Andrew Cuomo and the federal government are battling it out over 20,000 ventilators believed to be idling in a federal stockpile, ventilators that the governor - who is enjoying a moment of celebrity thanks to his swift and reassuring response to the crisis, even as New York has emerged as the epicenter, and one of the few places where hospitals are truly overwhelmed by the crisis - badly needs.
Without them, the state could see dozens of unnecessary deaths, something that would reflect poorly on the national mortality rate, and an easily preventable tragedy.
As deaths spiked on Wednesday and Thursday, Cuomo proclaimed that he had given hospitals permission to split ventilators between two patients, something that can be accomplished with a minor modification, but is said to be a practice of last resort, as it greatly diminishes the quality of care, according to professional medical groups.
During his Thursday press conference, Cuomo revealed that the need for ventilators is on track to be even greater than he initially anticipated, as the state is finding that patients with severe cases are staying on the ventilators longer than expected. Typically, serious respiratory illnesses requiring ventilation will have a patient hooked up for 3-4 days. For COVID-19, the range expands to 11-21 days, with some cases lasting as long as 30 days.
The longer a patient is ventilated, the lower their odds of survival, Cuomo added. Because of this, the state needs three times as many ventilators as it would for other respiratory illnesses.
New York Gov. Andrew Cuomo on Tuesday made an impassioned plea for thousands of ventilators to be sent to his state within the next 14 days to deal with an expected severe shortage given the wave of patients expected to be infected with the coronavirus. He urged the Trump administration to use the Defense Production Act to get corporations to produce the equipment. And the government should also send the state the 20,000 ventilators now in a federal stockpile, he said.
VP Pence later promised Cuomo 4,000 out of the stockpile (surely, the ventilators must be divided up based on need, and regardless, the federal stockpile still leaves states well short of their ideal numbers). But at least Cuomo is getting the national guard building an overflow COVID-19 hospital at the Javits Center and doctors and nurses and flowing in to volunteer.
Earlier this week, during a Fox News Town Hall, Trump slammed Cuomo for not stocking up on more ventilators in accordance with a report by the state Department of Health which found the state would be short by roughly 15,000 ventilators.
"He had a chance to buy - in 2015 - 16,000 ventilators at a very low price and he turned it down. I'm not blaming him or anything else. But he shouldn't be talking about us. He's supposed to be buying his own ventilators. We are going to help," Trump said.
Cuomo accused Trump of lying, and although Trump seemed to get some key details wrong, his mistakes are understandable. Really, what this report said, was that the state should depend on federal support if something like the Spanish Flu ever happened. But really, there was no adequate preparation for this on the federal or state level.
"In the event of an overwhelming burden on the health care system, New York will not have sufficient ventilators to meet critical care needs despite its emergency stockpile. If the most severe forecast becomes a reality, New York State and the rest of the country will need to allocate ventilators and other scarce resources," the report read.
Which is why, Cuomo said Thursday, he believes Trump should use his newly authorized executive authority to order companies to start manufacturing more ventilators, which will be needed by all states, something that Trump has also inexplicably refused to do.
Calling the technique “not ideal, but workable,” Cuomo said ventilator splitting may be necessary given some projections that suggest the state may need as many as 30,000 ventilators in the coming weeks, compared to the 6,000 to 7,000 that it has on hand. At this point, there's no way New York will be able to "flatten the curve" enough to compensate for this gulf.
Cuomo's announcement drew immediate criticism in a joint statement issued by several medical associations advising clinicians "that sharing mechanical ventilators should not be attempted because it cannot be done safely with current equipment."
But with the country facing a potential shortage of hundreds of thousands of ventilators, according to some projections, the technique could soon be replicated in hospitals nationwide, unless hundreds of thousands of ventilators are added to the US supply in the coming months - something that doesn't look likely.