WASHINGTON (CN) — Doctors take an oath to preserve life to the best of their ability. Neither skill nor desperation can manifest a ventilator, however, in the coming days when facilities across the country exhaust their supplies to treat the surging population of Americans becoming sick with Covid-19.
The respiratory disease caused by novel coronavirus has infected over a million people globally and killed more 73,000 since first emerging in China last December. At its most fatal, without the assistance of a lifesaving ventilator, the virus grips its victims with an agonizing asphyxia. Survivors of acute infections liken the experience to having ground glass in the lungs.
The United States will reach peak use of its ventilator supply on Saturday, April 11, according to a forecast continuously updated by the Institute for Health Metrics and Evaluation, part of University of Washington Medicine.
And with each new wave of patients seeking care, American doctors and nurses are brought closer to a harrowing dilemma they likely heard about last month from their brethren in Italy — whose early experience with the virus offered for many nations a case study in pandemic response — about whose life will be supported with a ventilator or who will wait, and potentially die, as a result.
To meet demand, President Donald Trump tasked companies like General Motors and Ford with manufacturing 100,000 ventilators in 100 days. Neither company got started, however, before this week. Ford expects to have produced just 1,500 ventilators by April’s end. By mid-May, GM says it could produce 10,000 ventilators per month.
As for the strategic national stockpile, the Federal Emergency Management Agency shared documents with Congress last week indicating that just 9,500 ventilators were left. Those stocks are now totally depleted, the Health and Human Services Department confirmed Monday to the House Oversight Committee, as demand continues to rise.
The circumstances are far from ideal, and it may very well be that the first leg of a rationing race in one of the world’s wealthiest nations has already been lost. On this, only time will tell. Physicians in the meantime will rely on their own prowess and their state’s rationing guidance where and if it exists. Most states offer protocols, but there are no federal recommendations to anchor them.
Neither the White House nor the Health and Human and Services Department returned multiple requests for comment.
“The impulse of physicians is always, and ought to always be, to care for the sick and vulnerable,” said Dr. Daniel Sulmasy, professor of biomedical ethics at Georgetown University where he is also acting director of the Kennedy Institute of Ethics. “We hope we can avoid rationing, but if not, a fair way of doing it must be based on a combination of need, prognosis and the chance of actually benefiting or surviving.”
Those issues are typically applied against a scoring system with criteria varying from state to state. The criteria for and against access to ventilators consider diverse factors including pregnancy, Alzheimer's disease or even status as a first responder to the pandemic.
Under the best circumstances in medicine, the utilitarian approach — achieving the greatest good for the greatest number of people — poses its own difficulties. In crisis, the premise becomes even complicated.
As hospital systems feel the full weight of coronavirus response, for example, the Health and Human Services Department Office for Civil Rights issued a stark warning to doctors on disability discrimination when confronting expected supply shortages.
Care cannot be denied to a person with a disability on the basis of “stereotypes, assessments of quality of life, or judgments about a person’s relative worth based on the presence or absence of disabilities,” the guidance states.