The U.S. has more critical care hospital beds per capita (34.7 per 100,000 population) than most other countries -- almost 10 times as many as China (3.6) and about triple the rate in Italy (12.5).

But the number of ICU beds and mechanical ventilators in U.S. hospitals is only a fraction of what may be needed in the weeks and months to come if worse-case scenario projections for COVID-19 become reality, according to a March 13 report from the Society of Critical Care Medicine (SCCM).

The American Hospital Association (AHA) has reportedly predicted that if the COVID-19 virus continues to spread as projected, 4.8 million patients would need hospitalization, 1.9 million COVID-19 patients would require admission to ICUs and 960,000 would require mechanical ventilation.

Unfortunately, according to the SCCM, that's about five patients for each ventilator that could be put into service. And that's not even the worst-case scenario: recent projections from the CDC, reported by the New York Times, indicate that COVID-19 hospitalizations in the U.S. could go as high as 21 million.

The report from the SCCM Ventilator Task Force estimated that some 62,000 fully functional mechanical ventilators are in operation in the U.S., with roughly 100,000 older models that could be put in use if needed, including 22,976 noninvasive ventilators, 32,668 automatic resuscitators, and 8,567 CPAP units.

The task force members noted that the addition of these older hospital ventilators, along with stockpiled ventilators from the CDC and anesthesia machines, "increases the absolute number of ventilators to possibly above 200,000 units."

But the report also warned that many of the older ventilators may not be capable of supporting patients with severe respiratory failure and that supplies for the ventilators may not be available "due to interruptions in the international supply chain."

"Moreover, an analysis of the literature suggests that U.S. hospitals could absorb between 26,000 and 56,000 additional ventilators at the peak of a national pandemic, as safe use of ventilators requires trained personnel," wrote task force members Neil Halpern, MD, and Kay See Tan, PhD, both of Memorial Sloan Kettering Cancer Center in New York City.

Halpern and Tan further noted that if the AHA or CDC COVID-19 case projections become a reality, a shortage of ICU physicians and support staff trained in mechanical ventilation could limit the maximum number of ventilated patients to approximately 135,000.

On Monday, President Trump reportedly acknowledged a potential ventilator shortage should COVID-19 hospitalizations surge markedly.

While the reported AHA and CDC projections paint a bleak picture of ICU coronavirus preparedness, pulmonologist and critical care specialist Lewis Rubinson, MD, told MedPage Today that those projections do not take into account the unprecedented efforts now in place in the U.S. to slow the spread of coronavirus cases and "flatten the curve" of infections and illness.

Rubinson is chief medical officer for Morristown Medical Center in Morristown, New Jersey, and he is a past chair of the SCCM's Fundamental Disaster Management Task Force.

"For the most part, if we really do what we need to do, we may have sufficient numbers of critical care beds and ventilators to get through this," he said. "But it is going to take significant collaboration -- with the public actually practicing social distancing, testing ramping up to allow us to do the case finding and contract tracing to reduce transmission speeds, and hospitals maximizing the availability of ventilation."

Rubinson said rapid testing for coronavirus is also urgently needed to improve the ability of hospitals to address the coronavirus pandemic.

"Right now it is taking about 2 days or even 4 to get a test back," he said. "So if I ventilate a patient suspected of having COVID-19 and they don't have it, I have to treat them as if they do until the test comes back. In this scenario, we are burning through our personal protection equipment unnecessarily and my staff efficiency is much lower than it needs to be."

"Rapid testing is enormously important for operational efficiency to allow us to perform surge capacity patient managment."

As of Monday, the CDC reported that just over 25,000 specimens had been tested for COVID-19 by the CDC and public health laboratories across the nation.

Speaking at a joint press conference Monday that included President Trump, Vice President Mike Pence, and health officials, Assistant Secretary for Health Admiral Brett Giroir, MD, said that by the end of the week, around 2000 laboratories across the nation will have the capacity to test approximately 1.9 million, with another 2 million tests available next week, and 5 million the following week.

One limitation of the SCCM report was a reliance in some cases on old data. Ventilator counts, for example, were estimated from a 2009 American Hospital Association survey. Figures for critical care beds per capita in the U.S. also dated to 2009; for European countries the data were from 2012. The Asian data were from 2017, however.