Health authorities around the world are trying to find ways to fill their hospitals with multiple fans to cope with an increasing number of coronavirus patients.
Car manufacturers are offering to help build more cars. In New York City Mayor Bill de Blasio says he needs 15,000 people.
While the vast majority of people suffering from Covid-19 disease exhibit only mild symptoms, approximately 6% need hospital treatment, with older patients at higher risk.
The Australian authorities say they are sure they can avoid any shortage of fans.
Experts told Guardian Australia that these efforts will be crucial, because a shortage of fans would endanger life.
“The reason why this crisis is due to the fact that without the ventilators, patients will die,” says Professor David Story, deputy director of the University of Melbourne Integrated Intensive Care Center and staff anesthesiologist at the Austin hospital.
The professor. Sarath Ranganathan, a member of the board of directors of the Lung Foundation Australia and director of respiratory and sleep medicine at the Royal Children’s Hospital in Melbourne, said: “The experience in Italy and Spain and the modeling used by mathematicians all over the world, indicate the number of people who will become severely ill with Covid-19 will significantly exceed their ability to take care of them using respiratory support.
“Without access to the ventilators, many patients who could survive the infection will die.”
What is a fan and how does it work?
A mechanical ventilator is a machine used to support patients with severe respiratory conditions affecting the lungs, including pneumonia.
Before a patient is placed on a ventilator, Day says that medical personnel – often anesthesiologists – will perform a procedure called intubation.
After a patient has been sedated and given a muscle relaxant, a tube is placed through the mouth and into the trachea.
Day says the procedure is routine but, with Covid-19 patients, medical personnel must take extreme precautions to make sure they are not infected with the virus.
“We have people in almost complete fire retardant,” he says.
The breathing tube is then connected to the ventilator and medical personnel can adjust the speed with which it pushes air and oxygen into the lungs and regulate the oxygen mixture.
When should a patient go on a ventilator?
Before deciding to put a patient on a ventilator, Story says doctors are looking for signs of “respiratory failure”.
“The respiratory rate will increase, they will seem distressed, the CO2 in the blood will increase and they can be sedated and confused,” he says.
He says that while a normal respiratory rate is around 15 breaths per minute, if the rate reaches around 28 times per minute, this is a sign that ventilation may be needed.
Before getting on a mechanical fan, prof. John Wilson, president-elect of the Royal Australasian College of Physicians and respiratory physician, says there may be other attempts to increase a patient’s oxygen levels.
These “non-invasive” ventilation methods can include oxygen masks and cylinders.
The story says that with Covid-19, medical personnel were trying to avoid non-invasive methods because patients coughed and spread again, increasing the risk of the virus being transferred to medical personnel.
How long should a patient need a ventilator and for how long?
Ranganathan says that when a doctor sees that a patient needs a ventilator, “it is needed quickly”.
He says: “The patient can be supported for short periods of time using manual forms of ventilation such as the use of a system of bags and masks with oxygen, but in general the connection to a ventilator must be made within 30 minutes if critical.”
History says that in severe Covid-19 patients, a life-threatening condition called acute respiratory distress syndrome (Ards) can develop that requires ventilators to deliver smaller volumes of oxygen and air, but at higher speeds.
This could mean that a patient may have to be on a ventilator “for weeks”.
To avoid complications from the respiratory tube that runs down the throat, Story says a tracheostomy is performed so that the tube can pass directly into the trachea through the neck.
“Patients can be more awake with tracheostomy and the hole heals itself,” says Story.
“If patients develop Ards they will stay in an intensive care unit for weeks and die without ventilators.”
Why a shortage of fans is important and what is being done to avoid it.
One of the most obvious ways to avoid a shortage of fans is primarily to reduce the number of people who contract the disease. This means following all health advice, including social removal and hygiene rules.
In Australia, the Australian Healthcare and Hospitals Association, Australia and New Zealand Intensive Care Society and the minister of industry, Karen Andrews, have all expressed confidence that a shortage can be avoided.
The Australian government is also investigating whether fans used on animals in veterinary clinics can be converted. Sleep apnea machines and anesthesia machines are also options.
History says that fans used in ambulances could be used as backups.
All this work will be crucial to saving lives if social exclusion measures and community blockages do not hinder the flow of ICU patients.
Wilson said: “Healthcare professionals responsible for managing life-threatening serious cases such as Covid-19 are extremely concerned about their ability to use adequate support for a large number of patients who are expected to suffer from respiratory failure.
“In essence, this means that many will not be able to be treated with mechanical ventilation and that staff, families and patients will have to make difficult decisions about the limits of support. There are many ethical dilemmas in this, and none can be easily solved. “