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Amid Desperate Need for Ventilators, Calls Grow for Federal Intervention Amid Desperate Need for Ventilators, Calls Grow for Federal Intervention
(32 minutes later)
As hospitals prepare for a flood of desperately ill patients unable to breathe on their own, mechanical ventilators have become the single most important piece of equipment that can mean the difference between life and death.As hospitals prepare for a flood of desperately ill patients unable to breathe on their own, mechanical ventilators have become the single most important piece of equipment that can mean the difference between life and death.
Now, with American hospitals facing a grave shortage of the vital devices, the Big Three automakers, small engineering firms, software designers and medical equipment manufacturers are rushing to figure out ways to produce more of them. But President Trump has so far declined to use powers that public health experts say could make a real difference in getting more ventilators to places that need them the most — right now.Now, with American hospitals facing a grave shortage of the vital devices, the Big Three automakers, small engineering firms, software designers and medical equipment manufacturers are rushing to figure out ways to produce more of them. But President Trump has so far declined to use powers that public health experts say could make a real difference in getting more ventilators to places that need them the most — right now.
What is really needed, a number of public health experts and former government officials say, is for Washington to take control of the nation’s existing ventilator supply. Because peak coronavirus infections will hit cities and regions at different times in the coming months, a centralized federal effort could send unused machines to hospitals that need them most.What is really needed, a number of public health experts and former government officials say, is for Washington to take control of the nation’s existing ventilator supply. Because peak coronavirus infections will hit cities and regions at different times in the coming months, a centralized federal effort could send unused machines to hospitals that need them most.
“This is a national crisis,” said Frank Kendall, who served as under secretary of defense for acquisition and logistics in the Obama administration. “In a time of scarcity, you can’t leave it up to companies and governors to manage it themselves.”“This is a national crisis,” said Frank Kendall, who served as under secretary of defense for acquisition and logistics in the Obama administration. “In a time of scarcity, you can’t leave it up to companies and governors to manage it themselves.”
Mr. Kendall said that only the federal government had the authority to take over the allocation of ventilators, both from manufacturers who are in the business of selling devices to the highest bidder, and state leaders unlikely to voluntarily let go of machines they fear they might need in the future.Mr. Kendall said that only the federal government had the authority to take over the allocation of ventilators, both from manufacturers who are in the business of selling devices to the highest bidder, and state leaders unlikely to voluntarily let go of machines they fear they might need in the future.
“As the states become more desperate, someone has to referee the situation,” he said. “The marketplace isn’t set up to do that.”“As the states become more desperate, someone has to referee the situation,” he said. “The marketplace isn’t set up to do that.”
The United States currently has between 160,000 and 200,000 ventilators, but as many as one million patients could need to use one of the machines over the course of the outbreak, according to the Society of Critical Care Medicine. In New York, the epicenter of the outbreak in the U.S., hospitals are already on the verge of running out, Gov. Andrew Cuomo said this week.The United States currently has between 160,000 and 200,000 ventilators, but as many as one million patients could need to use one of the machines over the course of the outbreak, according to the Society of Critical Care Medicine. In New York, the epicenter of the outbreak in the U.S., hospitals are already on the verge of running out, Gov. Andrew Cuomo said this week.
Mr. Trump’s solution has been to push the private sector to voluntarily address the shortage. In a Twitter post on Sunday, he encouraged the big car companies to jump in to help make ventilators, and General Motors and Ford responded with announcements that they would partner with medical device companies to produce the machines.Mr. Trump’s solution has been to push the private sector to voluntarily address the shortage. In a Twitter post on Sunday, he encouraged the big car companies to jump in to help make ventilators, and General Motors and Ford responded with announcements that they would partner with medical device companies to produce the machines.
But military experts say Mr. Trump could also tap the logistical prowess of the Pentagon and the legion of defense contractors primed to quickly solve complex challenges. The federal government could address problems in the global supply chain that are depriving ventilator companies of the components they need to increase production.But military experts say Mr. Trump could also tap the logistical prowess of the Pentagon and the legion of defense contractors primed to quickly solve complex challenges. The federal government could address problems in the global supply chain that are depriving ventilator companies of the components they need to increase production.
Other, quicker options are being explored around the country, including stepping up production of the type of resuscitators used by paramedics and repurposing simpler ventilators used by plastic surgeons and elective surgery centers.Other, quicker options are being explored around the country, including stepping up production of the type of resuscitators used by paramedics and repurposing simpler ventilators used by plastic surgeons and elective surgery centers.
G.M. said this week that it would partner with the ventilator company Ventec Life Systems to produce up to 200,000 machines. Ford said it would help 3M and GE Healthcare increase production of respiratory machines they already make. And Medtronic, one of the world’s largest medical device makers, is in talks with Tesla and other car companies, including General Motors and Ford.G.M. said this week that it would partner with the ventilator company Ventec Life Systems to produce up to 200,000 machines. Ford said it would help 3M and GE Healthcare increase production of respiratory machines they already make. And Medtronic, one of the world’s largest medical device makers, is in talks with Tesla and other car companies, including General Motors and Ford.
