This article is from the source 'nytimes' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/03/18/business/ventilator-shortage-coronavirus.html

The article has changed 16 times. There is an RSS feed of changes available.

Version 14 Version 15
There Aren’t Enough Ventilators to Cope With the Coronavirus There Aren’t Enough Ventilators to Cope With the Coronavirus
(32 minutes later)
As the United States braces for an onslaught of coronavirus cases, hospitals and governments are confronting a grim reality: There are not nearly enough lifesaving ventilator machines to go around, and there is no way to solve the problem before the disease reaches full throttle.As the United States braces for an onslaught of coronavirus cases, hospitals and governments are confronting a grim reality: There are not nearly enough lifesaving ventilator machines to go around, and there is no way to solve the problem before the disease reaches full throttle.
Desperate hospitals say they can’t find anywhere to buy the medical devices, which help patients breathe and can be the difference between life and death for those facing the most dire respiratory effects of the coronavirus.Desperate hospitals say they can’t find anywhere to buy the medical devices, which help patients breathe and can be the difference between life and death for those facing the most dire respiratory effects of the coronavirus.
American and European manufacturers say they can’t speed up production enough to meet soaring demand, at least not anytime soon.American and European manufacturers say they can’t speed up production enough to meet soaring demand, at least not anytime soon.
And while the acute shortages are global, not just in the United States, some European governments are deploying wartime-mobilization tactics to get factories churning out more ventilators — and to stop domestic companies from exporting them.And while the acute shortages are global, not just in the United States, some European governments are deploying wartime-mobilization tactics to get factories churning out more ventilators — and to stop domestic companies from exporting them.
The United States, by contrast, has been slow to develop a national strategy for accelerating the production of ventilators. That appears to reflect in part the federal government’s sluggish reaction to the coronavirus, with President Trump and others initially playing down the threat. This week, Mr. Trump urged governors to find ways to procure new ventilators. “Try getting it yourselves,” he said.The United States, by contrast, has been slow to develop a national strategy for accelerating the production of ventilators. That appears to reflect in part the federal government’s sluggish reaction to the coronavirus, with President Trump and others initially playing down the threat. This week, Mr. Trump urged governors to find ways to procure new ventilators. “Try getting it yourselves,” he said.
That will be hard and in some cases impossible.That will be hard and in some cases impossible.
“The reality is there is absolutely not enough,” said Andreas Wieland, the chief executive of Hamilton Medical in Switzerland, one of the world’s largest makers of ventilators. “We see that in Italy, we saw that in China, we see it in France and other countries. We could sell I don’t know how many.”“The reality is there is absolutely not enough,” said Andreas Wieland, the chief executive of Hamilton Medical in Switzerland, one of the world’s largest makers of ventilators. “We see that in Italy, we saw that in China, we see it in France and other countries. We could sell I don’t know how many.”
Mr. Wieland’s company is shipping machines as fast it can get them off the assembly line. He has moved office workers to the factory and hired more employees. Even so, he can’t keep up with the crush of orders. “Italy wanted to order 4,000, but there’s not a chance,” he said. “We sent them something like 400.”Mr. Wieland’s company is shipping machines as fast it can get them off the assembly line. He has moved office workers to the factory and hired more employees. Even so, he can’t keep up with the crush of orders. “Italy wanted to order 4,000, but there’s not a chance,” he said. “We sent them something like 400.”
The coronavirus attacks people’s lungs, in some cases compromising their ability to breathe. Ventilators, which deliver air to the lungs through a tube placed in the windpipe, are a crucial tool to keep these patients alive. The computerized, bedside machines can cost as much as $50,000.The coronavirus attacks people’s lungs, in some cases compromising their ability to breathe. Ventilators, which deliver air to the lungs through a tube placed in the windpipe, are a crucial tool to keep these patients alive. The computerized, bedside machines can cost as much as $50,000.
Hospitals in the United States have roughly 160,000 ventilators. There are a further 12,700 in the National Strategic Stockpile, a cache of medical supplies maintained by the federal government to respond to national emergencies.Hospitals in the United States have roughly 160,000 ventilators. There are a further 12,700 in the National Strategic Stockpile, a cache of medical supplies maintained by the federal government to respond to national emergencies.
