Federal officials repeatedly warned that US hospitals lacked enough ventilators

Drums of warnings undermine President Donald Trump's claim last week "nobody in their wildest dreams" could have imagined the demand for respirators that now exist. Demand is pushing hospitals to the brink of New York City and threatening to do so in parts of the state of Washington, California, Louisiana and beyond.
In addition, a 2017 study funded by the National Institute of Health and the Centers for Disease Control and Prevention found that "there is significant concern that intensive care units (ICUs) may have insufficient resources to treat all people in need of ventilator support" and that even supplies are kept in the so-called Strategic National Stockpile "may not be sufficient to meet the demand during a serious public health crisis."
But federal agencies emphasized the risk of inadequate ventilator and other equipment as far back as President George W. Bush's administration. In July 2003, a report from the State Responsibility Office noted that "few hospitals reported having the equipment and supplies needed to deal with an outbreak of infectious disease on a large scale. Half of the hospitals we examined had, for every 100 staffed beds, fewer than 6 ventilators, 3 or fewer personal suits for personal use protective equipment and fewer than 4 insulation beds. "

Many more reports that pointed to the lack of fans followed, some in response to outbreaks such as bird flu or SARS:

  • ONE May 2003 GAO Report found that "few hospitals have adequate medical equipment, such as the ventilators often needed for respiratory tract infections … to deal with the large increases in the number of patients that may result" from an infectious disease outbreak.
  • A November 2005 Congressional Research Service report warned of a possible H5N1 bird flu pandemic: "If this load were to start a pandemic … a large number of victims may require intensive care and ventilation support, likely to exceed the national capacity to provide this level of care."
  • That same month, the Department of Health and Human Services published a Pandemic influenza plan, who said: "Despite planning and preparedness, however, a severe pandemic may cause deficiencies, such as mechanical respirators, and medical care standards may need to be adjusted to provide care and rescue as much as possible. as many lives as possible. "
  • A July 2006 report of the Congressional Budget Office sent to Senate leaders stated: "The CBO's December assessment noted that the United States has about 100,000 fans, with three-quarters of them in use on any given day. According to HHS, a severe flu pandemic like that in 1918 would require 750,000 respirators to treat victims. "
  • Ministry of Defense in August 2006 Pandemic influenza implementation plan: "There is likely to be significant demand for respirators, especially in the event of a pandemic before a vaccine is available. Where possible, storage should be taken into account rather than just-in-time procurement of sufficient numbers of respirators. , antiviral medicines, and other medical devices including personal protective equipment (PPE).
  • In November 2007, an interior department influenza pandemic plan stated: "The health care system is likely to be overwhelmed, creating a shortage of hospital staff, beds, ventilators and other supplies.
  • And 2009 Occupation Environmental Publication noted: "Health services can be overwhelmed, creating a shortage of hospital staff, beds, ventilators and other supplies.
  • An August 2009 report from the executive office to the president related to preparing for an H1N1 outbreak said: "During the summit, 1 or 2 in every 2,000 Americans may be hospitalized. Cases requiring mechanical ventilation or intensive care can reach 10 to 25 per 100,000 population, requiring 50 to 100 percent or more of the total ICU capacity available in the United States and places a great deal of stress on a system that normally operates at 80 percent of capacity. "
  • And 2015 study by researchers from the Department of Health and Human Services and the Center for Disease Control and Prevention modeled the need for ventilators during a flu outbreak, calculating that "an additional 7,000 to 11,000 respirators will be needed, averting a total pandemic of 35,000 to 55,000 deaths. % car [clinical attack rate], with a high severity scenario, will need approx. 35,000 to 60,500 additional fans, and avert a total pandemic from 178,000 to 308,000 deaths. "

"There has always been a concern about an airway disease, easily transmitted, appears to be an infectious disease," said Marcia Crosse, who worked at GAO from 1983 to 2018, most recently as director of health care.

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Frontline health professionals feel like & # 39; lamb to the slaughterhouse & # 39;

During global outbreaks of H1N1, SARS and MERS, Crosse said, "we avoided the bullet time and time again."

"But the CDC has been well aware, HHS has been well aware, the intelligence community has been well aware" of the risk, she added. "Of course no one knew the specifics, we didn't know it would be a coronavirus from China, but the threat of an airway disease was known."

On Tuesday, Prime Minister Andrew Cuomo predicted New York would need another 30,000 fans to effectively combat the pandemic. The Federal Emergency Management Agency has sent 4,000 fans so far, Cuomo so Wednesday, adding that the state has purchased another 7,000 and is looking to buy more. On Friday, he confirmed that the state is now almost halfway to the number he expects it to need.

On Thursday night, in an interview with Fox News & # 39; Sean Hannity, Trump again minimized the urgent need for additional medical equipment, saying "I don't think you need 40,000 or 30,000 ventilators. You go to big hospitals sometimes, and they want two respirators and all of a sudden they say, & # 39; Can we order 30,000 respirators? & # 39;

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Ventilators usually cost at least $ 15,000, and although any major hospital will have more than two, they have historically kept on hand just what it takes to serve patients in conditions outside of a pandemic.

Car manufacturers are running to make fans. But it's not that easy

Dr. Steven Choi, head of quality management for the Yale School of Medicine and the Yale New Haven Health system, said that diseases like coronavirus put unusual pressure on respiratory resources.

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"However, people need to understand that a typical adult patient usually stays in the ICU for only three to four days," he said. "What we see with Covid-19 patients in Asia, Italy and the US is that when patients end up getting sick enough to be admitted to the ICU, they need to be intubated and stay on a ventilator for two to three weeks, which dramatically increases the requirements for ICU beds and fans. "

Large companies, including Ford and General Motors, are working quickly to produce additional fans. On Friday, Ventec Life Systems and General Motors announced a partnership that is expected to produce more than 10,000 respirators per month starting in April.

CNN's Curt Devine contributed to this report.

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