“This is not a business model problem,” said Vafa Jamali, a senior vice president at Medtronic. “This is a society problem.”“This is not a business model problem,” said Vafa Jamali, a senior vice president at Medtronic. “This is a society problem.”
But the fruits of these partnerships will not arrive in time to save the thousands of patients who will need the machines in the coming weeks. Ventec’s timetable for increasing production fivefold, for example, is three months.But the fruits of these partnerships will not arrive in time to save the thousands of patients who will need the machines in the coming weeks. Ventec’s timetable for increasing production fivefold, for example, is three months.
Touring a vast convention hall that was to be turned into a makeshift hospital, Mr. Cuomo said on Tuesday that the state needed 30,000 ventilators in the coming weeks — not months — to cope with skyrocketing infections. “I don’t need ventilators in six months,” he said. “And I don’t need ventilators in five months, four months or three months.” After he spoke, Vice President Pence said the federal government would send 4,000 more to New York.Touring a vast convention hall that was to be turned into a makeshift hospital, Mr. Cuomo said on Tuesday that the state needed 30,000 ventilators in the coming weeks — not months — to cope with skyrocketing infections. “I don’t need ventilators in six months,” he said. “And I don’t need ventilators in five months, four months or three months.” After he spoke, Vice President Pence said the federal government would send 4,000 more to New York.
Besides the slow timetable, experts on medical devices questioned the wisdom of bringing in an unrelated industry like the automakers to manufacture a sophisticated medical device.Besides the slow timetable, experts on medical devices questioned the wisdom of bringing in an unrelated industry like the automakers to manufacture a sophisticated medical device.
“It’s not like making a sedan or S.U.V.,” said Dr. Hugh Cassiere, a pulmonologist who sits on a Food and Drug Administration panel for anesthesia and respiratory devices.“It’s not like making a sedan or S.U.V.,” said Dr. Hugh Cassiere, a pulmonologist who sits on a Food and Drug Administration panel for anesthesia and respiratory devices.
“Sounds good as a sound bite, but the practicalities may be very difficult,” added Dr. Cassiere, who is helping oversee care for more than 40 severely ill coronavirus patients on ventilators at North Shore University Hospital on Long Island.“Sounds good as a sound bite, but the practicalities may be very difficult,” added Dr. Cassiere, who is helping oversee care for more than 40 severely ill coronavirus patients on ventilators at North Shore University Hospital on Long Island.
Experts in the field say there are other ways to rapidly boost the ventilator supply for overwhelmed hospitals. Most ventilators are sophisticated machines that keep critically ill people alive by delivering oxygen into the lungs through a tube inserted in the windpipe. Full-feature machines can cost as much as $50,000, but doctors say even basic models that cost less than $2,000 can sustain a patient in acute respiratory distress. The most grievously ill may need to remain on the machines for weeks until they can breathe on their own.Experts in the field say there are other ways to rapidly boost the ventilator supply for overwhelmed hospitals. Most ventilators are sophisticated machines that keep critically ill people alive by delivering oxygen into the lungs through a tube inserted in the windpipe. Full-feature machines can cost as much as $50,000, but doctors say even basic models that cost less than $2,000 can sustain a patient in acute respiratory distress. The most grievously ill may need to remain on the machines for weeks until they can breathe on their own.
There are tens of thousands of no-frills resuscitators used by paramedics and the military. Plastic surgeons and outpatient surgery centers also have ventilators in their offices. With elective procedures indefinitely on hold in much of the country, those machines are now sitting idle.There are tens of thousands of no-frills resuscitators used by paramedics and the military. Plastic surgeons and outpatient surgery centers also have ventilators in their offices. With elective procedures indefinitely on hold in much of the country, those machines are now sitting idle.
“I think it will be faster to throw a couple ventilators on a truck and drive them to a hospital than wait for new ones to arrive,” said Dr. Adam Rubinstein, a plastic surgeon in Miami who has been compiling a list of doctors willing to loan out their ventilators in a pinch. “So far, no one has said no.”“I think it will be faster to throw a couple ventilators on a truck and drive them to a hospital than wait for new ones to arrive,” said Dr. Adam Rubinstein, a plastic surgeon in Miami who has been compiling a list of doctors willing to loan out their ventilators in a pinch. “So far, no one has said no.”
In recent days, mechanical engineers and software designers across the country have been crowdsourcing plans for simple ventilators that could be made with 3-D printers and components readily available at hardware stores. Hospitals have been pulling old machines out of storage and requisitioning ventilators that anesthesiologists use during surgery.In recent days, mechanical engineers and software designers across the country have been crowdsourcing plans for simple ventilators that could be made with 3-D printers and components readily available at hardware stores. Hospitals have been pulling old machines out of storage and requisitioning ventilators that anesthesiologists use during surgery.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Larry Kronick, the president of PMT Partners, a Florida company that sells a simple breathing machine already used by the military and ambulance crews, said he had 1,000 of his Oxylator respirators ready to go, but buyers have been scarce.Larry Kronick, the president of PMT Partners, a Florida company that sells a simple breathing machine already used by the military and ambulance crews, said he had 1,000 of his Oxylator respirators ready to go, but buyers have been scarce.