That probably won’t be enough if the number of serious coronavirus cases keeps climbing.That probably won’t be enough if the number of serious coronavirus cases keeps climbing.
“In a worst-case scenario it would be very difficult to have a sufficient number,” said Thomas R. Frieden, the director of the Centers for Disease Control and Prevention during the Obama administration.“In a worst-case scenario it would be very difficult to have a sufficient number,” said Thomas R. Frieden, the director of the Centers for Disease Control and Prevention during the Obama administration.
In the United States, roughly half of the intensive-care ventilators in use were made by foreign companies, including Dräger and Getinge, according to estimates by ECRI, an independent nonprofit group that evaluates medical technology. There are fewer than a dozen American companies — including giants like General Electric and Medtronic — that make ventilators, according to Greg Crist, a spokesman for AdvaMed, the trade group that represents American medical device makers. They are scrambling to accelerate production.In the United States, roughly half of the intensive-care ventilators in use were made by foreign companies, including Dräger and Getinge, according to estimates by ECRI, an independent nonprofit group that evaluates medical technology. There are fewer than a dozen American companies — including giants like General Electric and Medtronic — that make ventilators, according to Greg Crist, a spokesman for AdvaMed, the trade group that represents American medical device makers. They are scrambling to accelerate production.
But the machines are complicated, made up of hundreds of smaller parts produced by companies all over the world. There is no simple way to substantially increase the output.But the machines are complicated, made up of hundreds of smaller parts produced by companies all over the world. There is no simple way to substantially increase the output.
“We are in a global supply chain situation, like it or not, so everybody making ventilators here or elsewhere is going to be looking for parts, often coming from the same suppliers,” said Marcus Schabacker, chief executive of ECRI. “There’s a domino effect coming into play.”“We are in a global supply chain situation, like it or not, so everybody making ventilators here or elsewhere is going to be looking for parts, often coming from the same suppliers,” said Marcus Schabacker, chief executive of ECRI. “There’s a domino effect coming into play.”
Earl Refsland, the chief executive of Allied Healthcare Products, a small ventilator manufacturer in St. Louis, said that ramping up production quickly was not possible. For his company, which makes about 1,000 ventilators a year, it will take at least eight months to sharply increase production.Earl Refsland, the chief executive of Allied Healthcare Products, a small ventilator manufacturer in St. Louis, said that ramping up production quickly was not possible. For his company, which makes about 1,000 ventilators a year, it will take at least eight months to sharply increase production.
“These are ventilators to keep people alive,” Mr. Refsland said. “We aren’t making wagon wheels. It takes a while.”“These are ventilators to keep people alive,” Mr. Refsland said. “We aren’t making wagon wheels. It takes a while.”
Demand has spiked just as countries are forcing people to stay home to slow the coronavirus’s spread. To bring more workers into factories, companies first need to buy protective gear for staff and spend money on cleaning services.Demand has spiked just as countries are forcing people to stay home to slow the coronavirus’s spread. To bring more workers into factories, companies first need to buy protective gear for staff and spend money on cleaning services.
Without an adequate supply, doctors may have to make life-or-death decisions about who needs the machines most.Without an adequate supply, doctors may have to make life-or-death decisions about who needs the machines most.
Johns Hopkins University’s hospital system bought some new ventilators a few weeks ago, when the leadership saw the coronavirus spreading. But the Baltimore hospital network is struggling to find more to buy.Johns Hopkins University’s hospital system bought some new ventilators a few weeks ago, when the leadership saw the coronavirus spreading. But the Baltimore hospital network is struggling to find more to buy.
“We’re scrounging,” said Gabe Kelen, director of Johns Hopkins’ office of critical event preparedness. “We’re looking at every possible place we might get one.”“We’re scrounging,” said Gabe Kelen, director of Johns Hopkins’ office of critical event preparedness. “We’re looking at every possible place we might get one.”
