As a public service, The Inquirer is making this article and other critical public health and safety coverage of the coronavirus available to all readers.

Health officials have worried for weeks that Pennsylvania and New Jersey won’t have enough ventilators to try to save the most critically ill COVID-19 patients.

But the situation is worse than anticipated. Instead of at least 3,000 ventilators, Pennsylvania only has 2,000, state Health Department officials said this week. The state could need three times as many at the apex of the virus’ spread, according to a study from the Harvard Global Health Institute.

And in New Jersey, which already is seeing a crush of cases, there are just 1,700, less than half of what could be needed, according to the same study.

Medical experts estimate that people who require the sophisticated machines to breathe could need the treatment for an average of 12 days. Some would need to be on a ventilator for weeks.

About half of all patients who require intensive care will likely need a ventilator to survive, health experts said. The Harvard study estimated that if 40% of a population is infected over the course of six months, about 80% of people under age 65, and 71% of those over that age, will recover without hospitalization, but about 12,300 Pennsylvanians and 8,300 Garden Staters, at peak times during that six-month period, will require ICU treatment.

Pennsylvania’s tally is “a concerningly low number,” said Jeremy M. Kahn, professor of critical care medicine and health policy and management at the University of Pittsburgh. “It’s a frighteningly low number.”

Kahn and public health students have tried to simulate the expected surge of cases in April to predict how the state’s hospitals will bear up. The model assumed 3,000 to 3,500 machines, roughly one for every ICU bed in the state, Kahn said.

A ventilator pumps pure oxygen into lungs so inflamed by the virus that they cannot function otherwise.

“The problem with viral pneumonia is, there’s so much inflammation in the lung that oxygen cannot diffuse into the blood,” Kahn said. “With a ventilator we can give 100% oxygen.”

This improves the transfer of oxygen into the blood and, because the machine is pumping air into a person’s body, gives it a break from the stress of breathing. Just the work of breathing alone can exhaust a COVID-19 patient, Kahn said. The ventilators don’t guarantee survival and introduce health risks of their own, including infection. About half of people who require a ventilator die, Kahn said.

Health officials from both states acknowledged an inadequate supply of the equipment. New Jersey also has more ICU beds than ventilators, Health Commissioner Judith Persichilli said Monday.

“We do believe ... there should be a one-to-one ratio of ventilator to critical-care bed,” Persichilli said Monday afternoon. “So looking at our full inventory and our number of beds, we have a deficit of about 300.”

The state has asked the federal Department of Health and Human Services (HHS) for 400 ventilators. But even if that happens, New Jersey would only cover the existing ICU beds without factoring in the still-to-come surge.

Pennsylvania is also working to procure more ventilators, said Rachel Levine, state health secretary, and is seeking companies that could sell ventilators or other needed supplies, like masks.

“Many manufacturers have called that they might be able to make these masks or sell ventilators,” Levine said Tuesday.

The state does not have an official count of how many ventilators may be needed, a Department of Health spokesperson said Tuesday.

A number of Pennsylvania and New Jersey counties, contacted for local ventilator counts, said they did not know that number and recommended calling local health systems.

New Jersey had 3,675 coronavirus cases and Pennsylvania 851 as of Tuesday night.

New Jersey’s count is the second highest of any state. Pennsylvania’s rate is growing exponentially, Levine said. The Philadelphia and Pittsburgh areas are hardest hit.

The ventilator situation locally mirrors the national picture.

Dr. Ashish K. Jha, director of the Harvard Global Health Institute, said Tuesday that the United States currently ranks third in the world in the number of identified coronavirus cases, with 46,000.

“But it’s rising rapidly as our testing infrastructure started to get up and running,” Jha said. “Most of us are expecting that within about a week, we will have more cases than any other country in the world.”

The nation has a significant shortage of ventilators. If 40% of Americans get infected over a six-month period, hospitals will need three times the number of beds and ventilators that are currently available.

The federal government has 20,000 ventilators in national emergency reserve, he said.

“We have known for a long time that we would be hit by a pandemic that would require ventilatory support, and that’s why we have 20,000 in the national strategic reserve,” he said. “I think many of us for many years have said that is completely inadequate if we end up getting into a real pandemic.”

The supply also can’t be quickly bolstered, he said. It takes from two to three months to manufacture a device, and companies at maximum production can make 10,000 in a quarter.

Auto makers and other companies are prepared to retool their factories to start producing ventilators, he said. Ventilators are expensive to buy and store, he said, but that has never stopped the U.S. from stockpiling other things.

“We have a lot of military equipment that we hope we never use in the same way we should have been doing it, but at this point, we don’t," Jha said. “Once we get through this pandemic, my hope is that we will never make that mistake again, but it’s water under the bridge now.”

The state of medical treatment with a shortage of ventilators could become improvisational, even primitive. There are alternatives to ventilators, but those could aerosolize the virus, making it more likely for health care workers to be infected, Kahn said. Doctors and nurses could even resort to using a hand pump to do the work of an ailing person’s lungs.

“We would take medical students and would ‘bag’ the patients, that’s the verb we use,” he said. “This is the kind of medicine you’d be practicing in Antarctica or in extreme situations.”

Also likely, he said, will be doctors being forced to make decisions on who has access to a ventilator and who does not based on a patient’s probability of survival. National health experts have resorted to the idea of shifting ventilators around the country if the virus dies down in one area and flares up in another.

“We need hundreds of thousands in the next month or two,” Jha said, “so unfortunately, obviously, a major problem is that we didn’t do anything the last two months, so it’s a lot of time lost.”

The near-lockdown and social distancing in the region is the best chance to minimize the scenario of surrendering one life to save another, Kahn said. The lockdown slows the spread of the illness, he said, and it may not be too late to slow it enough that the torrent of cases expected in the coming weeks could be reduced to a trickle, small enough for the health care system to manage.

“I am very fearful,” he said. "I don’t yet think it’s inevitable. I am now hopeful we can spread the infection over enough weeks and months where we don’t have to make those horrible decisions about two patients, one ventilator. "