Dire situation in New York State

[NameRedacted]

Not sure if this has been posted yet but this is Governor Cuomo's press conference from yesterday. I watched it live. To those of you not in NY State you may have seen portions of it on the national news.



It's pretty somber and gloomy and is well worth watching. It really helps you understand the nature of the problem.


Edit: You can skip the first 4 1/2 minutes.

It's about an hour long so for those that don't want to watch here are the main points - from memory - so numbers may be wrong.

• The number of cases in NY State is doubling every 3 days.
• The peak in NY State will be reached in 14-21 days.
• We'll need 140,000 beds at the peak and we only have 53,000.
• We need an extra 30,000 ventilators and the Federal Government has promised only 400.
• We are short of PPEs and staff - sorry can't remember the numbers on these.

I live in upstate NY and it's not bad here yet. My gf is at high risk (diabetes and a heart condition). I'm doing my best to protect her. We have enough food for 3 weeks I think and apart from going for a walk every day the only times I'm planning to leave the house over the next few weeks are to pick up her prescriptions. We couldn't get any in advance as her doctor's office was proving obtuse and seems overwhelmed now. She's just sick of talking to them on the phone.



She has a brother in Brooklyn. Fortunately, he's been laid off but has no car and so wasn't able to build up much of any supplies. Another brother is still working locally in one of the most unessential "essential" jobs you could imagine. She's worried sick about both of them.



People finally started to take it seriously here about a week ago, although there are some people who still believe and spread stupid conspiracy theories (I'm looking at you - people on NextDoor).


By far the biggest problem is the shortage of ventilators and it's going to be a national problem and in a few weeks I think we'll see the death rate spike everywhere.


Stay safe guys.

 

[garyt]

If this is too political delete it. But I saw where Cuomo refused to purchase 1600 ventilators in 2015, for use in any future pandemic.

 

[USGrant1962]

I don't get his point on 400 ventilators - is he suggesting that the Federal Government is sitting on a massive stockpile of ventilators and not sharing them with NY? Where is this stockpile?

 

[Fermion]

New York is in need of supplies but so are other areas of the country. It is great if they get their 30,000 ventilators but the other hospitals in other states also need supplies.

 

[RetiredAt55.5]

I don't get his point on 400 ventilators - is he suggesting that the Federal Government is sitting on a massive stockpile of ventilators and not sharing them with NY? Where is this stockpile?

This article says there 16,600 in the Strategic National Stockpile and it gives some history on it.

https://publicintegrity.org/health/coronavirus-and-inequality/the-governments-secret-ventilator-stockpile-is-nowhere-near-enough-to-fight-the-coronavirus/

 

[Boho]

Thanks for the update. I don't know why I didn't check the news first thing in the morning like I always do but this is the first I heard of the expected timeline for the next 21 days.

I live in Brooklyn and don't drive but I have a good backpack with a hip belt that I put to good use with about 5 trips to the supermarket within a week, sometimes two a day. It wasn't until the last trip when the lines were crazy. I think I got more weeks worth of stuff than most people.

I have a washboard and ordered a tub. No more building laundry room for me, I think.

I'm considering a strategy like ordering one or two grocery items from Amazon every couple of days. I have to wait 1-1/2 months for my order of OJ and envelopes, both estimated to arrive on May 14, and I'm thinking the date is of the item it will take longest to ship. The fewer items you order at a time, maybe the better.

 

[Chuckanut]

The situation is dire in many places. Mr. Musk acquired over 1200 ventilators for LA and 50,000 masks for Seattle. We need people who can get us more pies to divide up. We don't need people who are demanding all the slices for their own folks.

If the Feds are sitting on ventilators... What are they waiting for?

 

[HadEnuff]

very scary. we have a son in Brooklyn. We live in Upstate NY, about 250 miles from NYC, on a lake. Pretty secluded this time of year, however, we wintered in Florida, and are still here. We have made the decision not to try to get home at this point, not wishing to try the two-day drive, with an overnight somewhere.
Things could get just as bad down here.
Scary times, gonna get scarier.

 

[Fermion]

If the Feds are sitting on ventilators... What are they waiting for?

Maybe they are waiting to see which areas need them?

New York says they "may" need them. So the Fed ships every single ventilator they have to New York. What happens when it turns out Seattle needs 1000 and New York still has 4500 spread out that are not being used yet?

You don't deplete a emergency reserve immediately, before they are even needed. You ration.

