The Urge to Build More ICU Beds and Ventilators: Intuitive but Errant | Annals of Internal Medicine | American College of Physicians

This article is a bit technical, but worth reading in my opinion.

Throughout the coronavirus 2019 (COVID-19) crisis, much attention has been devoted to the fraught question of how to allocate intensive care unit (ICU) beds and mechanical ventilators if the supply of these resources is insufficient to provide them to all patients considered to be in need.

Contemplating such tragic choices naturally conjures thoughts that we might have avoided these dilemmas by rapidly manufacturing new beds and ventilators at the first sign of a looming pandemic, or by rapidly converting existing beds and machines such that they could be used to expand the supply of critical care resources.

These ideas stem from the natural human heuristic and conventional clinical ethos to mount unstinting effort toward saving the lives of those who fall ill. These views are also psychologically reinforced by the instinct to deploy aggressive medical technology to win the “war” against the pandemic.

Indeed, the instinct to save the lives of the desperately ill, which exemplifies the “rule of rescue” (1), is so intuitively powerful as to make it hard for humans to even consider competing approaches. No one would condone a response to the COVID-19 pandemic that did not include using the nation’s full supply of critical care resources.

However, the drive to build even more beds and ventilators will do more to assuage public anxiety and outrage than to reduce overall mortality, owing to both the poor outcomes among patients with COVID-19 receiving mechanical ventilation and the diversion of clinical workforces.

We argue that supply-side investments in critical care in the midst of the pandemic would not substantially improve population health in the short term and would worsen it in the long term. As psychologically disruptive as it may be to consider not expanding the critical care supply, such expansions would magnify the already considerable skew of U.S. health care toward intensive care.

We further argue that even modest improvements in public health measures, such as physical distancing (which might be promoted by infomercials featuring sports or movie stars) and training more health care workers to become expert in serious illness communication, would be more effective than investments in critical care for improving short-term population health.

Before COVID-19, the United States had more ICU beds and ventilators per capita than nearly any other country (2). Indeed, an assessment of ICU occupancy and ventilator use revealed that during noncrisis times, the United States has a glut of critical care resources. In any given hour, only two thirds of ICU beds are occupied and only one third are occupied by patients receiving mechanical ventilation (3). Although these numbers have been starkly different during the COVID-19 crisis, they highlight our substantial existing capacity to care for those most likely to benefit from critical care.


Source: The Urge to Build More ICU Beds and Ventilators: Intuitive but Errant | Annals of Internal Medicine | American College of Physicians

One comment

  1. The expectation of healthcare is driven purely by emotions. This is reinforced by politicians, drug companies, and hospitals. “Together we can beat cancer”, “live longer with drug x”, or give us 30,000 ventilators and all these sick people with covid-19 will be saved.

    All parents will demand that an insurance company spend $1million for a baby in NICU. It could have been your child so you will be in full agreement. The baby might grow up and discover the cure for cancer and must be saved. I totally understand this. But do you spend $1 million on a 90-yr-old nursing home patient in ICU? I can only speak for myself but don’t spend $1 million on me if I am in a nursing home. $1 million will cover hundreds of children covered by CHIP.

    Pandemics of this severely was, as one governor called it, a 500-year flood. Do you try stocking all the medical supplies and try to keep the technology current or do you stock for a 25-year flood? It is important to note that the USNS Comfort has more ICU beds than the entire state of Maine. I think the best thing is that congress should mandate and always required and fund military units so they have 10% more than their needs so that medical equipment and staff can be activated to support civilian hospitals in a matter of a few weeks. Having the USNS Comfort or a few MASH units available for civilian use is not a bad thing and they call still have a wartime mission.

    It will be interesting when the post pandemic studies come out. I think the numbers are highly skewed now, but I am not sure which way. Since Medicare pays 3x for patients with covid-19, everybody has it. Has anybody died just from covid-19 only? Infection rates, death rates, treatment outcomes will all be called into question and the facts will be disputed by all. Some experts were only giving advice in absolute terms such as the world must quarantine without the holistic view of the long-term permanent damage for years to come will be. Will more people now die from not be able to eat or afford health insurance because they lost their jobs? In the end, I think emotions will rule and we will not be any better off than we were this year. Politicians will demand to buy a million beds and ventilators and half way through, cut the budget to give more money to illegal immigrants.

    PS: the link is broken to the reference article.


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