South Carolina hospitals may be without the breathing machines needed to save critically ill patients as the coronavirus spreads. If that happens, finding more can be extremely challenging.
Many thousands of state residents may need intensive care during the COVID-19 pandemic, an analysis by Post and Courier shows. The number of ventilators – used to fill the lungs of patients with the most severe cases – may not match. Whether the state supply can handle the tension depends on whether people follow orders to stay home.
The newspaper began asking questions about the number of fans in South Carolina more than a week ago. At the time, the State Department of Health and Environmental Control did not know the answer. The agency searched hospitals on Sunday to find out, said Dr. Rick Toomey, executive director of DHEC. The results: South Carolina has 1,260.
Manufacturers are overwhelmed with purchase orders. The National Strategic Stock has a stock of 16,600 fans, reported the Center for Public Integrity, but has not yet released any to the states. DHEC did not request anything from the federal government.
South Carolina received its first shipment of the stock last week, including only protective equipment.
Many hospitals have refused to disclose how many fans they have in their stores.
Roper St. Francis Healthcare said it has about 50 ventilators at its four Charleston hospitals. Two weeks ago, the system tried to acquire another 25.
They are on hold, with no expected delivery.
Whether hospitals have enough will depend on the extent of the spread of the disease, said Dr. Chris McLain, chief physician at Roper St. Francis. If the cases are contained, “then we look good,” he said. Otherwise, “you can sell out quickly”.
Between 13,000 and 31,000 South Carolina residents may need intensive care during the coronavirus pandemic, the newspaper’s analysis shows. There are about 950 intensive care beds to accommodate them, most of them grouped in populous cities in the state.
Not all residents will need help at the same time. If people follow orders to distance themselves socially and the health department does everything in its power to fight the virus, these cases will spread over time. Like a tidal barrier, the overhead of a hospital depends on the size of the wave of patients who fall ill at once.
The ventilators breathe for patients who are unable to oxygenate their own blood, said Dr. Scott Hayes, president of the state division of the College of Emergency Physicians. The size of a medium suitcase, the machines are often used in severe cases of seasonal flu, which killed 103 South Americans in mid-March.
He stressed that the proportion of patients who will need the help of a ventilator is small.
“Everyone needs to be aware and not panic,” said Hayes.
With a price between $ 25,000 and $ 50,000, it is difficult to find fans in normal times.
About 14 percent of the state’s fans were already in use when DHEC completed its survey. At the moment, the agency does not expect scarcity.
“We are constantly reevaluating our resources and planning accordingly,” said a spokeswoman.
More shipments are expected from the national stock in the coming weeks. Although some fans are available, they are likely to be assigned to states in greatest need, such as New York. DHEC has requested 130 more and is “waiting for an answer about what we will receive,” said Toomey on Wednesday.
In other countries with larger outbreaks, tense intensive care has led to death. Nearly 7,000 people died in Italy, and doctors had to decide which patients would be helped to breathe.
How many in SC will need intensive care
The Pandemic Influenza plan of the Department of Health and Environmental Control of SC, updated in 2017, considers three scenarios: The virus infects 15%, 25% and 35% of the population. How long it would take for these projections to materialize depends on many factors.
In that plan, the state predicts that 12% of those infected will need to be hospitalized and there will be at least 2,000 deaths. The 2005 federal government plan estimates that 15% of patients will need an ICU bed.
| Scenario | South Carolina | Charleston Residents |
|---|---|---|
| No. infected, 15% | 762,619 | 60,886 |
| Not hospitalized, 15% | 88,464 | 7,063 |
| No. Requiring intensive care, 15% | 13,270 | 1,059 |
| No. infected, 35% | 1,779,444 | 142,067 |
| Not hospitalized, 35% | 206,416 | 16,480 |
| No. Requiring intensive care, 35% | 30,962 | 2,472 |
People with heart problems and diabetes are among the most likely to need intensive care, including ventilatory support, according to research published in JAMA.
These are two conditions that many South Carolina residents struggle with. The Centers for Disease Control and Prevention ranks the state 11th in diabetes-related deaths in the country. Deaths from heart disease are not much better.
During a briefing last week, President Donald Trump said the United States has “an enormous number” of fans. But he acknowledged that it will not be enough.
“There has never been a case like this, where no matter what you have, it is not enough,” he said.
In a call with the country’s governors last week, Trump warned that there will not be enough fans for everyone and advised state leaders to obtain their own supplies.
ICU capacity and ventilators will remain at the top of the minds of hospital leaders, McLain said.
Roper St. Francis can use some ventilators from other parts of the hospital, such as surgery, if necessary. But it also depends on how many patients currently need surgery.
Without any social distance or public health efforts, cases of illness will double every 10 days, according to the American Hospital Association. New York Governor Andrew Cuomo said that cases double in New York City, the country’s current access point, every three days. Leaders said they needed thousands more fans to deal with the outbreak.
Sheldon Jacobson, a computer scientist and professor at the University of Illinois at Urbana-Champaign, said the peak of the disease should occur in the next two to three weeks. The likely intensity of the pandemic in South Carolina is difficult to determine, in part because very little is known about the new virus.
“We are still at the very beginning of this process,” said Jacobson. “There is much more that we need to learn and observe.”
