Additional reporting by Will Welch
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Hospitals around New York and the nation are scrambling to get their hands on as many ventilators as possible to treat a rapidly increasing number of COVID-19 patients.
But even if New York got the 30,000 ventilators it might need to combat an onslaught of seriously ill patients, the state could be caught with too few respiratory therapists, who manage the machines that move air in and out of patients’ lungs.
Roughly 7,500 New Yorkers are licensed to work as respiratory therapists and respiratory therapist technicians, according to the state Department of Education.
That leaves New York with more limited access to ventilator personnel than all but one other state in the U.S., as a share of population, with just 38 therapists and technicians per 100,000 people, according to THE CITY’s analysis of the American Association for Respiratory Care data.
Only Minnesota has fewer. For New York City, the figure is even lower, at 32 professionals per 100,000 people.
“Overall, we just don’t have enough therapists,” said Claire Aloan, an associate professor and program director of the Department of Respiratory Therapy Education at SUNY Upstate Medical University.
No One Else Trained
Only 13 schools in the state offer respiratory therapy programs, leaving too few graduates to fill available positions, Aloan noted.
During the past year, New York issued fewer than 400 new respiratory therapist or technician licenses, state data shows.
Their work is essential to running the machines safely, and cannot be quickly taught, say professionals.
First a patient is intubated, with a plastic tube inserted into the trachea either by a doctor, or some nurses and respiratory therapists themselves.
Once intubated, the person is hooked up to a ventilator. Respiratory therapists adjust the machine at regular intervals to make sure that the patient’s chest is rising correctly, and that they are receiving proper levels of oxygen while expelling carbon dioxide.
These specialists also collect blood samples from the arteries and review them to evaluate oxygen and carbon dioxide levels. In addition to pumping oxygen into the lungs, respiratory therapists also administer medication through the ventilation system.
“There really is no one else trained to do that,” Aloan explained.
Some health care workers could be trained in an emergency on the basics of ventilation — like how to set up the machine and how to read levels to make sure they’re in the right place, Aloan said. But any intervention would require a respiratory therapist.
During a standard hospital shift, respiratory therapists have a handful of patients they care for with varying degrees of respiratory illness, according to interviews with several in the profession. But staff will soon be overwhelmed by a wave of patients with serious lung issues caused by the novel coronavirus.
As someone gets progressively sicker and their lung capacity changes, the more often and intensely a respiratory therapist needs to intervene to manage their care and tweak the ventilation. That could require just one respiratory therapist assigned per patient.
“A ventilator isn’t going to fix a patient. It’s not going to heal the lungs, but it buys us some time so we can give the physicians time to find the right medication mixture to get rid of the virus,” said Shawna Strickland, associate executive director at the American Association for Respiratory Care.
As with doctors and nurses, the work potentially exposes respiratory therapists to coronavirus, with the risk of infection heightened by a reportedly dire shortage of masks and other protective equipment. Any health professionals who show symptoms that may indicate infection must remain at home — and off the job — for at least seven days, under city Department of Health guidance.
Asking for More
Coupled with a shortage in experts who keep the ventilators working, ventilators themselves are becoming scarcer.
New York has fewer than 6,000 ventilators statewide, according to Gov. Andrew Cuomo — 4,000 scattered around hospitals and nursing homes, as well as “several hundred” more in the state’s own emergency medical stockpile.
The Cuomo administration is currently doing a survey of any facility that might have a ventilator, a spokesperson for the governor told THE CITY.
Colleges that teach respiratory courses are also preparing to hand over any ventilators they have over to hospitals that might need them, according to school officials.
In New York City, aides to Mayor Bill de Blasio say 3,500 ventilators exist in New York City hospitals, 1,500 of which are currently in use by patients.
Hospitals are being asked to cancel or postpone elective surgeries to free up hospital beds and ventilators, a measure that will likely take place next week, Cuomo said Friday.
For instance, NYU Langone Health hospitals cancelled the majority of their elective surgeries, cutting down the surgery load by 70%, according to the hospital’s spokesperson.
As they brace for dwindling availability of ventilators, doctors throughout the country are trying to figure out ways to hook more than one patient up to a machine.
A YouTube video posted March 14 by an emergency medical physician in Detroit shows how to connect up to four people to a single ventilator. The video had more than 515,000 views as of early Friday afternoon.
As the state and city work towards doubling the existing hospital bed capacity to treat the influx of sick New Yorkers, the governor warned Thursday morning that more beds without a supply of ventilators will be futile.
“The beds do very little good without a ventilator, because almost all of these COVID cases require the ventilator,” Cuomo told reporters at an Albany press conference. “A bed is great. But if you don’t have a ventilator it’s virtually useless.”
Both the governor and the mayor have requested ventilators from the federal government, where at least 10,000 ventilators sit in the federal stockpile, Vice President Mike Pence said Wednesday.
De Blasio has requested 15,000 additional ventilators by April, a seeming impossible feat.
Just 1,000 More
The city Health Department conducted its last comprehensive survey of ventilators of city hospitals in 2005. Then, hospitals reported that 40% of their ventilators were unused.
Erich Giebelhaus, a NYC Health Department Emergency Preparedness/Response official, stressed at the time how crucial mechanical ventilators are in a pandemic where no antivirus or vaccine is available.
The U.S. The National Institutes of Health estimated any vaccine for COVID-19 won’t be available for at least a year.
“One of the main ways we can help increase patient care capacity is to purchase ventilators,” Giebelhaus said when he presented the report’s findings in 2006.
The city’s report estimated that under an epidemic similar to a H2N2 influenza, 1,331 ventilators would be needed.
For an epidemic as lethal as the Spanish Flu, hospitals would need 9,454 additional ventilators just for the influenza patients — roughly 8,000 more ventilators than what city hospitals had at the time.
While the COVID-19 virus is not yet as deadly as the 1918 Spanish Flu, which caused more than 600,000 U.S. fatalities, it is 12 or 14 times more lethal than the H2N2 Influenza in 1957, in which 70,000 people died nationwide.
Fifteen years since the report, New York City hospitals have acquired just 1,000 more ventilators.
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