In Nobel laureate Amartya Sen’s book “Poverty and Famines,” he argues that famines arise not from a lack of food, but from a system that promotes unequal distribution of existing food. That logic easily applies to shortages of ventilators and other medical supplies for fighting Covid-19.
As states run short of masks and other personal protective equipment, tests, ventilators, and drugs, they have largely been sourcing these much-needed resources on their own. This free-for-all has prompted unnecessary stockpiling and uneven distribution of resources based on purchasing power instead of on patient need. In tandem, the federal government has also been amassing its own supply.
This disorganized reservoir of resources — scattered across hospitals, states, and the federal government — presents a challenge to the country: How do we decide where this equipment should be used? Effective allocation will be the nation’s next big test.
The widespread need for ventilators in particular poses a challenge. The White House hopes to have health care systems redistribute their ventilators to areas of greater need, but Jared Kushner’s task force has admitted that the government does not have enough data to guide such decisions. Ventilator makers like Medtronic are also asking the federal government for more clarity on where to send the machines they produce.
To solve this problem, the U.S. needs three things.
First, it needs an acceptable framework for allocating machines like ventilators. This framework must specify, for example, which hospitals will get priority, how the machines will be delivered, and when those who lend the machines will get them back if they are shared across health care networks.
Second, it needs a trusted independent body to oversee the allocation of ventilators and other scarce resources.
Third, the country needs data to inform all these decisions: data on the pandemic’s dynamics to predict ventilator needs, along with hospital-level data to track ventilator use.
The three of us are not logistics experts, and so can’t address the first two issues. But we are data scientists and have strong opinions on the third one. To maximize the lifesaving potential of equipment needed to care for patients with Covid-19, the U.S. urgently needs national-level visibility over supply and demand, ideally with a common platform that states and hospitals can use to share precise information about current ventilator availability and anticipated future need. Without this degree of data transparency, we risk underusing a precious collective resource that could save many lives.
The United Kingdom has leveraged the data transparency of its nationalized health care system to effectively allocate supplies during this crisis. The U.K., like the U.S., is experiencing pandemic-induced shortages of blood. Unlike the U.S.’s fragmented network of blood banks, the National Health Service’s Blood and Transplant service in the U.K. maintains complete visibility over the country’s stockpile of blood products across all NHS trusts. Throughout the crisis, the NHS has been able to predict how many days its stock will last and redistribute blood between trusts if there are impending regional depletions.
The U.S. desperately needs, but doesn’t have, a similar national IT infrastructure or at the very least, a standardized data reporting system that can compare regional needs against existing resources.
The Centers for Disease Control and Prevention currently asks hospitals to send in daily Excel spreadsheets of patient volume and supply availability. That is a prohibitively cumbersome approach to data collection or analysis. To improve upon this, there are two ways forward: either create a better method for actively collecting data or add in passive ways to collect data.
To identify the number and location of ventilators currently in use, the CDC’s approach is active but inefficient: Hospital staff must manually enter their estimates into spreadsheets. An approach undertaken by critical care physicians at Boston’s major hospitals — creating a collaborative to share ventilator usage data and ensure fair allocation — offers a more efficient alternative. But to scale such efforts nationally, we need to work smarter by taking advantage of passive real-time data that can be collected from electronic health records.
Existing technology can hasten the process of developing new solutions. Data interoperability — the frictionless movement of data between machines, electronic health records, hospitals, and governments — is not a new idea in health care. Data standards organizations, such as HL7 and Schema.org, have developed “languages” by which data can be efficiently shared between hospitals, and these are already being used for clinical, financial, and research purposes. Health tech company Audacious Inquiry has already partnered with HL7 to develop standards for data transfer between inpatient medical devices and electronic health records to improve awareness of equipment use during the pandemic. Other organizations, such as Veterans Affairs and multiple members of the private-sector Covid-19 Healthcare Coalition, have also begun gathering hospital-specific data to predict future needs.
To keep up with Covid-19, the kind of active data collection that is happening in Boston should be paired with existing methods of passive surveillance from the private sector.
That approach has many benefits. It would allow a state, a large health system, or other trusted entity to accurately predict upcoming needs, distribute ventilators accordingly, and ensure that the recipient hospitals have the necessary infrastructure — enough respiratory therapists, compatible electronics, spare parts, and necessary drugs — to actually use the machines.
It would also enable collaboration. Equipped with real-time data on shortages across the country, health systems with excess ventilators could strategically share them with those in areas that have been overwhelmed with Covid-19 patients. Earlier this month, California, Oregon, and Washington shipped 1,000 excess ventilators to New York City, an obvious area of need. A data-driven approach to scaling the West Coast’s generosity would ensure that no ventilator sits unused when it could be helping someone breathe in another state. This approach preserves patient-level privacy as it collates data on hospital dynamics without individual patient identifiers.
Amartya Sen recently said of the U.S.’s coronavirus response that “equity has not been a particularly noticeable priority.” This is our opportunity to make it a priority. To maximize the lifesaving potential of our country’s ventilators, we need a plan to get them to where they are needed most. Complete visibility over the country’s existing resources — empowered by a robust national data reporting system — will help us do this, and we need to build it as soon as possible.
Jayson Marwaha is a general surgery resident in Washington, D.C. John Halamka is an emergency physician, president of the Mayo Clinic Platform, and former chief information officer of Beth Israel Deaconess Medical Center and Harvard Medical School. Gabriel Brat is a trauma surgeon and intensivist at Beth Israel Deaconess Medical Center and assistant professor of surgery and instructor in biomedical informatics at Harvard Medical School.
We launched the National Medical Device Registry in April and are offering equipment tracking on ventilators to both clinical facilities and manufacturers at no charge during the pandemic. We also have solutions for tracking (and authenticating) PPE and other mobile medical devices. If you’re interested in the program, get in touch with me directly visit us at https://www.locatorx.com/lx/medical-device-tracking-during-the-covid-19-pandemic-and-beyond
According to this study, “Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation…” https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows#1
Stat itself noted a couple weeks ago that ventilators are likely overused…https://www.statnews.com/2020/04/21/coronavirus-analysis-recommends-less-reliance-on-ventilators/
To address this problem we need to focus on what is really needed, and it has become clear that ventilators are not the necessary or life-saving limiting factor they seemed in March.
Wouldn’t your critique fit better to PPE? I’m informed ventilators have about a 10% success rate. Is that percentage wrong? It’s no one’s fault that ventilators don’t work and we still don’t know why. In any case, ventilators aren’t helpful to the vast majority of patients. PPE, however, is different and misallocations have surely occurred. I’d suggest you focus on that.
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