The hospital system has considered whether it could work with the university’s engineering department to build its own ventilators — an option that Dr. Kelen described as “extreme,” given that they’ve never built the complex machines before — and has also convened a group of doctors and ethicists to figure out how to essentially ration the use of ventilators if there are more patients than machines.The hospital system has considered whether it could work with the university’s engineering department to build its own ventilators — an option that Dr. Kelen described as “extreme,” given that they’ve never built the complex machines before — and has also convened a group of doctors and ethicists to figure out how to essentially ration the use of ventilators if there are more patients than machines.
As the initial epicenter of the coronavirus outbreak, China snapped up whatever slack there was in the market for the assisted-breathing machines. When the disease spread to South Korea and Italy, hospitals in those countries put their orders in. Now manufacturers are getting inundated with orders from all over the world.As the initial epicenter of the coronavirus outbreak, China snapped up whatever slack there was in the market for the assisted-breathing machines. When the disease spread to South Korea and Italy, hospitals in those countries put their orders in. Now manufacturers are getting inundated with orders from all over the world.
The United States is toward the back of the queue, according to manufacturers.The United States is toward the back of the queue, according to manufacturers.
Ventec, a small ventilator company with headquarters near Seattle, recently filled an order to sell 150 ventilators to Japan, said Chris Kiple, its chief executive.Ventec, a small ventilator company with headquarters near Seattle, recently filled an order to sell 150 ventilators to Japan, said Chris Kiple, its chief executive.
Ventec is hustling to accelerate its production, adding employees and increasing their hours, he said. In an attempt to prevent the coronavirus from spreading among its staff, Ventec introduced mandatory temperature checks for everyone entering its factory. A janitorial staff works 24 hours a day to sanitize surfaces.Ventec is hustling to accelerate its production, adding employees and increasing their hours, he said. In an attempt to prevent the coronavirus from spreading among its staff, Ventec introduced mandatory temperature checks for everyone entering its factory. A janitorial staff works 24 hours a day to sanitize surfaces.
Updated July 15, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
But even with the increased production, the company won’t be able to quickly satisfy the surging demand.But even with the increased production, the company won’t be able to quickly satisfy the surging demand.
For days, Mr. Kiple said, he has been getting nonstop phone calls from frantic hospital administrators, governor’s offices and other government officials looking for more machines. He’s even received inquiries from a number of wealthy individuals hoping to buy their own personal ventilators, a fallback plan in case the American hospital system buckles.For days, Mr. Kiple said, he has been getting nonstop phone calls from frantic hospital administrators, governor’s offices and other government officials looking for more machines. He’s even received inquiries from a number of wealthy individuals hoping to buy their own personal ventilators, a fallback plan in case the American hospital system buckles.
“I can tell you with a 100 percent confidence that every single manufacturer is facing a backlog right now,” Mr. Kiple said.“I can tell you with a 100 percent confidence that every single manufacturer is facing a backlog right now,” Mr. Kiple said.
European countries — already reeling from tens of thousands of virus-infected patients — are responding forcefully. Some governments are restricting domestic medical supply companies from fulling international orders.European countries — already reeling from tens of thousands of virus-infected patients — are responding forcefully. Some governments are restricting domestic medical supply companies from fulling international orders.
In Germany, where about 25,000 ventilators are now available nationwide, the government ordered 10,000 from a domestic manufacturer, Dräger, to be made over the next year. The company, whose stock has risen more than 50 percent in the last week, said it was rushing to fulfill the orders, but faced constraints because of safety testing and the availability of components.In Germany, where about 25,000 ventilators are now available nationwide, the government ordered 10,000 from a domestic manufacturer, Dräger, to be made over the next year. The company, whose stock has risen more than 50 percent in the last week, said it was rushing to fulfill the orders, but faced constraints because of safety testing and the availability of components.
Italy, which has nearly 30,000 confirmed coronavirus cases and more than 2,100 deaths, is perhaps facing the gravest shortage of ventilators. In the Northeast region of Veneto, officials are looking into whether ventilators designed for animals can be used on humans, local media reported.Italy, which has nearly 30,000 confirmed coronavirus cases and more than 2,100 deaths, is perhaps facing the gravest shortage of ventilators. In the Northeast region of Veneto, officials are looking into whether ventilators designed for animals can be used on humans, local media reported.
