|Image from NPR|
NPR had an alarming story today revolving around an interview about the current limits of intensive care resources for treating COVID-19 patients, in particular whether there will be enough ventilators for the most severely afflicted. But by far the most interesting info was buried when NPR linked to but otherwise ignored a research report by a society of intensive care professionals on just that very topic.
Why so little interest in that report, especially when it answered some of the questions raised in the main body of the story?
Here's the story: As The Pandemic Spreads, Will There Be Enough Ventilators?
First the gloomy main body:
Ventilators are generally a temporary bridge to recovery — many patients in critical care who need them do get better. These machines can be crucial to sustaining life in certain emergency situations. And if there is a surge in seriously ill patients, as COVID-19 spreads, ventilators could be in short supply, from hospital to hospital or nationally.
And if there's an increase in very sick patients on a scale like what happened in China, Dr. Eric Toner says, the U.S. is not prepared. Toner studies hospital preparedness for pandemics at the Johns Hopkins Center for Health Security.
"We are not prepared, nor is any place prepared for a Wuhan-like outbreak," Toner tells NPR, "and we would see the same sort of bad outcomes that they saw in Wuhan — with a very high case fatality rate, due largely to people not being able to access the needed intensive care."
Toner says all hospitals have some lifesaving ventilators, but that number is proportional to the number of hospital beds in the institution. An average-sized hospital with 150 beds, for example, might have 20 ventilators. If more were needed, hospitals that need them could rent them, he says — at least for now. But if there's a surge of need in a particular community — patients with serious pneumonia from COVID-19 or pneumonia related to flu, for example — all hospitals in the area would be competing to rent from the same place. "So that's a very finite resource" he says.
The latest study available estimates there are about 62,000 ventilators in hospitals nationwide. That figure is seven years old — so the actual number could be higher.
There are also some machines in federally stockpiled emergency supplies, though the exact number isn't public.
"There is a strategic national stockpile of ventilators, but the numbers are classified," says Toner. It's been "publicly stated," he says, that there are about 10,000 ventilators in the national stockpile. "That number might be a bit outdated, but it's probably about right," he says. Other estimates range from 4,000 to somewhat less than 10,000.
At that point NPR linked to this highly pertinent and current - it's dated yesterday - report by the Society of Critical Care Medicine, U.S. ICU Resource Availability for COVID-19, which paints a much less dark picture.
First, look at Figure 1, the comparison of U.S. critical care beds to other countries. The United States has 34.7 ICU beds per 100,000 inhabitants, significantly more per capita than anywhere else except Germany, which was second with 29.2. After that, the numbers drop off sharply. If you're in the UK or China - 6.6 and 3.6 per capita respectively - just hope you won't need a critical care bed.
The report gives comprehensive numbers for ventilators on hand and details of all aspects of employing them during an emergency, including the limits on our ability to absorb surge supplies due to the need for spare parts, disruptions in international supply lines, and the need for trained personnel to safely use ventilators.
Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators. Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply. The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 continuous positive airway pressure (CPAP) units.
Centers for Disease Control and Prevention Strategic National Stockpile (SNS) and other ventilator sources: The SNS has an estimated 8,900 ventilators for emergency deployment. These devices are not full featured but offer basic ventilatory modes. Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy them. States may have their own ventilator stockpiles as well. Respiratory therapy departments also rent ventilators from local companies, further expanding the supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals’ surge capacity.
The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units.
I'll note that the absolute number of ventilators does not include U.S. military resources which may also be available, and which probably exceed the medical capabilities of most countries.
All in all, I was quite reassured to read that linked report.
As of today, the U.S. has had only 1,629 COVID-19 cases and 41 deaths (about half of which occurred at the same Kirkland, Washington, nursing home). That's only 5 cases per million of population. There were a little over 100,000 cases worldwide, most of them in only five countries, when WHO declared it a pandemic.
Of course, we and the rest of the world will have many more cases before the pandemic subsides. But let's not ignore the realities that the U.S. has had remarkably few cases in comparison to nearly every other country, that we are far better resourced than others to handle the most severely afflicted patients, and that our population is spread out over a large landmass that will make it feasible to surge more resources to the locations in greatest need as events dictate.
So get a grip. Stay away from large crowds, wash your hands often, and let's all hope that Tom Hanks recovers quickly.