Society of Critical Care Medicine Releases Report on Current US Medical Resource Availability During COVID-19 Crisis

The Society of Critical Care Medicine released a report last week on the current US medical resource availability during the current COVID-19 crisis.

Since the liberal mainstream media refuses to report the truth on this crisis we are posting this information here.

Via the Society of Critical Care Medicine.

With the onset of COVID-19,¹ and the strong possibility of large percentages of the U.S. population being admitted to the hospital and intensive care unit (ICU), the Society of Critical Care Medicine (SCCM) has updated its statistics on critical care resources available in the United States.² Our goal is to provide information regarding the resources both available and needed to care for a potentially overwhelming number of critically ill patients, many of whom may require mechanical ventilation.¹ In this report, we address the most current data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. We also seek to provide context to the data…

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Mechanical ventilators: Reports from ICUs worldwide suggest that the most common reason for COVID-19 patient admission to the ICU is severe hypoxic respiratory failure requiring mechanical ventilation.

Supply of mechanical ventilators in U.S. acute care hospitals: Based on a 2009 survey of AHA hospitals, U.S. acute care hospitals are estimated to own approximately 62,000 full-featured mechanical ventilators.¹⁰,¹¹ Approximately 46% of these can be used to ventilate pediatric and neonatal patients. Additionally, some hospitals keep older models for emergency purposes. Older models, which are not full featured but may provide basic functions, add an additional 98,738 ventilators to the U.S. supply.¹⁰ The older devices include 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8567 continuous positive airway pressure units.

Centers for Disease Control and Prevention Strategic National Stockpile (SNS) and other ventilator sources: The SNS has an estimated 12,700 ventilators for emergency deployment, according to recent public announcements from National Institutes of Health officials.¹² These devices are also not full featured but offer basic ventilatory modes. In simulation testing they performed very well despite long-term storage.¹³ Accessing the SNS requires hospital administrators to request that state health officials ask for access to this equipment. SNS can deliver ventilators within 24-36 hours of the federal decision to deploy them. States may have their own ventilator stockpiles as well.¹⁴ Respiratory therapy departments also rent ventilators from local companies to meet either baseline and/or seasonal demand, further expanding their supply. Additionally, many modern anesthesia machines are capable of ventilating patients and can be used to increase hospitals’ surge capacity.

The addition of older hospital ventilators, SNS ventilators, and anesthesia machines increases the absolute number of ventilators to possibly above 200,000 units nationally. Many of the additional and older ventilators, however, may not be capable of sustained use or of adequately supporting patients with severe acute respiratory failure. Also, supplies for these ventilators may be unavailable due to interruptions in the international supply chain. Alternatively, ventilator manufacturers could be encouraged to rapidly produce modern full-featured ventilators to allow experienced clinicians to use supplemental ventilators that are familiar to them and can be readily incorporated into the hospital ventilator fleet and informatics systems. An analysis of the literature suggests, however, that U.S. hospitals could absorb a maximum of 26,000 to 56,000 additional ventilators at the peak of a national pandemic, as safe use of ventilators requires trained personnel.¹⁵

Estimates of hospitalized patients requiring critical care and mechanical ventilation: The U.S. Department of Health and Human Services estimated in 2005 that 865,000 U.S. residents would be hospitalized during a moderate pandemic (as in the 1957 and 1968 influenza pandemics) and 9.9 million during a severe pandemic (as in the 1918 influenza pandemic).¹⁶ A recent AHA webinar on COVID-19 projected that 30% (96 million) of the U.S. population will test positive, with 5% (4.8 million) being hospitalized. Of the hospitalized patients, 40% (1.9 million) would be admitted to the ICU, and 50% of the ICU admissions (960,000) would require ventilatory support.¹⁷ Such projections, however, are gross estimates. Some assumptions underlying these projections are uncertain, and the pacing of a large outbreak would influence whether ICU resources in isolated locations or nationally are severely taxed over many months or quickly overwhelmed over a shorter period. Additionally, COVID-19 patients may remain mechanically ventilated for indeterminate periods of time, with some developing prolonged or chronic critical illness requiring the extended use of ICU beds, ventilators, supplies, and trained clinicians.

Staffing to care for critically ill patients: As large numbers of critically ill patients are admitted to ICU, step-down, and other expansion beds, it must be determined who will care for them. Having an adequate supply of beds and equipment is not enough. Based on AHA 2015 data, there are 28,808 intensivists who are privileged to deliver care in the ICUs of U.S. acute care hospitals. Intensivists are physicians with training in one of several primary specialties (eg, internal medicine, anesthesiology, emergency medicine, surgery, pediatrics ) and additional specialized critical care training. However, 48% of acute care hospitals have no intensivists on their staffs.³ Based on the demands of the critically ill COVID-19 patient, the intensivist deficit will be strongly felt. Additionally, there are an estimated 34,000 critical care advanced practice providers (APPs) available to care for critically ill patients.¹⁸ Other physicians with hospital privileges, especially those with previous exposure to critical care training or overlapping skill sets, may be pressed into service as outpatient clinics and elective surgery are suspended. All other ICU staff (eg, APPs, nurses, pharmacists, respiratory therapists) will also be in short supply. Without these key members of the ICU team, high-quality critical care cannot be adequately delivered. Moreover, an indeterminate number of experienced ICU staff may become ill, further straining the system as need and capacity surge.

From the report–

Read the full report here.
Hat Tip Larry Johnson

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