By Christopher Cotton and Neil Renwick
Christopher Cotton, Ph.D., is a Professor of Economics at Queen’s University where he holds the Jarislowsky-Deutsch Chair of Economic & Financial Policy and is the Director of the John Deutsch Institute for the Study of Economic Policy. Neil Renwick M.D., Ph.D, is a Clinician Scientist and Head of the Laboratory of Translational RNA Biology at Queen’s University and an Associate Attending Physician at The Rockefeller University Hospital in New York City.
Last week, NY Governor Andrew Cuomo issued a plea to the rest of the country: “Help New York. We’re the ones hit right now… We need relief. We need relief for nurses working 12-hour shifts. We need relief for doctors. Help us now and we will return the favor.”
This request is based on the fact that states like New York, New Jersey, and Michigan are being hit hardest by the COVID-19 pandemic now, and are likely to see their apex in the next week or two, while other states are unlikely to reach their peak until later this spring. Today, as New York faces a shortage of health care workers, there are other places in the U.S. with excess medical capacity, where doctors and nurses not yet being pushed beyond their breaking point.
We claim such an argument not only applies to doctors and nurses but also applies to life-saving ventilators as well.
Ventilators are designed to be reused. They are easy to clean and transport. While states like Michigan and New York expect to lose lives due to having too few ventilators over the next two weeks, other states will have ventilators going temporarily unused.
A new study funded by the Bill and Melinda Gates Foundation estimates that the need for ventilators to fight the pandemic will peak at an estimated 19,481 devices during the second week of April. But, there is a lot of uncertainty around this number and the actual ventilator need at the peak of the crisis is likely to be somewhere between 10,000 and 40,000.
According to the study, New York could need upward of 10,000 ventilators at its peak demand that will occur in the next week or so. Michigan could need almost 5,000 ventilators during the same period. At the same time, Florida and Virginia, for example, are not expected to hit their peak demand for ventilators until May and are unlikely to need more than 1,200 and 650 ventilators for COVID-19, respectively.
Although we don’t have precise data on the number of ventilators available, the estimates we have suggest that the country has enough ventilators. It just doesn’t have enough ventilators in the places they are needed now. A 2010 study estimated that there were 62,188 full-feature medical ventilators, plus an additional 98,738 ventilator devices with fewer features, at hospitals in the U.S. These estimates do not include federal or state stockpiles. Furthermore, we could increase the capacity to lend ventilators by putting a temporary stop to all elective medical procedures across the country.
With most COVID-19 patients that need a ventilator remaining on it from between one and three weeks, there is an opportunity to use them (or have them on hand during peaks as backup options) in the hardest-hit locations and then return them to the later-hit locations before they are needed. This could save lives.
This is almost certainly easier said than done. Individual hospitals and state governments may be very hesitant to temporarily share their ventilators with other states when they may need the ventilators three to five weeks from now. This last point is particularly problematic when there is uncertainty about how long the equipment shortage may last in the hardest-hit states, and perhaps no way for the leaders in New York and Michigan to credibly commit to returning the medical commitment before it is needed elsewhere.
Overcoming such challenges requires strong leadership from the federal government. State leaders and hospitals need a guarantee that their equipment will be returned before it is needed locally, even if such a guarantee requires federal government intervention. Policy may also prioritize the allocation of federally owned ventilators or aid to the states that actively work to help others. The national government should also lead the logistics behind any such effort.
When Cuomo explained the difficulty of securing medical equipment for New York hospitals, he said, “It’s like being on eBay with 50 other states, bidding on a ventilator.” Putting aside the question of which is the 51st state, we see this as one of the fundamental issues with the United State’s response to the pandemic. The states are being left to respond independently and in competition with one another.
The states are individually working to minimize deaths within their own borders, competing with one another for scarce resources. But what we really need is a coordinated effort between all states, hospitals, and medical professionals to minimize total deaths across the entire United States.