The Washington Post - 19.03.2020

A8 EZ RE THE WASHINGTON POST.THURSDAy, MARCH 19 , 2020

the coronavirus outbreak

BY CHRISTOPHER ROWLAND

Hospitals a re holding b ack from
ordering m ore medical ventilators
because of the high cost for what
may be only a short-term spike in
demand from the coronavirus epi-
demic, supply chain experts and
health researchers say, intensify-
ing an anticipated shortage of life-
saving equipment for patients
who b ecome critically ill.
The lack of ventilators — and
growing calls for a more aggres-
sive government role t o fill the gap
— w as a subject of tense e xchanges
this week between President
Trump and state officials. The is-
sue also revealed a disconnect be-
tween d ifferent parts of the health-
care industry, w ith the main h ospi-
tal association disputing the ac-
counts about the adequacy of
supply of the lifesaving equip-
ment.
Mechanical ventilators, which
help patients breathe or breathe
for them, a re considered critical to
the nation’s effort to contain the
worst effects of the pandemic and
avoid a crisis like the one Italy is
facing. Depending on how bad the
coronavirus pandemic gets in the
United States, individual cities
co uld c ome u p thousands o f venti-
lators short as patients flood hos-
pitals, researchers say.
“It’s a challenge for states, local
governments and hospital admin-
istrators to allocate tens of mil-
lions o f dollars to something when
they don’t know if they need it or
not,” said Chris Kiple, chief execu-
tive of Ventec Life Systems, a small
ventilator manufacturer in Wash-
ington state. “But if they don’t do
it, they are going to be caught
flat-footed, and facilities are going
to be faced with not enough venti-
lators to meet demand.”
Ventilator m anufacturers could
achieve, within a few months, a
significant boost in production
fr om about 50,000 units a year
currently, said Julie Letwat, a
he alth-care lawyer with McGuire-
Woods in Chicago who is monitor-
ing the industry. Orders have not
flooded in, she said, because most
hospitals can’t afford to increase
inventory of expensive equipment
for what could turn out to be a
short-term event.
“The risk is that they’ll never be
used, and hospitals can’t eat the

cost,” she said. “Most hospitals in

this country a re not profitable.”

Ventilators range from $25,

for a basic model to $50,000 for a

machine used in the most ad-

vanced intensive-care units. Buy-

ing them also requires additional

large investments in staff and

training. Letwat said federal gov-

ernment investment would be the

surest way to boost s upply.

Governors and local health au-

thorities worry about an insuffi-

cient supply of ventilators and

have been calling on the Trump

administration to move aggres-

sively to solve the problem. The

president i ndicated Wednesday he

has a plan to boost ventilator sup-

plies but did not provide specifics.

“We are ordering thousands and

thousands of ventilators and they

are complex,'' Trump said at a

White House p ress briefing.

Other governments have

rushed to stock up. The United

Kingdom has asked Rolls-Royce

Holdings, which makes jet en-

gi nes, and other heavy manufac-

turers to make ventilators. Germa-

ny o rdered 10,000 ventilators with

Dragerwerk AG, which Dow Jones

said was the company’s largest or-

der e ver.

In t he United States, Trump told

state officials on a conference call

Monday that states and local gov-

ernments should procure their

own equipment. “Respirators,

ventilators, a ll of the e quipment —

try getting it yourselves,” Trump

told the governors, according to

the New York Times, which first

reported the call.

The Trump administration has

barely begun to release up to

13,000 older ventilator models

ca ched around the country in the

federal Strategic National Stock-

pile, saying state officials have not

requested them.

Maryland Gov. L arry Hogan (R),

chairman of the National Gover-

nors Association, said leaders na-

tionwide are scrambling to secure

ventilators to prepare hospitals for

a surge of coronavirus patients,

but there a re not enough a vailable.

“There is a problem with sup-

plies and ventilators,” Hogan said

Monday. “ There’s not enough sup-

plies. The states don’t have

enough. The federal government

doesn’t have enough. They’re not

getting distributed fast enough.

And t hat’s a problem for all o f us.”

Hospital officials do not know

how many patients will need ven-

tilator care in the United States or

whether the system will be over-

whelmed. They say they are in a

race against the spread of the vi-

rus, hoping measures to keep peo-

ple in their homes will reduce the

size of the short-term spike in

those seeking c are.

Nancy Foster, vice president for

quality and patient safety policy a t

the American Hospital Associa-

tion, said hospitals are canceling

elective surgeries to try to free up

ventilators. “Knowing exactly

what is enough is hard at the mo-

ment,” Foster said.

She also said hospitals are pre-

paring to move ventilators to hot

spots of infection within multi-

hospital systems and b ring older

models b ack into use.