 

[Rianne]

If this is too political delete it. But I saw where Cuomo refused to purchase 1600 ventilators in 2015, for use in any future pandemic.

i have 4 brothers, one has an autoimmune disease(few T cells). I (not sure why I bought it, bad flu season I think last year) have an N99 military grade mask I bought on Amazon. Three weeks ago, I offered it to him. His response "Naaa, I'm good." He did not take virus seriously.
Hindsight is 20/20. Hate to cliche but we need to act now, not nitpick decisions 2 years ago or 3 weeks ago.

 

[copyright1997reloaded]

You don't deplete a emergency reserve immediately, before they are even needed. You ration.

This is the unfortunate truth. If it gets really bad, unlikely that will be contained to NY and there will be a ventilator shortage in a number of areas. (This is coming from someone who lives there, although I am upstate but not super far away from NYC. In my country plus the surrounding counties with one level I trauma center the number of confirmed positives is 222 as of yesterday in a three county area.)

 

[OldShooter]

[rant]There is an implicit myth that drives the public discourse in times like this: That the relief organizations are well-oiled and experienced machines and, thus, any problems are due to incompetence.

In reality, the organizations are being built on the fly and all disasters are unique. So being in the middle of one is like changing all four tires while you're blasting down the road to an uncertain destination.

BTDT on a small scale flying search & rescue. I have also had most of the national Incident Command System training, which is basically to teach standard language and standard org charts for people who are coming together to deal with a problem.

Overlay this with a political situation where every elected official considers themselves to be in charge; sheriff, mayor, governor, cabinet secretary, president, etc. and one of their most important goals is to push everyone aside and get on TV. All of this prevents the people who actually know what they're doing from doing it efficiently.

Logistics is also a nightmare. Space has to be identified and procured. The staff has to be housed and fed beginning at time zero. Then the inbound and outbound freight capacity has to be acquired and organized. Radios, telephones, computers, ... all have to be pulled from emergency warehouses and distributed. Special things like gowns and masks, respirators, etc. must also be acquired or identified and moved. All of this requires a triage function that serves to prioritize, making almost no one happy.

Really, it's a miracle that anything at all gets accomplished. Think about it and be grateful, folks.[/rant]

Edit: As I read this I realize it could be interpreted as an attack on posters here. Really, as I think about it the rant is probably aimed mostly at the politicians and idiots [MOD EDIT]who want to hog all the resources and to see themselves on TV. Apologies to anyone who was offended.

 

[Ready-4-ER-at-14]

I have a specific question about ventilators. I understand that fda approval for ventilator requires a complex and sophisticated system. I have some medical, biological, and engineering background so I hope my question is not so bad that it totally embarrasses me

I always try to look outside of the box a bit and I have a basic engineering question.
If the reason for the ventilator is simply to get oxygenated air into diseased lungs and any increase leads to more people living, why couldn't the government use some makeshift heart lung device similar to old iron lungs at least for the non critical people?

I envision a bulky chest plate type thing with both an exhaust and a blower port. This could be molded plastic with airtightness around neck and waist area. They are then hooked up to a compressor vacuum system with some sort of cam regulator opening and closing the ports (pressure and suction) to simulate and assist breathing. Yes we would have to breathe with the cycle of the machine. Some sort of nasal oxygen tube and a source of moisture in the oxygen supply.

 

[Fermion]

I wonder if you could fill someone's lungs with that hyperoxygenated fluid that deep divers use? There are probably only a couple of those systems in the USA though.

 

[Rianne]

so I hope my question is not so bad that it totally embarrasses me

Not at all. It just sounds complicated, to me anyway. I heard something similar suggested on the news but my ignorance is way beyond engineering solutions.

 

[USGrant1962]

We’ll, today Cuomo said the Feds have supplied 4,000 ventilators.

EDIT - he also said there is no strategic stockpile and the Feds are procuring them now, like the States are.

 

[gerntz]

Not making light of situation, but I seriously doubt this is true:

"The number of cases in NY State is doubling every 3 days."

What I believe is true is that the number testing positive is increasing at that rate due to massively increased number of tests of people who have had the virus for some time or suspect they have it. Where is the number of persons tested stated?

As numbers tested keep increasing, the number of newly known cases will continue to rise for a while but the percent infected will drop.

Great article today on subject in WSJ:

https://www.wsj.com/articles/is-the...as-they-say-11585088464?mod=opinion_lead_pos8

 

[FIREd]

In Italy, some doctors are using off-the-shelf diving/snorkelling masks as makeshift ventilators.

https://www.dailymail.co.uk/news/article-8143099/The-ventilators-diving-masks-Italy.html

 

[NW-Bound]

Lots of finger pointing now.

How can societies stock up supplies and equipments for every imaginable disaster possible? Even if you could afford it, where would you put it?

