A new report suggests that the Strategic National Stockpile of ventilators could be just a drop in the bucket compared to the amount of units required in the U.S. to combat COVID-19.
The total number of the lifesaving machines that are stockpiled is just about 16,600, according to a Center for Public Integrity (CPI) report
. To put this figure in perspective, the healthcare system in the U.S. already has about 160,000 ventilators. If COVID-19 is as bad as the 1918 Spanish Flu, a Johns Hopkins estimate
has determined that up to 742,000 patients in the U.S. could need ventilators — and a more moderate wave could still mean that over 64,000 would be needed.
The Strategic National Stockpile (SNS) number, confirmed to Integrity by an unnamed U.S. HHS official involved with the program, was not exactly a secret — until the latest administration.
“All of a sudden that number has become protected infrastructure information for some reason,” Richard Branson, of the University of Cincinnati Medical Center, who has worked with government officials in stockpile allocation planning for emergencies, told CPI authors.
Branson told center reporters that he met with federal officials in the past who wanted to more than double the ventilators in the reserve and that in 2014 a $13.8 million government contract was given to Philips Respironics to come up with a new model respirator, but no versions had in fact been produced or bought of what was known as the Advanced All Hazard Stockpile Ventilator.
The SNS was started in 1999, initially in case there was a mass attack in the U.S. with weapons of mass destruction.
“The reality is, the stockpile could never have enough money to be the immediate fallback for everybody, and nobody does anything themselves,” Greg Burel, who was director of the stockpile until he left in January, told Integrity writers.
In H1N1 flu in 2009, which killed 12,000 in the U.S., got the attention of Congress, which approved $7.7 billion in special funding, and instructed Burel to make it ready for a pandemic as well as other mass casualty events. There were just 4,000 ventilators stashed in the reserve, according the CDC's Eileen M. Malatino, in a review published in 2008
in the journal Respiratory Care
, in which she detailed both the numbers and types of units in the stockpile at the time.
“The ventilator model acquired in 2001 was the Uni-Vent Eagle 754 (Impact Instrumentation, West Caldwell, New Jersey), followed in 2003 by the LP10 (Puritan Bennett, Pleasanton, California). In August 2006, the DSNS received notification from Puritan Bennett that the company would cease manufacture and worldwide sales of the LP10 by November 2006,” she wrote at the time.
To help meet demand, industry is stepping up, including GE Healthcare, which is moving to round-the-clock ventilator production.
“As the global pandemic evolves, there is unprecedented demand for medical equipment, including ventilators,” GE Healthcare’s chief executive officer Kieran Murphy said in a statement. “We continue to explore all options to support this increased need.”
The trade-offs for SNS purchase decisions were between many competing needs, which Burel said forced “hard” choices — obscure pharmaceuticals likely to go out of production without government buys versus the ventilators, which were already a popular item in the medical world and would continue to be produced in fairly large numbers.
More were bought, however. The tally rose to 8,000 in 2010 and to the 16,600 now stockpiled, HSS's Amber Dukes told the authors by email.
Nor would the machines alone be enough — trained staff to run them is not available at the estimated numbers, according to the reporters, citing a 2015 federal report that estimated only another 50,000 new patients could be safely ventilated at this point.
The situation is just that much worse for already stressed rural hospitals, noted David Wallace, a critical care specialist at the University of Pittsburgh.
“If we expect patients to remain in those locations, that’s going to put new stresses and strains on those hospitals,” he told CPI.