Inadequate leadership and a deeply troubling absence of crucial information concerning the coronavirus has resulted in a strange, haphazard ventilator dilemma. While some hospitals are overrun with worsening patients, pleading for essential medical supplies, others are largely business as usual, unsure when, or if, the coronavirus will spread among their nearby population. As a result, nobody seems to know exactly how many ventilators — which have been keeping some coronavirus patients alive — are actually needed as we continue to battle this pandemic, and whether or not we’re facing a serious ventilator shortage.
Currently, there are roughly 173,000 ventilators sprinkled across the U.S., but a preliminary study from Harvard Medical School anticipates that 31 times as many patients could end up needing one over the course of the coronavirus outbreak. Preparing for the worst, some states have already established guidelines for which persons would secure access to ventilators if there were a shortage — or rather, which persons would secure basic, lifesaving treatment (many of these guidelines claim likeliness of survival to be a key factor in making such decisions, as opposed to socioeconomic status — however, Rihanna was somehow able to get a personal ventilator for her father, who’s since recovered from the coronavirus). Other states have been either sending out or receiving ventilators, depending on their local situation.
As disorderly as it may sound, many states have been bidding against one another, even competing with the federal government in some cases, for ventilators from private manufacturers. Apparently, the federal government just purchased tens of thousands more ventilators — shortly after invoking the Defense Production Act to facilitate the rapid production of ventilators by large American manufacturing plants — but they could take weeks or even months to be dispersed, a timeline that some suggest is too slow.
Thus, some individuals, mostly doctors, are taking matters into their own hands, constructing makeshift ventilators with garden hoses, lamp timers, electronic valves and even plumbing supplies, or retrofitting sleep apnea machines with tape and farm wire. While that may sound like the opposite of adequate, professional medical equipment, these ventilators could end up saving lives.
As pulmonary and critical care physician Cedric “Jamie” Rutland explains, on an extremely basic level, ventilators essentially breathe for you, and he says many of these make-do ventilators are capable of accomplishing that. However, perhaps needless to say, Rutland much prefers authentic ventilators, which provide information on the mechanics and physiology of your lungs, leading to better care down the road. “I have a patient of mine who’s a mechanical engineer — a very, very smart man — and he developed one of these small ventilators,” Rutland says. “Looking at the pictures, the renderings he showed me, I’m not going to be able to get most of the information I want from it.”
While that might sound problematic, when it comes to simply keeping someone alive and breathing, hey, whatever works — even an upgraded garden hose. “If the ventilators we use now are Lamborghinis, the ventilators they’re selling are probably Honda Civics,” Rutland explains. “They don’t have all the bells and whistles, but when you think about a crisis situation, the Honda Civic DX still gets you from A to B. When I was in college and drove that car, it still got me to the club, it still got me to In-N-Out — whatever.”
Or as emergency room physician Lorenzo Paladino more pessimistically told CBS News about slapdash ventilators, “I compare it to a life jacket on an airplane. It’s not a substitute for the airplane. And if you’re wearing it, then you’re in a disaster and it’s dire. The life jacket is merely to keep you alive until you are rescued.”
Nonetheless, while the sentiment behind these makeshift ventilators is welcomed — and while we can never be too prepared — as Rutland explains, “The question right now is actually, are they necessary? California has done an excellent job with flattening the curve, and I haven’t seen the surge in my hospital that I expected to see.”
Again, though, an overarching lack of leadership and pertinent information has left people unsure about how to respond, and unsure about what they may or may not need in the coming months.
Furthermore, many doctors have begun pushing back against the perhaps heavy-handed use of ventilators because an overwhelming number of patients put on them — 80 percent or more — have subsequently died. Doctors also warn that being put on a ventilator can result in lasting lung problems. “It’s not the presence of the virus that’s the pathology here,” Rutland explains. “It’s the response that the immune system creates because of the virus being in the lungs. That’s the issue. When you have an immune response that’s so profound that, instead of your lungs being full of air, they’re full of white blood cells to where you can’t gas exchange any longer, that creates a problem. Your oxygen level goes down. Now, when you put someone on positive-pressure ventilation, that stimulates the lungs, but it increases the inflammatory response as well. So, sometimes, you put somebody on positive-pressure ventilation and give them a lot of pressure, and it can make them worse.”
Under normal circumstances, this kind of thing can be avoided, but the coronavirus itself and the strain that a pandemic puts on our health-care system has posed some extra challenges. “When you’re not used to being a pulmonary critical care doctor and seeing these ill, ill patients, you end up doing things that maybe you shouldn’t,” Rutland explains. “You end up intubating people maybe earlier than you should.” He emphasizes the importance of using ventilators as a last resort — when a patient is on the verge of not breathing — but as hospitals flood with people, doctors and nurses are facing unprecedented choices, and some are perhaps acting too quickly. “When you have people that don’t do this every day, you’re going to get patients on the ventilators early, and you’re going to get some injuries,” Rutland says.
Coronavirus survivor David Lat was put on a ventilator, and as he explains in a piece for the Washington Post, his lungs may never be the same: “For me, my lungs must rebuild their capacity. I experience breathlessness from even mild exertion. I used to run marathons; now I can’t walk across a room or up a flight of stairs without getting winded. I can’t go around the block for fresh air unless my husband pushes me in a wheelchair. When I shower, I can’t stand the entire time; I take breaks from standing to sit down on a plastic stool I have placed inside my bathtub.”
Absolutely none of this is to say that ventilators are bad. Under normal circumstances, ventilators are almost always a last resort, so people dying on them should be no surprise. If anyone were given the choice between not breathing at all and breathing, but maybe having lasting damage, surely most would choose the latter, which is why, even if New York hospitalizations are falling and California is successfully flattening the curve, the very notion that doctors could need to slap together ventilators is yet another example of how America was and still is utterly unprepared for this pandemic.
For three years, Trump and his administration have been slashing funding for public health and infectious disease programs. As a direct result, if we do indeed end up needing more ventilators, a whole lot of people in the supposedly highly developed U.S. could have to settle for having some garden hose contraption that their doctor DIY’d between patients shoved into their lungs, rather than a real, sophisticated piece of medical equipment.
Oh, but first, this is America, so be sure to check that your health insurance covers saving your life during a pandemic — surprise: some don’t — before they even do that.