Guest post by Larry C. Johnson
For the past week it appeared that NY Governor Cuomo realized it was more important to be an adult and eschew partisan politics. That was then. He is now in full partisan panic pandemonium. He is now accusing the Feds of dragging their feet in getting NYC 30,000 ventilators. Here is the quote:
“What are you doing sending 400 when I need 30,000 ventilators,” Cuomo said. “You’re missing the magnitude of the problem.”
No Cuomo, you do not understand. For starters, you do not have 10,000 patients on a ventilator now. The number of patients who test positive does not mean that all will require a ventilator. The numbers available so far indicate most who test positive for corona virus are not being hospitalized. That means the numbers for ventilators are not going to skyrocket and immediately outstrip the existing capability.
But Cuomo is missing a more important point. Shame on him. He has a duty to help educate his constituency. Let us start with the production reality–you cannot magically produce ventilators overnight. The existing manufacturers have limited, not UNLIMITED, capabilities to expand production. Bringing other companies, like GM on line, will require about a month to retool and repurpose machinery and quality control techs.
Producing the machines is the easy part. It is the human infrastructure that is the problem. If there are 30,000 ventilators up and running then you need an additional 45,000 ICU qualified nurses and an additional 22,500 Respiratory Therapy Technicians. (I am assuming one ICU nurse can handle two patients per shift. There are three eight hour shifts per day. I am assuming that one Respiratory Therapy Tech can handle 8 ventilators per shift and there are three eight hour shifts per day).
Along with the ventilators and the nurses and the respiratory techs you will also need oxygen, vacuum and forced air lines for each ventilator station. The nurses and techs also will have to put on new personal protection gear and respirators for each patient encounter (normally, a nurse assigned to a patient can last about three hours in a PPE (Personal Protection Equipment) suit and mask). There is another major complication to consider–every time the nurse goes in and out of the patient room then the nurse (or tech) must put on and then take off the personal protection gear. This can be time consuming if done properly.
I have some background for opining on this topic. I worked my way through college as a Respiratory Therapy Tech and handled patients on ventilators. The ventilators require regular changes of the tubing that connects the patient to the machine. And there are also medications sometimes administered via the ventilator as an aerosol. Getting a trained, certified Respiratory Therapy Tech requires about two years of school/training. Even with that basic training the new Tech is not ready to handle ventilators. That requires additional training.
Getting a qualified ICU nurse is more daunting and more concerning. Ideally the nurse has a four year degree. But there are very sound ICU nurses now on the job with only two years of post-high school education. But to become qualified to work effectively in an ICU a nurse will have to have a minimum of one month of training. (That means the nurse has basic orientation to the policies and procedures for providing intensive or critical care to very sick patients). Ideally the nurse would have six months of training under her or his belt. (Note–my wife was the Nurse Manager for a very prestigious, internationally renowned critical care unit and I have interviewed her).
Someone needs to tackle Governor Cuomo and hit him with a tranquilizer. He needs to calm down and take some time to understand how complex this problem is. Providing a ventilator without having the nurses and technicians required to operate and maintain the ventilator is meaningless and futile.
UPDATE–There are 62 hospitals listed in NYC (see here). According to this data there are 23,762 beds. The vast majority of these are not, repeat NOT, Intensive or Critical Care beds. The number of ICU beds, which means they have the ability to use and maintain a ventilator, is probably about 1500 total.
As of Tuesday morning, New York State had 25,665 cases. Here is what we do not know:
- What percent of people who are tested positive for Corona are admitted to a hospital?
- What percent of those admitted to a hospital are then placed in a Critical Care or Intensive Care unit?
If all who test positive for Corona are admitted to the hospital then you can see how the existing hospital capacity can be quickly overwhelmed.
According to the New York Times (as of Tuesday), 12% of those who tested positive for Corona in the State of New York were hospitalized. That number is manageable at present. 23% (750) of those hospitalized in the State of New York were put into an ICU (or CCU). We do not know how many of those are in NYC hospitals.
Here is what we know with certainty:
- There are not enough ICU or CCU beds to handle more than 1500 patients in NYC right now.
- There are not enough ICU qualified nurses and Respiratory Therapists to handle more than 1500 critical care patients in respiratory distress from Corona.
- The real problem is not the lack of ventilators. It is the lack of personnel to set up and operate those ventilators.
It would be very helpful if Federal and State officials would provide concrete numbers on the percent of Corona patients requiring hospitalization and critical care intervention.