I am part of a team that saves lives on a daily basis. I’m an intensive care doctor who marshals years of training and a brilliant group of nurses, nurse practitioners, physician assistants, respiratory therapists, and others to bring people back from the brink of death after car accidents, heart attacks, strokes, and now, COVID-19.
Skilled as we are, we still need vital medical technology like mechanical ventilators that quite literally breathe life into people who cannot breathe for themselves.
Tragically, at the time when we need them most, we soon won't have enough ventilators.
There has been substantial media coverage about the ventilator shortage that our country faces. The Society of Critical Care Medicine estimates that in a best-case scenario, we have about 200,000 ventilators in the United States. That includes traditional mechanical ventilators and other devices like anesthesia machines that can be repurposed to work as ventilators. We believe that as many as 900,000 to one million Americans will need this support — that’s five times what we have.
This means that people whom we know how to save will die. It means that my colleagues and I — and our counterparts everywhere — will be forced to decide who will live and who will die.
This is happening now in Italy, where smart, capable medical minds have to make cold calculations regarding age, medical history, and illness severity before placing a patient on a precious respirator.
Can we avoid this terrible situation?
Probably not entirely, given the rapid upswing in COVID-19 hospital admissions that we are seeing. However, there are at least three steps that we — as a society, not just the medical community — can take to give everyone who falls to this virus the best chance.
First, we need to slow the spread of this virus. That is why we are effectively on a societal lockdown, why schools and nonessential businesses are closed. This is what is meant by “flattening the curve.” If we can decrease the number of people who need a ventilator at any one time, we have a fighting chance of saving more seriously ill people.
Every person who does not truly need to be out, interacting with other people, needs to stay home, even if you feel well, even if you are at low risk.
This is not a drill. This is not an overreaction.
Second, we need more ventilators. Thankfully, ventilator manufacturers and other companies that can adapt their production lines are working on this, but it takes time (see point No. 1). Ventilators are complicated, about as complicated as a modern car. Think about asking a refrigerator company to start making cars and you get the idea.
We are already working with children’s hospitals (as children are at low risk for virus complications) and veterinary hospitals (since pets don’t get it at all) to use their equipment, so now what we need is an infusion of additional stock.
Third, we need people to start having difficult conversations about what life support they would want if they become gravely ill. If you know that you would never want to be on a breathing machine, tell someone now. Better yet, put it in writing and give copies to your physician and your entire family.
Not everyone — especially those who are already medically fragile — want ventilator support because once it is started, they may never come off of it.
Making your wishes known will make the decision easier for loved ones, and will give another person a chance at life. These discussions are never easy but have never been so important for the health of our communities.
I have nerves of steel. I have plunged a scalpel into someone’s neck to create an airway when they couldn’t breathe. I have performed CPR more times than I can count. I have told countless families that their loved ones would not make it because their organs failed beyond the point of recovery.
I have never told someone that they would die because I didn't have enough equipment.
But that is what we are facing. That — more than the shortage of masks, gowns, and other protective equipment we need to keep us healthy and able to save patients — is what catches my breath.
Your health-care providers now need you to take care of us. Please do your part to forestall this catastrophe. Start with staying home.