Around 100 of the 323 hospitals surveyed are located in rural areas or small towns. In that context, it makes more sense that supplies in a pandemic might not be readily at hand. However, 34 were either major teaching hospitals associated with the nation’s top universities or special pathogen centers specialized in treating infectious disease. The report suggests that even these hospitals are understaffed, under-resourced, and generally not at the level they should be to face a pandemic. Hospitals complain the wait to receive a definitive answer on a test is a week or more. Patients either occupy hospital beds, waiting, or are sent home, potentially spreading the virus more.

New York Governor Cuomo put it succinctly. He wrote in a tweet, “Our single greatest challenge is ventilators. We need 30,000 ventilators. We have 11,000.”

Strangely, Cuomo’s pleas triggered the president to lash out at Cuomo’s cited shortage. His deal with GM to produce ventilators has fallen through and he is refusing to enforce the Defense Production Act in order to strong-arm manufacturers into producing the needed supplies.[4]

Having failed to secure more ventilators, he then attacked the whole notion of New York needing ventilators.[5] In one of his nightly task force briefings, and again on Sean Hannity’s show, the president said he didn’t believe there needed to be so many ventilators.[6] He says that thousands of ventilators have been delivered and are sitting in a warehouse in Edison, New Jersey.”[7] He doesn’t understand that Cuomo is saying they are going to need 33,000 ventilators in the future. Right now, they have 11,000, which is not enough to manage the expected number of cases in the next two weeks.[8]

This ventilator wrangling and the tantalizing dust-up between the president and the press only serves to distract from two deeper issues. First, the ventilators used to be there, stockpiled, gathering dust. Eventually the cost of retaining ventilators for a future pandemic became too much of a drain. Economic shortfalls, some of which were caused by the lack of federal preparedness funds, led to New York selling the emergency ventilators it did have in storage.[9]

The second issue is even more telling. In 2018, in remembrance of the 100^th anniversary of the 1918 H1N1 influenza pandemic, NYC Health + Hospitals ran an executive-level pandemic response workshop. The workshop thrust administrators and healthcare providers into a modernized pandemic influenza scenario and asked them to make strategic decisions. The workshop found some holes in response, which resulted in four main recommendations. First, inefficiencies appeared in the way groups shared data, so a flexible, easy to access record keeping system shared broadly needed to be implemented. Second, decision makers often had narrow training and experience that would benefit from a broader, interdisciplinary “brain bank.” Third, local preparedness leaned heavily on messages coming out of groups from the WHO, the CDC, FEMA, and state health departments, so the communication there needed to be as clear and targeted as possible. Fourth, and, perhaps most surprising, pandemics in the modern era disrupt the hospital as a commercial venture. Without big-money bailouts, cancelations of elective surgeries would sink even a robust hospital system like New York City’s.

They published some recommendations just a few weeks ago, in Disaster Medicine and Public Health Preparedness.[10] But no one has implemented these recommendations, even in New York.[11]

Notes

[1] HHS Office of Inspector General, “Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020. OEI-06-20-00300” (Washington, DC: Department of Health and Human Services, April 3, 2020), https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp.

[2] HSS OIG, “Hospital Experiences.”

[3] HSS OIG, “Hospital Experiences.”

[4] Yasmeen Abutaleb et al., “The U.S. Was Beset by Denial and Dysfunction as the Coronavirus Raged,” The Washington Post, April 4, 2020, https://www.washingtonpost.com/national-security/2020/04/04/coronavirus-government-dysfunction/.

[5] Geoff Baker, “Trump Administration Backs off a Deal for Bothell’s Ventec and GM to Produce ‘up to 20,000’ Ventilators a Month amid Coronavirus Crisis,” The Seattle Times, March 26, 2020, https://www.seattletimes.com/business/local-business/ventec-and-gm-hoping-to-produce-up-to-20000-ventilators-a-month-amid-coronavirus-crisis/.

[6] Quint Forgey and Matthew Choi, “Trump Downplays Need for Ventilators as New York Begs to Differ,” POLITICO, March 26, 2020, https://www.politico.com/news/2020/03/26/trump-ventilators-coronavirus-151311.

[7] Trump Berates Reporter for “threatening” Question during Briefing (CNN, 2020), https://www.youtube.com/watch?v=1uWT_L58MGc.

[8] “Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces NYS on Pause Functions Extended for Additional Two Weeks,” Governor Andrew M. Cuomo, April 6, 2020, https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-nys-pause-functions-extended-additional.

[9] Justin Elliott, Annie Waldman, and Joshua Kaplan, “How New York City’s Emergency Ventilator Stockpile Ended Up on the Auction Block,” ProPublica, April 6, 2020, https://www.propublica.org/article/how-new-york-city-emergency-ventilator-stockpile-ended-up-on-the-auction-block?token=sYBNO6t1202JOb6ILFkA_eTWzPmpol3N.

[10] Syra Madad et al., “Ready or Not, Patients Will Present: Improving Urban Pandemic Preparedness,” Disaster Medicine and Public Health Preparedness, March 16, 2020, 1–4, https://doi.org/10.1017/dmp.2020.7.

[11] Brian M. Rosenthal, Jennifer Pinkowski, and Joseph Goldstein, “‘The Other Option Is Death’: New York Starts Sharing of Ventilators,” The New York Times, March 26, 2020, https://www.nytimes.com/2020/03/26/health/coronavirus-ventilator-sharing.html.