Louisiana coronavirus: A third of state's 2,750 ventilators won’t help. Here’s why

Andrew Capps | Lafayette Daily Advertiser

A third of ventilators across Louisiana won’t be suitable for coronavirus patients in severe respiratory distress, forcing the Louisiana Public Health department to adjust estimates that now show a greater need as cases continue to spike.

Out of the state’s 2,749 ventilator units, 920 are emergency portable ventilators (EPVs) that don’t provide adequate acute care management for long-term respiratory illnesses like COVID-19.

The realization prompted the state to change how it reports regional ventilator capacity, painting an even more dramatic picture of a feared shortage of the critical breathing machines as the number of cases and patients continue to surge.

Of the state's 1,829 hospital-level, full-care ventilators, just 952 units — or 52% — were available as of Monday, with availability differing dramatically across Louisiana's nine healthcare regions.

Previous estimates that included the emergency portable ventilators deemed ineffective for COVID-19 had statewide availability at about 72% as of Thursday.

Gov. John Bel Edwards highlighted concerns about the state's need for ventilators Tuesday after health officials reported another record day with more than 1,200 new cases and 54 additional deaths. Louisiana has reported a total of 5,237 cases and 239 deaths.

"The numbers like we’re reporting today keep us on a very steep trajectory in terms of our case growth and we know that that puts us firmly on the path to exceeding our capacity to deliver health care.” Edwards said during a briefing, noting that since Thursday the number of COVID-19 patients requiring hospitalization and those needing more intensive care with ventilators has doubled.

The state health department reported Tuesday that 1,355 COVID-19 patients required hospitalization, or about 26% of the reported cases, while 438 required more intensive ventilator care, or about 8% of the total cases.

Edwards said he was pleased to learn President Donald Trump approved on Monday sending 150 additional ventilators, which the governor noted is "not everything that we need, but it will help."

The New Orleans area is expected to run out of ventilators Saturday and hospital beds Tuesday, Edwards said.

In New Orleans, where more than 3,100 people have tested positive for COVID-19, making it the state's hardest hit region and a national hot bed for the disease, 217 full-care ventilators remain available, or just under 40% of the four-parish region's supply.

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Dr. Joseph Kanter, assistant state health officer and New Orleans region medical director for the state health department, explained the severity of COVID-19’s impact on a patient’s lungs puts necessary care beyond the abilities of emergency ventilators, which are often limited in how they control a patient’s air flow, rate of breath and oxygen concentration, all vital specifications in combating a primarily respiratory illness.

“A portable ventilator might be appropriate to transport a patient for a half-hour ambulance ride or as a temporizing measure,” Kanter said. “But when you have these patients who not only are extremely sick, but are sick with a primary respiratory disease, it’s their lungs that are sick, and they become incredibly challenging to manage on a ventilator, more so than normal ICU patients.”

“These patients are in the ICU because it is their lungs that are failing, so the ventilation becomes an important issue,” he added.

MORE: Coronavirus: As Louisiana's cases rise, a look at how many ventilators, beds are available

The portable ventilators won't be effective for long-term COVID-19 care, Kanter said, and the new estimates for need with fewer available ventilators underscores the urgency of the situation.

"If current trajectories hold and we do not get the resupplies that we have asked for, we are looking in Region 1 (New Orleans) at running out of ventilators at some point within a week," Kanter said. "We have a lot of requests out, and a lot of purchase orders with private companies, but signing an order is not the same as having a truck headed to your state right now."

The situation in Acadiana isn't as dire yet, the area's regional medical director Dr. Tina Stefanski said, as 54%of the region's 207 full-care ventilators remained available Monday. But the concern is similar.

"A high percentage of individuals are ventilated to help support their breathing, and they remain hospitalized and on those machines for a longer period of time than we typically see with other respiratory illnesses, which is one of the reasons why we hear concerns about the shortage of ventilators," Stefanski said Tuesday. "A higher number of these individuals are requiring respiratory support and then they’re staying on these machines longer to help support their breathing."

MORE: Louisiana suffers deadliest coronavirus day with 54 new deaths, more than 1,200 new cases

Kanter said the Department of Health has been tracking full-care ventilators and EPVs separately for some time, and the change in how LDH reports ventilator availability doesn't show a sudden increase in ventilator need but instead more accurately reflects the states existing, limited availability.

Innovations that would allow patients to share ventilators have also been considered in the state's response to the virus' spread, and Kanter said that just needing to have those conversations is "extremely drastic."

Still, those solutions typically have the same limitations that the emergency ventilators have in that they don't allow doctors to tailor critical care to a patient's specific needs.

"There are ways you can kind of DIY a ventilator to ventilate for two or even three patients at a time, which is not as nice a solution as it sounds because it means you have to take three patients and split the difference to put them all on the same settings," Kanter said. "The fact that those conversations are being entertained right now is drastic."

MORE: Louisiana's hospitals could be overwhelmed by COVID-19 virus in all but best scenario

The state's impending shortage of ventilators also doesn't appear to be a short-term problem, as states compete with each other and with the federal government for access to more ventilators, as well as personal protective equipment, testing kits and other supplies.

Kanter said the federal government's characterization of the coronavirus pandemic as a war was mostly accurate, but he is seeing a disheartening lack of coordination among the country's agencies tasked with waging the fight.

"The federal government has said that this is like being in a war, and I think that’s true to a large degree," he said. "But what it feels like now is like each battalion is competing against one another to get the stuff that they need, which is crazy."

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