“I can make 1,000 more, but I need money to buy materials,” he said.“I can make 1,000 more, but I need money to buy materials,” he said.
Eric Honroth, the North America president for Getinge, a Swedish company that makes 10,000 ventilators annually, said he would welcome government intervention to solve supply-chain bottlenecks for components, but that production would be better left to companies with expertise in the field.Eric Honroth, the North America president for Getinge, a Swedish company that makes 10,000 ventilators annually, said he would welcome government intervention to solve supply-chain bottlenecks for components, but that production would be better left to companies with expertise in the field.
“These are complex machines that require complicated technology to keep patients alive,” he said. “I would have some trepidation and reticence about someone else trying to manufacture what we do. It’s not like we’re manufacturing masks.”“These are complex machines that require complicated technology to keep patients alive,” he said. “I would have some trepidation and reticence about someone else trying to manufacture what we do. It’s not like we’re manufacturing masks.”
Then there is the issue of who will run the new devices. Dr. Mahshid Abir, an emergency physician at University of Michigan, said most ventilators require specialized training to operate. With so many health care workers falling ill, there is an additional staffing challenge: patients tethered to breathing machines need to be monitored 24 hours a day. The New England Journal of Medicine estimates that there are only enough respiratory therapists to care for 100,000 patients at one time.Then there is the issue of who will run the new devices. Dr. Mahshid Abir, an emergency physician at University of Michigan, said most ventilators require specialized training to operate. With so many health care workers falling ill, there is an additional staffing challenge: patients tethered to breathing machines need to be monitored 24 hours a day. The New England Journal of Medicine estimates that there are only enough respiratory therapists to care for 100,000 patients at one time.
“You can’t just put someone on it and press start and you’re done with it,” Dr. Abir said. “There’s a lot of adjustments that need to be made, depending on how sick a patient is. Even if we got an indefinite number of ventilators, we don’t have an unlimited number of people to operate them.”“You can’t just put someone on it and press start and you’re done with it,” Dr. Abir said. “There’s a lot of adjustments that need to be made, depending on how sick a patient is. Even if we got an indefinite number of ventilators, we don’t have an unlimited number of people to operate them.”
In the meantime, G.M. and Ventec have been “working around the clock” on plans to make ventilators at a small electronics plant the car company owns in Kokomo, Ind., a G.M. spokesman said in a statement.In the meantime, G.M. and Ventec have been “working around the clock” on plans to make ventilators at a small electronics plant the car company owns in Kokomo, Ind., a G.M. spokesman said in a statement.
Over the weekend, the automaker began reaching out to its network of suppliers to find companies that can produce parts for Ventec’s machines. By Monday morning, G.M. had found sources for more than 90 percent of the required parts, but was still looking for producers who could supply the remaining components, the statement said.Over the weekend, the automaker began reaching out to its network of suppliers to find companies that can produce parts for Ventec’s machines. By Monday morning, G.M. had found sources for more than 90 percent of the required parts, but was still looking for producers who could supply the remaining components, the statement said.
The two companies are trying to work out a deal in which G.M. would essentially serve as a contract manufacturer, according to a person familiar with the discussions who was not authorized to discuss them. While the companies are working as quickly as possible, it could take four or more weeks for production to start, the person saidThe two companies are trying to work out a deal in which G.M. would essentially serve as a contract manufacturer, according to a person familiar with the discussions who was not authorized to discuss them. While the companies are working as quickly as possible, it could take four or more weeks for production to start, the person said
But Dr. James DuCanto, an anesthesiologist in Milwaukee, says relying too heavily on car companies to produce ventilators would be irresponsible. Facing a surge of desperately sick patients, many hospitals have been dusting off triage plans for rationing ventilators that require doctors to make excruciating decisions about which patients would get them if there aren’t enough.But Dr. James DuCanto, an anesthesiologist in Milwaukee, says relying too heavily on car companies to produce ventilators would be irresponsible. Facing a surge of desperately sick patients, many hospitals have been dusting off triage plans for rationing ventilators that require doctors to make excruciating decisions about which patients would get them if there aren’t enough.
Dr. DuCanto often uses the portable Oxylator breathing machine for patients who need short-term breathing assistance and he said they could provide a much faster solution. The machines, which cost $2,000, could be pivotal in sustaining scores of coronavirus patients in a crisis, he said. The only thing they need to function is an oxygen tank.Dr. DuCanto often uses the portable Oxylator breathing machine for patients who need short-term breathing assistance and he said they could provide a much faster solution. The machines, which cost $2,000, could be pivotal in sustaining scores of coronavirus patients in a crisis, he said. The only thing they need to function is an oxygen tank.
“These things absolutely save lives,” he said.“These things absolutely save lives,” he said.
The devices are so simple, he said, that machine shops across the country could be enlisted to produce the components.The devices are so simple, he said, that machine shops across the country could be enlisted to produce the components.
“It would be easy peasy to make them,” he said. “During a national crisis, there’s no need to reinvent the wheel.”“It would be easy peasy to make them,” he said. “During a national crisis, there’s no need to reinvent the wheel.”
Sarah Kliff contributed reporting.Sarah Kliff contributed reporting.