study authors wrote. Even if the US increased the supply of ventilators, there may not be enough experts that can treat patients with them.
These shortages are already happening in Italy. In parts of the country hardest hit by the coronavirus, clinicians are facing a shortage of medical supplies and hospital beds. Doctors are being forced to make tough decisions about who to treat. Ventilators are being rationed.
In a March letter, professionals coordinating the response in northern Italy wrote that hospitals in the area are seeing a high number of ICU admissions, because of respiratory failure that requires ventilation. About 10% of all patients who've tested positive for the virus have been admitted to ICUs, they wrote.
"Look what's happening in Italy right now. That's the cautionary tale," Aaron Carroll, a pediatrician and researcher who studies the healthcare system, said in a tweet.
Lydia Ramsey contributed reporting to this story.
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