The only way to reduce the problem is as many experts have said: "Lockdown, lockdown, lockdown".

China did that. They are slowly getting back to normal. Italy has been pleading with other countries to learn from its experience. It falls on deaf ears.

 

[Freedom56]

New York will get through this. I don't know why they don't convert CPAP machines to ventilators.

 

[Midpack]

Lots of finger pointing now.

How can societies stock up supplies and equipments for every imaginable disaster possible? Even if you could afford it, where would you put it?

The only way to reduce the problem is as many experts have said: "Lockdown, lockdown, lockdown".

China did that. They are slowly getting back to normal. Italy has been pleading with other countries to learn from its experience. It falls on deaf ears.

That’s fine, but there has to be a plan after lockdown and it’s not too soon to think about it and work toward same. As testing ramps up, and if effective therapies are discovered, we can start to selectively restart some of the economy and continue in stages. We can isolate those most at risk instead of everyone. Obviously overwhelming our healthcare system is at the top of the list, but it’s not the only consideration at some point. This is like a supply and demand curve - that changes daily.

The situation in NY is terrifying, so is Italy. But the response isn’t one size fits all. NY and Italy may need an outsized response, other areas may not.

And resources aren’t unlimited, more people will die from this than we’d like. We simply can’t instantly increase resources 100x, 1000x or whatever huge number for disasters - not for pandemics, hurricanes, earthquakes, wildfires and the like. That doesn’t stop some people from unreasonable expectations.

 

[NameRedacted]

If this is too political delete it. But I saw where Cuomo refused to purchase 1600 ventilators in 2015, for use in any future pandemic.

Just watched Cuomo's conference from today and he was asked this exact question. He denied it's true and told the reporter to go to a fact-checking source. I haven't had a chance to check it myself.



Even if it were true - I don't see the point you're trying to make. How many other States or countries bought up enough ventilators for this crisis?


This is like saying if someone offered me a piece of cake in 2015 and I refused I can never have cake again.

 

[NameRedacted]

I don't get his point on 400 ventilators - is he suggesting that the Federal Government is sitting on a massive stockpile of ventilators and not sharing them with NY? Where is this stockpile?

Yes there is and in fact the Federal government has now promised 4000 ventilators to New York.

 

[CRLLS]

Not every case that needs a ventilator needs a ventilator. If ventilaors are in short supply, here are some alternatives approved by the FDA.

https://www.fda.gov/medical-devices...ation-strategies-letter-health-care-providers

If the number of ventilators in your facility is running low, consider alternative devices capable of delivering breaths or pressure support to satisfy medically necessary treatment practices for patients requiring such ventilatory support. Health care providers should use their judgment based on the condition of the patient and the circumstances in the facility to choose the best option. Examples of alternative uses of respiratory devices used to address shortages might include the following, which the FDA believes may help increase availability:

For any patient needing ventilatory support, continuous ventilators labeled for home use may be used in a medical facility setting depending on the features of the ventilator and provided there is appropriate monitoring (as available) of the patient's condition.

For stable patients, emergency transport ventilators may be used for prolonged ventilation in a medical facility setting.

For any patient needing ventilatory support, anesthesia gas machines capable of providing controlled ventilation or assisted ventilation may be used outside of the traditional use for anesthetic indication. Because of significant differences between the anesthesia gas machine and traditional critical care ventilators, use or supervision by an anesthesia provider is recommended. Refer to the manufacturers' websites for specific instructions on safe use of anesthesia gas machines for this indication.

Noninvasive Ventilation (NIV) Patient Interfaces capable of prescribed breath may be used for patients requiring such ventilatory support, including NIV Patient Interfaces labeled for sleep apnea.

Continuous Positive Airway Pressure (CPAP), auto-CPAP, and bilevel positive airway pressure (BiPAP or BPAP) machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition.

If indicated, I'd prefer a CPAP machine over being ventilated. That's just my feeling.

 

[NameRedacted]

New York is in need of supplies but so are other areas of the country. It is great if they get their 30,000 ventilators but the other hospitals in other states also need supplies.

Yes but New York State has 50% of all the cases in the US and most of those in and around NY City. If you watch the video, Cuomo explains this. The peak is fast approaching in NY State now - so that is where the ventilators need to be deployed now. Once the peak is over the ventilators can be deployed elsewhere since those States are several weeks behind New York State. He's also recommending the the Federal Government use it's powers to get companies to switch to producing ventilators right now so that when this inevitably hits the rest of the country in 6 weeks time we'll have the resources required.


Watch the video it's all explained there and it's very informative.