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A Ventilator Stockpile, With One Hitch: Thousands Do Not Work

Accepted submission by upstart at 2020-04-02 05:50:24

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A Ventilator Stockpile, With One Hitch: Thousands Do Not Work []:

The Coronavirus Outbreak []


Continue reading the main storyA Ventilator Stockpile, With One Hitch: Thousands Do Not Work

While President Trump has assured states that thousands of ventilators remain at the ready, thousands more are in storage, unmaintained or otherwise unusable.

The Federal Emergency Management Agency sent about 7,000 ventilators to states, with 400 directed to New York, above, by Wednesday.

  • April 1, 2020

WASHINGTON — President Trump has repeatedly assured Americans that the federal government is holding 10,000 ventilators in reserve to ship to the hardest-hit hospitals around the nation as they struggle to keep the most critically ill patients alive.

But what federal officials have neglected to mention is that an additional 2,109 lifesaving devices are unavailable after the contract to maintain the government’s stockpile lapsed late last summer, and a contracting dispute meant that a new firm did not begin its work until late January. By then, the coronavirus crisis [] was already underway.

The revelation came in response to inquiries to the Department of Health and Human Services after state officials reported that some of the ventilators they received were not operational, stoking speculation that the administration had not kept up with the task of maintaining the stockpile.

In fact, the contract with a company that was maintaining the machines expired at the end of last summer, and a contract protest delayed handing the job to Agiliti, a Minneapolis-based provider of medical equipment services and maintenance. Agiliti was not given the $38 million task until late January, when the scope of the global coronavirus crisis was first becoming clear.

It is not known whether problems with the ventilators predated the contract lapse, but maintenance of the machines did halt. That delay may become a potentially deadly lapse.

“We were given a stop-work order before we’d even started,” said Tom Leonard, the chief executive of Agiliti, which had won the contract to service the ventilators in the stockpile. “Between the time of the original and the time of this contract award, I don’t know who was responsible or if anybody was responsible for those devices. But it was not us.”

Mr. Leonard said confidentiality agreements with the government over the stockpile prohibited him from giving specific figures on the number of ventilators the company was now working on.

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“We still have that first tranche of ventilators, although we’re accelerating the work to get them deployable,” Mr. Leonard said. “We haven’t seen or touched or had anything to do with the ones that have already been deployed to date.”

Ventilators are sensitive machinery that Mr. Trump described on Sunday as so complex they were like “building a car.” But, experts say, like a car, they cannot be stored for lengthy periods without maintenance. So few are surprised that as the nation’s hospitals scramble to pull together every usable ventilator they can find, some have come out of storage with depleted batteries, missing oxygen hoses and other issues.

California recently discovered that 170 of its ventilators arrived broken, disputing the claim from the Department of Health and Human Services that all of the ventilators shipped by the Federal Emergency Management Agency were ready to use. The agency said in a statement that problems with some ventilators were limited to the devices’ external batteries, and that federal officials were quick to assist the states with any technical issues.

Federal officials revealed on Wednesday that their stockpile of medical gear was nearly depleted. FEMA has shipped 26 million surgical masks, 11.6 million respirator masks and more than five million face shields to states, setting off a race to obtain millions of recently produced masks from a variety of manufacturers at a moment of huge price spikes for respirators that previously sold for about 85 cents.

The bigger struggle, however, has focused on ventilators because states have asked for tens of thousands more than the approximately 9,400 that the U.S. government currently has in its stockpile. The Defense Department is also making 1,065 ventilators available, although those require special training and are not used as frequently in hospitals.

As White House officials have for the first time looked at a supply they had not thought about, they have discovered it is not only far smaller than what they need — it is also in constant need of maintenance.

Aric Vacchiano, the vice president of U.S. sales and services at Vyaire Medical in Chicago, which produces the LTV 1200, one of the ventilators in the federal stockpile, said the company had been fielding calls from all over the country as hospital officials rushed to get the machines in working order.

“They’re reaching out in every direction,” Mr. Vacchiano said.

Vyaire was responsible for maintaining some of the ventilators in the federal stockpile until that contract ran out in late August. The company protested when a broader contract to keep the stockpile up-to-date was granted to Agiliti instead. The dispute was not resolved until January, when Agiliti again prevailed.

It then received thousands of ventilators — it would not say how many — for restoration, and that work is still underway.

A spokeswoman for Health and Human Services did not respond to questions about what had happened to ventilator maintenance during the lapse, but she said the agency had sped up the contract with Agiliti to make the remaining 2,109 ventilators available by April 30.

As of Wednesday morning, FEMA had sent about 7,000 ventilators to a number of states, with 4,000 directed to New York. Mr. Trump said he wanted to hold the current stockpile in reserve until it was clear where new hot spots would emerge.

Even with the federal help, states are scrambling for their own ventilators. They have flooded the few manufacturers in the country with orders, only to discover that the machines are largely made abroad, in China, Ireland, Switzerland and elsewhere.

“We’re very short,” Gov. Ned Lamont of Connecticut said on CNN on Monday. “We had our ventilators all set to come, and at the last moment FEMA redirected them,” he said, to “another place that they considered more urgent than Connecticut.”

Officials in Illinois say they asked for 4,000 and got 450. New Jersey sought 2,300 and got 300. New Mexico has only 370. Virginia requested 350 ventilators but has not received any. The governor of Illinois asked Vice President Mike Pence for 4,000 ventilators this week and was told the state would not need that many.

At the same time, states are trying to grab whatever else they can, converting anesthesia machines for use as ventilators and sometimes fashioning new valves on 3-D printers so that multiple patients can share the same machine. That has never been tested on a broad scale, and it carries some risks.

To manage the scarcity of ventilators in the stockpile, FEMA has begun sending a questionnaire to states seeking ventilators, asking about available resources and whether hospitals have tried converting anesthesia machines. A FEMA official said state leaders could submit requests for ventilators at any time but should not expect their delivery unless patients were at risk of dying within 72 hours without the devices.

And states are discovering that much of what they can get their hands on needs work.

“Devices are being deployed, and many times it’s not clear to us whether they’re from the Strategic National Stockpile or some cache of products that may have been from that specific hospital, from that specific state or maybe another entity locally,” Mr. Vacchiano said. “In many cases, especially in places like New York, we are definitely overnighting materials to step up to the plate and try to help.”

He estimated that 80 percent or more of the calls that Vyaire has received have come from the greater New York area.

“We’re not hearing or seeing units showing up being truly or fundamentally broken,” Mr. Vacchiano said. But, he conceded, “they probably have not been maintained.”

Jonathan Martin contributed reporting from Washington. Kitty Bennett contributed research.

The Coronavirus Outbreak []

    • How does coronavirus spread?

      It seems to spread very easily from person to person, [] especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. [] It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, [] and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. [] If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Should I wear a mask?

      Experts are divided on how much protection a regular surgical mask, or even a scarf, can provide [] for people who aren’t yet sick. The W.H.O. and C.D.C. say that unless you’re already sick, or caring for someone who is, wearing a face mask isn’t necessary. And stockpiling high-grade N95 masks will make it harder for nurses and other workers to access the resources they need. But researchers are also finding that there are more cases of asymptomatic transmission than were known early on in the pandemic. And a few experts say that masks could offer some protection in crowded places where it is not possible to stay 6 feet away from other people. Masks don’t replace hand-washing and social distancing.

    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. [] And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • Should I pull my money from the markets?

      That’s not a good idea. [] Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.


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