New York coronavirus patients may have to share ventilators
- Ventilators are a critical care tool for patients with severe cases of COVID-19, who may have trouble breathing on their own.
- Ventilators are in such short supply in New York that the governor has proposed using "one ventilator for two patients."
- Dr. Nicholas Hill, the chief of pulmonary and critical care at Tufts University School of Medicine, called it a "desperate, desperate measure," and said focusing on manufacturing and distributing more ventilators is a better bet for saving more lives.
- It's risky for patients to share breathing devices since people need to be of similar lung capacity and general size in order for the machines to treat them both well at the same time.
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New York doesn't have enough breathing machines.
"We've procured about 7,000 ventilators," New York Governor Andrew Cuomo said on Tuesday. "We need at a minimum, an additional 30,000 ventilators."
His state is shouldering by far the largest number of confirmed coronavirus cases in the nation: more than 25,660. Washington, the state with the second highest number of confirmed cases, has logged about 2,200 cases.
So far, New York has enough ventilators to meet its needs for coronavirus patients, but that could soon change. Fewer than 800 coronavirus patients in New York state are currently on respirators, Cuomo said, the machines that help blow oxygen into the lungs, assisting a person's normal breathing. But things are expected to get much worse within the next two months.
"New York is the canary in the coal mine," Cuomo said.
New York estimates more and more people in the state will get sick in the coming days and weeks - with an "apex" of illness projected to stretch as high as 140,000 cases within 60 days. The state's health authorities are already growing desperate for new ways they might treat critical patients down the line.
"We're going so far as to trying an experimental procedure where we split the ventilator, we use one ventilator for two patients," Cuomo said on Tuesday. "It's difficult to perform, it's experimental, but at this point we have no alternatives, so we're working on this experimental application. Picture two hospital beds, two people in beds, one ventilator between the two of them, but with two sets of tubes, two sets of pipes, going to the two patients."
Hours later, New York State Health Commissioner Howard Zucker confirmed the ventilator-sharing strategy is being discussed in the state, though it hasn't been trialed just yet.
"I'm not saying we're going to do this for sure, but we have to be prepared," Zucker said during an online health forum Tuesday with the Wall Street Journal. "We are not in normal circumstances. So we are looking at things in a creative way."
Dr. Nicholas Hill, who is the chief of pulmonary and critical care at Tufts University School of Medicine, told Business Insider that kind of ventilator-splitting strategy probably hasn't been used in about a hundred years.
"During the polio epidemics," Hill said, young patients shared iron lungs. "They would put, sometimes six or eight -mainly children - they'd line them up, stack them up in rows and columns."
'A desperate, desperate measure'
"It sounds like a cool idea," Hill said of the ventilator sharing strategy being floated in New York. "But I'm not aware that anybody's actually done it on any patients yet. And it would be a desperate, desperate measure."
Zucker, too, cautioned that it's risky for people to share their breathing devices, since people need to be of similar lung capacity and general size in order for the machines to treat them both well at the same time.
"If we could match four pretty much identical people, that would make it a lot easier," Hill said. "But I don't really know four identical people."
Doctors at Hill's hospital in Boston, where none of the coronavirus patients require ventilators yet, experimented with adding extra hookups to one of their roughly 140 breathing machines on Tuesday, trying out the splitting idea on artificial lungs, but said "they kept coming apart."
"If you made it easier to ventilate one lung, it took away or from another lung," he said. "It would be very time consuming to assemble, to manage, to have interpretable alarms, to monitor adequately. It would still be a demand, and maybe even a greater demand on support staff, nurses, respiratory therapists, it would take a lot of their time."
Hill said a better strategy would be for ventilator companies to make more ventilators.
Ventilator companies, instead, should make more supplies, Hill said.
"It doesn't make any sense to have Ford figure out how to make ventilators on the same assembly line that they've been making Rangers," he said.
Instead, ventilator makers themselves should be pumping out more machines, potentially, with some help from other manufacturing companies, in partnerships like the one which GM has provided. "That's where we need to put our time and resources, to make the machines that would do the job."
Part of the issue with ventilators, Hill said, is that the US healthcare system is designed to have very little "slack" in it, which means there are no extra machines to go around right now.
"Hospitals lose money unless they keep their beds full and they turn them over as quickly as they can," he said.
New York City Mayor Bill de Blasio said Tuesday afternoon that the federal government has promised to ship an additional 4,000 ventilators to New York. Half of those ventilators are headed to New York City, where more than 2,800 people have been hospitalised with the novel coronavirus.
"We may be in a situation where we just have to give someone who's salvageable a chance," Hill said, explaining that rationing might happen. "Someone who we think is unsalvageable, we'd have to keep them comfortable and do the best we can without ventilation support."
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