Choosing who lives and who dies.
You wouldn’t think nurses and doctors in the world’s most developed nation would be forced to make these kinds of decisions.
But in some of the hardest-hit states and cities in America, medics are preparing themselves to effectively play God with people’s lives as the number of coronavirus cases races towards a peak.
That’s because the country is rapidly running out of ventilators needed to give critically ill patients with COVID-19 the last chance at life.
It might sound like a simple fix for the Government: just ramp up the manufacturing sector or order the military into gear. But it’s not that straightforward.
Ventilators aren’t the only critical commodity in short supply needed to fight this war.
How the country found itself in this unenviable position dates back more than a decade — with the problem, still unresolved, being shouldered by the Bush, Obama and Trump administrations.
So, let’s start at the beginning.
Doesn’t America have a giant stockpile?
Yes, it does.
In 1999, the US Government launched what’s called the Strategic National Stockpile, which was created to prepare for an unusual, unprecedented national threat like a chemical, nuclear or biological attack.
It has since been expanded to also include an arsenal to fight a pandemic.
Over the past two decades, critical medical supplies — including life-saving equipment and medicines — have been stockpiled in strategically placed, undisclosed warehouses across the country.
But the supplies are only designed to act as a short-term, stop-gap buffer — to help respond to a sudden surge in demand — but it can’t replace a supply chain. Nor will it ever be able to.
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Take masks for example. The stockpile holds around 30 million simple surgical masks and about half that again of the more protective N95 masks.
Modelling predicts around 10 times that number — roughly 300 million — would be needed each month to deal with a full-scale pandemic influenza.
Given health officials have already started dipping into the reserve to help the country’s besieged hospitals, which are rapidly running out of critical supplies as coronavirus cases and deaths surge, it is unlikely to last long if the pandemic were to get worse.
So, why is America running out of ventilators?
This is where things get complicated.
The stockpile has around 12,700 ventilators. The US Government has refurbished a further 4,000.
As it stands, there are around 150,000 ventilators peppered through the nation’s hospitals. Health officials have estimated close to a million would be needed during the course of this outbreak.
That’s around five times the number currently circulating around the country.
The ventilator stockpile shortfall was first identified 13 years ago when public health officials warned it was the medical system’s key vulnerability. But they are expensive and bulky, making them difficult to transport.
So, in 2009, a medical taskforce issued a contract to build a large fleet of a new, lightweight version of the device that was cheaper and easy to rapidly deploy during a pandemic.
A small Californian-based company won the tender, which promised to build the machines for about $4,700 ($US3,000) each but the company was then bought out by a multi-billion-dollar firm.
After the take-over, the contract fell over because the new owner argued the product couldn’t be delivered for that price while maintaining the standards required.
The project produced zero ventilators, forcing the Government to restart the process with another company in 2014. Its design was approved last year, but its products are yet to make it to market.
Can’t Trump just fire up the military?
While US President Donald Trump does have war-time powers at his disposal, it’s not that easy.
Ventilators are complex machines and can’t afford to malfunction. If it stops working, a person stops breathing.
They have hundreds of parts, which must be manufactured and assembled exactly to the millimetre by highly skilled engineers.
Being even 1,000th of an inch out could be the difference between life and death for a patient. So, that more or less rules out the military.
What about using the manufacturing sector?
Mr Trump has enacted the Defence Production Act (DPA), which allows him to take control of the civilian economy and force factories to manufacture products needed for national defence.
He was initially hesitant to use it, preferring to instead, in his words, let the supply chain work and the threat of it being used as enough to spark the manufacturing sector into gear.
As it stands now, General Motors and Ford both committed to making the machines. But it takes time to convert a car assembly line into one that makes ventilators, let alone, train staff on how to make medical supplies.
@realDonaldTrump General Motors MUST immediately open their stupidly abandoned Lordstown plant in Ohio, or some other plant, and START MAKING VENTILATORS, NOW!!!!!!
At Ford’s Detroit manufacturing plant, workers took apart a ventilator and 3D scanned each of the roughly 300 parts, creating computer simulations of how the device could be assembled.
Workers are being trained and parts obtained, with hopes to have its first prototype ready within days.
But time is not on their side. The bulk of their devices are likely to come online in May, after the peak load of cases — expected to come mid-April.
So, the bottom line is retooling a factory and training a workforce to make a highly complex machine takes time.
Your questions on coronavirus answered:
Hang-on, aren’t there companies that already make ventilators?
Yes, there are companies which exist solely to produce ventilators. But ramping up overnight is not so straightforward, particularly during a pandemic.
Companies like Seattle-based Ventec are adding shifts and bringing in more workers.
But doing this at a time when the Government is telling employees to stay home throws up its own challenges.
It means factory workers needs protective equipment while on the job, they need to be temperature-checked on their way into the workshop and they need to be physically distanced.
Basically, it means it is really difficult to start making the hundreds of thousands of machines needed overnight.
What the experts are saying about coronavirus:
What does this mean for hospitals?
They have to innovate, find new ways of doing things and when all options are exhausted, they have to choose who gets the ventilator and who doesn’t.
This decision for a healthcare worker, who spends their entire career focused on saving lives, is difficult to swallow.
They are looking for their own alternatives — by testing out whether multiple patients can be ventilated at the same time, re-tooling anaesthetic devices and even considering CPAP machines, used to keep sleep apnoea patients breathing through the night.
Patients can also be manually ventilated using a bag valve mask but this is a time-consuming and tiring activity for already-understaffed and overworked hospitals.
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