Kathleen Johnson has been following the coronavirus outbreak closely from her Madison home. Like plenty of other people, she’s constantly heard about how central ventilators are to treating patients with COVID-19.
And she had a question for hospitals and health officials she was hoping WORT could help answer.
“If it came to it, how would [hospitals] figure out who gets a ventilator, and who’s left to die?” Johnson said.
The dilemma seems severe, and it is. But hospitals have not yet reached the point where such difficult decisions need to be made. In fact, discussions among health officials regarding the use of ventilators to treat patients with COVID-19 are evolving, and the role of ventilators could be shrinking with it.
Dr. John Koszuta is a Pulmonary Critical Care Physician and Intensivist with Bellin Health in Green Bay. He’s worked with patients with COVID-19, and stresses that if ventilators are used too early, they may actually increase the risk of a patient dying.
“In China, and Italy, and also in New York City, when you look at those people that go on a ventilator, their risk of dying goes up. Not because the ventilator’s a bad thing, but it represents a different way to ventilate people,” Koszuta said.
Koszuta said ventilators have the potential to worsen symptoms of COVID-19 if they’re used too early, since the virus attacks the lung’s ability to circulate oxygen, and ventilators pump air into the respiratory system.
“There are a lot of things this virus causes that affects both ventilation and perfusion, and those changes get worse when you go on a ventilator,” Koszuta said.
Koszuta says the use of ventilators is still important in combating the progression of COVID-19, but the equipment is not the first tool out of the box when treating patients.
Instead, he says his hospital uses non-invasive ventilation to treat patients early-on. That includes strategies like giving patients humidified oxygen—a procedure that helps patients breathe without the adverse effects of a ventilator.
State officials also agree that ventilators are not the first line of treatment for COVID-19. Dr. Ryan Westergaard is Wisconsin’s Chief Medical Officer. He told WORT in a briefing today that there’s more being learned about alternative strategies, including lying patients on their side to help remove mucus buildup in their lungs.
“In this particular epidemic, some people have learned things like using ventilators sparingly, or doing high-fluid nasal cannula oxygen, putting people ‘prone’ on their stomach are some other strategies,” Westergaard said.
However, Westergaard emphasized that the most severe cases still require ventilators.
But according to Koszuta and data from the Wisconsin Hospital Association, hospitals have enough ventilators to adequately treat patients given the virus’s current trajectory. The state is only using a quarter of its ventilator supply to treat patients.
Meanwhile, health care professionals and state officials are emphatic that the state’s shortage of adequate personal protective equipment is a more pressing question than ventilator supply.
But to answer Kathleen’s original question: who would get a ventilator and who would not if we did reach a shortage?, DHS Secretary Andrea Palm had this to say.
“We have not been in a situation where allocation was an issue,” Palm said.