NEW YORK — Hospitals and physicians are making difficult choices to contend with an almost certain shortage of ventilators in the coming days, as the coronavirus rapidly spreads throughout the state.
Emergency physicians are already being told to use their judgment in deciding who should be hooked up to a ventilator as stockpiles of the essential equipment dwindle. And hospitals are converting machines typically used to treat sleep apnea as bidding wars and supply constraints make it nearly impossible to acquire enough ventilators and protective equipment ahead of the projected apex of cases in New York.
Medical experts have warned there will be long-term ramifications both for the physical health of patients and the mental health of the doctors faced with life and death decisions — but the worsening pandemic has increasingly made such choices a necessity.
“Already, some emergency physicians are reporting being told the equivalent of ‘Use your best judgement. You’re on your own,’” said Art Fougner, a medical doctor and president of the Medical Society of the State of New York, in a statement on the ventilator shortage. “For sure, we will be seeing increasing depression and PTSD that will eclipse today’s physician burnout.”
Fougner advised medical centers to refer to the state Department of Health’s 2015 guidelines on ventilator allocation as a “framework to inform policy decisions.” The guidelines were written to help hospitals decide who should get ventilators in the event of an influenza pandemic.
“To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized,” the guidelines read.
But in a sign of the delicate balance between saving lives and calming a nervous public, the state health department is saying its own guidance is not official policy.
“The 2015 task force for life and law report is not a binding policy document and is not guiding the state’s response,” said state health department spokesperson Jill Montag. “The Governor has been clear from the start that his focus is procuring all the appropriate medical equipment to manage this public health response.”
Physicians are already expressing worries they will soon have to make tough ethical decisions to provide care without extra ventilators, with the New York chapter of the American College of Physicians calling on Gov. Andrew Cuomo to grant doctors immunity from liability for the decisions they make, according to a report in The New York Times.
Mayor Bill de Blasio recently refused to discuss plans for how to ration care if there are not enough ventilators to go around.
“The goal is to fight every minute to avoid ever having to get to that point,” he said at a Wednesday press conference.
Cuomo, asked a similar question, had virtually the same message.
“I don’t even want to think about that consequence,” he said Tuesday. “I want to do everything I can to have as many ventilators as we’ll need.”
Ventilators are in such short supply that even Tesla and SpaceX CEO Elon Musk couldn’t get his hands on them after promising to donate hundreds to the state. He shipped CPAP and BiPAP machines that are intended to help people with sleep apnea breathe through the night, according to two sources familiar with the matter.
“Not what we needed, nor what he’s been claiming to have and send,” said one hospital worker who requested anonymity.
Hospitals have scrambled to repurpose the machines to beneficial use. They will have to add extra HEPA filters and use them for patients with less severe symptoms, one official said.
The state health department approved Northwell’s protocol allowing BiPAP machines to be converted into ventilators, Cuomo announced on Thursday. He said the state has acquired 3,000 of the machines to be deployed to hospitals with the greatest need.
Musk has promised to eventually convert his factories in Fremont, Calif., and Buffalo, N.Y., to produce ventilators, and said last week he was “making good progress” on the effort. A Tesla spokesperson didn’t return a request for comment and more information.
Cuomo warned Thursday that the state could run out of ventilators in just six days. There are now more than 92,000 confirmed Covid-19 cases in the state and more than 2,300 deaths.
“There is no state and no country that has done anything to provide ventilators that we are not doing,” Cuomo said.
Sally Goldenberg contributed to this report.