“We do have the capacity in an

emergency to turn the switch on a

lot of different things. We could

change in a very short time,” said

Brahim Ardolic, e xecutive director

of Staten Island University Hospi-

tal, which is part of a 22-hospital

chain.

Foster said she has not heard

any American Hospital Associa-

tion member hospital say it was

not purchasing ventilators be-

ca use of cost. “They want to be

fully p repared to serve the n eeds of

their community and to do so in-

telligently,” s he said.

Hospitals meanwhile are

scrambling to buy personal pro-

tective equipment for medical

staff before the coming wave of

infection, including disposable

pr otective m asks called N95 r espi-

rators, which are in short supply

nationwide.

On the front lines of one of the

nation’s earliest outbreaks, J. Ran-

dall Curtis, a doctor in Seattle, has

treated six coronavirus patients in

the intensive-care unit at Harbor-

view Medical Center, t hree of them

requiring ventilators (including

one w ho died).

“Right now, we are mobilizing

additional staff and cordoning off

ICUs to take c are of these patients,

canceling surgeries, but we’re not

exceeding capacity,” h e said.

Nationally, the gap between de-

mand and supply of ventilators

could run into the tens of thou-

sands, according to estimates. An

analysis by the Society for Critical

Care Medicine, citing figures de-

veloped for the American H ospital

Association, said U.S. hospitals

have 62,000 full-featured ventila-

tors for advanced intensive-care

units and nearly 100,000 more

with lesser capabilities.

Contrast supply with potential

demand: More than 900,000 pa-

tients may need ventilator care

during the coronavirus pandemic,

the a nalysis c oncluded.

Keeping backup ventilators is

impractical for most hospitals be-

cause of the need to service and

maintain them and train addition-

al staff during rare events when

they are needed, said Lewis Ka-

plan, a trauma surgeon at the Uni-

versity of Pennsylvania and presi-

dent of the Society of Critical Care

Medicine.

“It’s like taking military planes

out of your boneyard,” he said.

“There can be a variety o f econom-

ic disincentives to be prepared for

the w orst thing that can happen.”

Not all p atients w ould be sick a t

once, so the shortfall may not b e as

dire as it m ay s eem, Kaplan added.

And many coronavirus patients

can be adequately treated with

older models of ventilators or less

invasive modes of respiratory

he lp, he said.

Medtronic, G E Healthcare, Bec-

ton Dickinson and Philips are

among the largest producers of

ventilators for the global market.

Several large manufacturers said

they are increasing manufactur-

ing of medical supplies, including

ventilators, but would not provide

specific n umbers.

“We are taking steps to increase

our manufacturing capacity and

output of equipment that is impor-

tant in the diagnosis and treat-

ment of covid-19 patients,” a

spokeswoman for GE Healthcare

said in a statement.

Competition for supply could

become an issue. With Europe’s

governments placing massive or-

ders, manufacturers also could

face delays in obtaining spare

pa rts because of supply-chain dis-

ruptions.

“A lot of these components for

these ventilators are coming from

other countries overseas, and

some of the parts they need are

creating a little bit of a backlog,”

said Timothy R. Myers, chief busi-

ness officer f or the American Asso-

ciation for Respiratory Care,

which represents health-care

workers who specialize in ventila-

tor t reatment.

Anthony S. Fauci, director of the

National Institute of Allergy and

Infectious Diseases, confirmed

Sunday the federal government’s

emergency stockpile of medical

supplies contains nearly 13, 000

ventilators. To access those, hospi-

tals are required to ask their state

and local governments, which

th en a sk the federal g overnment to

release supplies.

Secretary of Health and Human

Services A lex Azar said Sunday a t a

news briefing at the White House

that the government has barely

heard from states about tapping

the s tockpile.

“We have received, so far, only, I

think, one request for just several

ventilators,” he said. In contrast to

Fauci’s disclosure that the stock-

pile contains nearly 13,000, Azar

said the number w as not disclosed

for national security reasons.

Foster, of the American Hospi-

tal Association, said requests to

obtain v entilators f rom the S trate-

gic National Stockpile have not

begun because the locations of po-

tential shortfalls are not yet

known.

“It is a wait-until-it’s-needed sit-

uation,” she said. “We don’t know

which communities are going to

be hard hit a t any given time.”

[email protected]

Erin Cox contributed to this report.

More lifesaving ventilators are available, but hospitals can’t a≠ord them

ARND WIEGMANN/REUTERS

Ventilators, which cost $25,000 to $50,000 per machine, are considered critical to America’s effort to

contain the worst effects of the coronavirus pandemic and avoid a crisis like the one Italy is facing.

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