Coronavirus could make millions sick in the US but hospitals have fewer than 100,000 ventilators
According to estimates available from a 2010 study, only 62,188 full-feature mechanical ventilators were available in US acute care hospitals
An estimated 160 million to 214 million people in the US could be infected in the COVID-19 pandemic, according to a worst-case scenario projection made by the US Centers for Disease Control and Prevention (CDC). But the US has around 924,107 staffed beds in all hospitals, and an estimated 100,000 ventilators, or even less.
A ventilator is a machine that supports breathing. As COVID-19 is a respiratory illness, it is needed to help seriously ill patients breathe.
But today, as the US deals with a new respiratory infection caused by the novel coronavirus, the country does not have the required ventilators. According to estimates available from a 2010 study, only 62,188 full-feature mechanical ventilators were available in US acute care hospitals.
Over 10,000 ventilators are stored in the Strategic National Stockpile, a federal cache of supplies and medicines held in case of emergencies, according to Dr Thomas R Frieden, a former director of the Centers for Disease Control and Prevention, reports a New York Times article.
It adds, “Tens of thousands of other respiratory devices could be repurposed in an emergency, say experts, but the shortfall could be stark, potentially forcing doctors to make excruciating life-or-death decisions about who would get such help should hospitals become flooded with the desperately sick.”
Why are these numbers critical?
“The calculations based on the CDC’s scenarios suggested, 2.4 million to 21 million people in the US could require hospitalization, potentially crushing the nation’s medical system,” reports the New York Times.
The US has official planning assumptions for pandemic influenza, ranging from a moderate pandemic like 1968 or 1957 to one based on a very severe pandemic like 1918. And even these numbers should have acted as a wake-up call.
The report by the US Department of Health and Human Services (HHS) estimates that a severe influenza pandemic would require mechanical ventilators for 740,000 critically ill people. In a moderate pandemic-like situation, 64,875 ventilators will be needed.
The estimates are based on extrapolation from past pandemics in the US. “The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios. Because the virulence of the influenza virus that causes the next pandemic cannot be predicted, two scenarios are presented based on extrapolation of past pandemic experience,” says the report.
According to projections made in the November 2005 study by HHS, titled Pandemic Influenza Plan, in a severe pandemic, 90 million Americans could fall sick, 9,900,000 will need hospitalization, 45 million will need outpatient medical care, 1,485,000 will need ICU care, and there could be 1,903,000 deaths. In a moderate pandemic, 90 million could fall sick, 45 million will need outpatient medical care, 865,000 will need to be hospitalized, 128,750 will need ICU care, and 209,000 could die.
The worry about shortages of medical equipment is not unjustified. During the start of the COVID-19 outbreak in China, the latter had to build new hospitals to treat coronavirus patients. Italy is reportedly facing a massive shortage. An Atlantic report says that “doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.”
A March 14 Reuters article says, “Germany and Italy spearheaded a national scramble for ventilators as manufacturers warned on Friday that hospitals everywhere face a lack of vital equipment needed to treat coronavirus patients.”
So far, over 4,660 cases have been reported in the US, and 85 have died. However, it is not yet clear how much community transmission has happened in the US and how many people have been infected so far. Experts have already warned that if a Wuhan-like outbreak were to happen in an American city, US hospitals would be too overwhelmed to handle the crisis. On any given day, the occupancy rate of hospital beds in the US is about 65.5%, shows an estimate by the CDC.
Dan Hanfling, vice president of the technical staff at In-Q-Tel, a nonprofit technology development organization that grew out of the CIA, told FiveThirtyEight that one does not know how many ventilators there are in the US currently.
“The best estimate available comes from a 2010 survey that estimated the number of full-function ventilators in the country at around 62,000. In addition to that, Hanfling said, more machines are held in reserve in the Strategic National Stockpile — a collection of secret warehouses that contain supplies meant to help the country cope with a biological weapon attack, nuclear bombing or other localized large-scale emergency,” says the report. It adds, “Hanfling’s best guess: We’ve got about 100,000 ventilators. For the whole country.”
'Health systems will be overburdened'
Andy Slavitt, former Medicare, Medicaid, and Affordable Care Act head for Barack Obama, had recently said that hospitals and cities in the US could be overrun with COVID-19 cases by March 23.
While it is hard to get the exact numbers, another expert gave an idea of how bad the situation can be and how overburdened the healthcare systems are.
John Hick, medical director for emergency preparedness at Hennepin Healthcare in Minneapolis told FiveThirtyEight that they have been running with less than 5% of their intensive care unit beds available throughout winter. “Last Tuesday, across 32 hospitals, we had 21 beds available. And that’s with no COVID at all,” he said.
According to Dr Eric Toner, and Dr Richard Waldhorn, experts at the John Hopkins Center, there are about 46,500 medical ICU beds in the US and perhaps an equal number of other ICU beds that could be used in a crisis. “Even spread out over several months, the mismatch between demand and resources is clear,” they said in an analysis.
And not just hospital beds or ventilators, there will be a huge demand for medical staff too. The experts say that the impact of a COVID-19 pandemic on hospitals is expected to be severe in the best of circumstances. “Currently, US hospitals routinely operate at or near full capacity and have limited ability to rapidly increase services. There are currently shortages of healthcare workers of all kinds. Emergency departments are overcrowded and often have to divert patients to other hospitals,” says the John Hopkins team.
The experts say that in recent years, there has been a reduction in the overall number of hospitals, hospital beds, and emergency rooms. During a pandemic, the healthcare workforce would also be greatly reduced.
“Healthcare workers would face a high risk of infection because of contact with infected patients; many would need to stay home to care for sick relatives, and, in the absence of a vaccine, others might fear coming to work lest they bring a lethal infection home to their families. The provision of medical services to both COVID-19 and non-COVID-19 patients may be adversely affected in most communities,” they add.