A collaboration by hospitals and government has expanded the number of beds available for the state’s COVID-19 patients, but there is now a potentially greater challenge: how to find the ventilators that will be a critical component of treating the surge of patient admissions expected to fill the beds at month’s end.
There are about 1,400 ventilators in Connecticut, the governor’s office said Tuesday afternoon. The state could need 4,000 to treat patients in 12,000 hospital beds, depending on the magnitude of the surge projected to roll west to east across the state in three to four weeks, hospital and government experts said.
To make up the deficit, Gov. Ned Lamont’s office is trying to strike deals with private manufacturers while continuing to plead with the White House for a second shipment from the national stockpile. Hospitals are cooperating and shifting ventilators around the state to meet demand as the surge spreads. And pulmonary experts are engineering innovations to increase efficiency of existing machines — a Manchester pulmonary surgeon has designed a device that will enable two or more patients to survive on a single ventilator should there be a catastrophic spike in the hospitalization rate.
‘We think we have a game plan for those 12,000 beds,” said Josh Geballe, the state’s chief operating officer. “Getting 4,000 ventilators is going to be a challenge.”
Hospitals are now using about half of the state’s ventilator supply, according to government and medical officials. Geballe said state hospitals have enough ventilators to meet short-term patient needs. Shortages could become critical later this month or early next month if worst-case surge projections materialize, particularly in hard-hit Fairfield and New Haven counties.
There were 7,781 confirmed cases of COVID-19 across the state Tuesday evening, with 1,308 hospitalizations. About half the hospitalizations are in Fairfield County. Greenwich and Stamford Hospitals, on the front line, had 107 and 127 COVID-19 patients, respectively, Monday.
Greenwich Hospital CEO Norman Roth said Tuesday morning that 24 of his hospital’s COVID patients were in intensive care and 22 of those were on ventilators. Four patients have been taken of taken off ventilation and discharged to rehabilitation. Roth said his hospital received seven ventilators from the state Monday and currently has a surplus of 20 that are not being used.
Stamford Hospital declined to disclose the number of patients on ventilators.
Hartford HealthCare, working with a lower hospitalization rate, said it had 370 ventilators across its seven-hospital system, in addition to some single-use ventilators. Chief clinical officer Dr. Ajay Kumar said the hospital system does not believe it will experience a shortage at any point and even sent six ventilators to Stamford Hospital, which already is running short.
“We are comfortable to manage the surge to come,” he said.
UConn Health in Farmington has 12 modern ventilators, four older models, three designed for patient transport, and it is trying to rent 10 more, intensive care director Dr. Ray Foley said. He said the hospital had 11 COVID-19 patients on ventilators Tuesday and has begun considering how to allocate the devices among patients in the event of a shortage.
“As patients have been coming in sequentially, we’re able to absorb that,” he said. “If they come in all at once, that’s the problem.”
Asking the White House for help
Ventilators are complex medical devices operated by trained therapists. The machines regulate and assist patient breathing through a tube inserted into the trachea. and can be critical in the survival of COVID-19 patients. The virus attacks lungs in a way that impairs the body’s ability to distribute oxygen. Oxygen deficiency exacerbates pre-existing conditions and critically ill patients are likely to die without ventilation, medical experts said.
Patient survival rates decrease after long periods of ventilation and those discharged may require rehabilitation.
The doctors said projections based on the pandemic so far show that about 20% of COVID-19 patients require hospitalization and a fraction of those require ventilation.
As recently as late last month, there was wide concern that the state would not have enough hospital beds to meet a surge in hospitalizations. Several factors appear to have reduced the threat of a bed shortage, according to Geballe and others. Hospitals complied with Lamont’s request that they expand beds by 50% by reorganizing short-term medical priorities. Mobile field hospitals have created additional capacity. And there are contingency plans to create even more beds, if necessary, by expanding hospital operations into vacant hospital buildings, unused nursing homes and even sports arenas. Social distancing and other mitigation measures also may reduce admissions.
The added hospital capacity pushed ventilators, the subject of global shortages, to the top of the state’s priority list.
A week ago, Lamont ordered 100 ventilators from manufacturer BioMed Devices in Guilford. But Geballe said Monday that purchases on the private market are being threatened by supply chain problems experienced by the manufacturers.
The state asked the Trump administration for 1,500 ventilators a week ago and got 50. Geballe said the governor continues to press Washington for more, but has been concerned by the response. He said the White House said it will send more machines when Connecticut notifies the White House it is within 72 hours of running short. Geballe said Lamont’s office is concerned about how long the federal supply lasts.
Governors across the country have been critical of the White House decision to hold back ventilator shipments. President Donald Trump has said he believes governors are overestimating their requirements and, to conserve its supply, the federal government will ship machines when and where it projects imminent shortages.
Lamont and his staff speak daily with state hospital administrators and the Connecticut Hospital Association. Among the topics are preparations among the hospitals to redistribute ventilators from hospitals with relatively low volumes of critical patients to those experiencing ventilator shortages. Geballe said there are also discussions about moving critical patients rather than the often large, complex devices.
“It is clear that we are going to need additional ventilators,” the Connecticut Hospital Association said in a statement Monday. “Right now, the immediate need is greatest in those parts of the state that have the most COVID patients. Connecticut hospitals are working with the state to ensure that hospitals with immediate need have access to available ventilators or can borrow them from other hospitals. Working as one, hospitals will continue to assess need across the state and redistribute ventilators as the disease progresses.”
Kumar said Hartford Health Care’s shipment of ventilators to Stamford shows “This is a state issue, this is a country issue, not just a Hartford HealthCare issue. We’re in this together.”
Dr. Saud Anwar, a pulmonary surgeon and intensive care physician at Manchester Memorial Hospital, has developed a design innovation that appears, at least initially, as if it will enable hospitals to maximize use of existing ventilators if the spike in hospital admissions creates a catastrophic shortage. With Connecticut engineer Robert Conley, Anwar, who is also a Democratic state senator from South Windsor, developed a device that would adapt a one-person ventilator to serve two, four or even more patients.
Multi-person devices would be used in limited, emergency situations, Anwar said. Their use could create risks and they would have to be operated by highly trained respiratory therapists, he said.
Anwar said he made the design public and it has been downloaded from the internet tens of thousands of times in 313 U.S. cities and in 80 countries. He said the device has been approved for use in New York, but not in Connecticut.
He said some pulmonary medical societies have warned against the expansion of ventilators because of the risks, but he believes the potential benefits in an emergency outweigh limitations.
“It is one thing to sit around at a conference and oppose something,” Anwar said. “I’m on the front line, in the ICU, fighting to save lives. The way I look at it is, ‘Great. Tell it to my patient, who is going to die.’ “
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Courant staff writers Emily Brindley and Alex Putterman contributed to this report.
Edmund H. Mahony can be reached at emahony@courant.com.