The government has sent about 25 engineers and other staff members from the ministry of defense to help with production of ventilators at Siare Engineering, a manufacturer near Bologna. The company has quadruped production to make up to 150 ventilators a week. It delayed deliveries to other countries like India to meet the need in Italy.The government has sent about 25 engineers and other staff members from the ministry of defense to help with production of ventilators at Siare Engineering, a manufacturer near Bologna. The company has quadruped production to make up to 150 ventilators a week. It delayed deliveries to other countries like India to meet the need in Italy.
“It’s an urgent need for our country,” said Enrico Tozzi, who leads Siare’s export division. “We are completely in an emergency.”“It’s an urgent need for our country,” said Enrico Tozzi, who leads Siare’s export division. “We are completely in an emergency.”
And in Britain, where the country expects to need far more than the 5,000 ventilators now available, Prime Minister Boris Johnson on Monday called on carmakers and other manufacturers to immediately begin helping make ventilators, a move reminiscent of the country’s mobilization to build Spitfire fighter planes during World War II. The government said it got more than 400 calls from businesses offering to help build ventilators.And in Britain, where the country expects to need far more than the 5,000 ventilators now available, Prime Minister Boris Johnson on Monday called on carmakers and other manufacturers to immediately begin helping make ventilators, a move reminiscent of the country’s mobilization to build Spitfire fighter planes during World War II. The government said it got more than 400 calls from businesses offering to help build ventilators.
The American government has considered, to some extent, a similar option. A federal report, obtained by The New York Times and dated March 13, noted that the president could invoke the Defense Production Act of 1950, which allows for the mandatory mobilization of manufacturing lines to produce key supplies. (Mr. Trump announced on Wednesday that he would do so.)The American government has considered, to some extent, a similar option. A federal report, obtained by The New York Times and dated March 13, noted that the president could invoke the Defense Production Act of 1950, which allows for the mandatory mobilization of manufacturing lines to produce key supplies. (Mr. Trump announced on Wednesday that he would do so.)
So far, though, there have been no investments in technology to help manufacturers increase production, scant marshaling of federal resources and limited coordination to help distribute machines. Instead, it’s essentially every state for itself, which leaves manufacturers having to decide which hospitals or governments need the machines the most — and, in theory, who is willing to pay a premium.So far, though, there have been no investments in technology to help manufacturers increase production, scant marshaling of federal resources and limited coordination to help distribute machines. Instead, it’s essentially every state for itself, which leaves manufacturers having to decide which hospitals or governments need the machines the most — and, in theory, who is willing to pay a premium.
Some industry officials said they recently had been discussing production issues with members of the White House’s coronavirus task force and officials at the Department of Health and Human Services.Some industry officials said they recently had been discussing production issues with members of the White House’s coronavirus task force and officials at the Department of Health and Human Services.
Given the size of the United States, the problem is more complicated than raw numbers. An unused ventilator in Detroit, for example, does not help an overwhelmed hospital in Dallas.Given the size of the United States, the problem is more complicated than raw numbers. An unused ventilator in Detroit, for example, does not help an overwhelmed hospital in Dallas.
“You may have more than sufficient resources close by or even across the country but face clustered outbreaks that exceed the capacity locally,” said Dr. Greg S. Martin, president-elect of the Society of Critical Care Medicine and professor of medicine at Emory University in Atlanta.“You may have more than sufficient resources close by or even across the country but face clustered outbreaks that exceed the capacity locally,” said Dr. Greg S. Martin, president-elect of the Society of Critical Care Medicine and professor of medicine at Emory University in Atlanta.
There’s also the question of finding enough trained personnel to staff the machines. Under normal circumstances, Dr. Martin said, physicians receive years of training before they are entrusted with operating ventilators in life-or-death situations.There’s also the question of finding enough trained personnel to staff the machines. Under normal circumstances, Dr. Martin said, physicians receive years of training before they are entrusted with operating ventilators in life-or-death situations.
Rachel Abrams contributed reporting.Rachel Abrams contributed reporting.