Thursday, April 16, 2020
More lifesaving ventilators are available. Hospitals can’t afford them.
By Christopher Rowland
Hospitals are holding back from ordering more medical ventilators because of the high cost for what may be only a short-term spike in demand from the coronavirus epidemic, supply chain experts and health researchers say, intensifying an anticipated shortage of lifesaving equipment for patients who become critically ill.Health industry experts cite cost and uncertainty as disincentives to stocking up, leaving a potential life-and-death gap in treatment options for patients in the coronavirus outbreak.
The lack of ventilators — and growing calls for a more aggressive government role to fill the gap — was a subject of tense exchanges this week between President Trump and state officials. The issue also revealed a disconnect between different parts of the health-care industry, with the main hospital association disputing the accounts about the adequacy of supply of the lifesaving equipment. Mechanical ventilators, which help patients breathe or breathe for them, are considered critical to the nation’s effort to contain the worst effects of the pandemic and avoid a crisis like the one Italy is facing. Depending on how bad the coronavirus pandemic gets in the United States, individual cities could come up thousands of ventilators short as patients flood hospitals, researchers say.
“It’s a challenge for states, local governments and hospital administrators to allocate tens of millions of dollars to something when they don’t know if they need it or not," said Chris Kiple, chief executive of Ventec Life Systems, a small ventilator manufacturer in Washington state. “But if they don’t do it, they are going to be caught flat-footed, and facilities are going to be faced with not enough ventilators to meet demand."
Ventilator manufacturers could achieve, within a few months, a significant boost in production from about 50,000 units a year currently, said Julie Letwat, a health-care lawyer with McGuireWoods in Chicago who is monitoring the industry. Orders have not flooded in, she said, because most hospitals can’t afford to increase inventory of expensive equipment for what could turn out to be a short-term event.
“The risk is that they’ll never be used, and hospitals can’t eat the cost," she said. “Most hospitals in this country are not profitable."
Ventilators range from $25,000 for a basic model to $50,000 for a machine used in the most advanced intensive care units. Buying them also requires additional large investments in staff and training. Letwat said federal government investment would be the surest way to boost supply. Governors and local health authorities worry about an insufficient supply of ventilators and have been calling on the Trump administration to move aggressively to solve the problem. The president indicated Wednesday he has a plan to boost ventilator supplies but did not provide specifics. “We are ordering thousands and thousands of ventilators and they are complex,” Trump said at a White House press briefing. Other governments have rushed to stock up on ventilators. The United Kingdom has asked Rolls-Royce Holdings, which makes jet engines, and other heavy manufacturers to make ventilators. Germany ordered 10,000 ventilators with Dragerwerk AG, which Dow Jones said was the company’s largest order ever.
In the United States, Trump told state officials on a conference call that states and local governments should procure their own equipment. “Respirators, ventilators, all of the equipment — try getting it yourselves,” Trump told the governors, according to the New York Times, which first reported the call.
The Trump administration has barely begun to release up to 13,000 older ventilator models cached around the country in the federal Strategic National Stockpile, saying state officials have not requested them. On Tuesday, the Defense Department said it will contribute an additional 2,000 ventilators to the effort.
U.S. health system is showing why it’s not ready for a coronavirus pandemic
Maryland Gov. Larry Hogan (R), chairman of the National Governors Association, said leaders nationwide are scrambling to secure ventilators to prepare hospitals for a surge of coronavirus patients, but there are not enough available.
“There is a problem with supplies and ventilators,” Hogan said Monday. “There’s not enough supplies. The states don’t have enough. The federal government doesn’t have enough. They’re not getting distributed fast enough. And that’s a problem for all of us.”
Hospital officials do not know how many patients will need ventilator care in the United States or whether the system will be overwhelmed. They say they are in a race against the spread of the virus, hoping measures to keep people in their homes will reduce the size of the short-term spike in those seeking care.
Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said hospitals are canceling elective surgeries to try to free up ventilators. “Knowing exactly what is enough is hard at the moment,” said Foster, whose organization was one of three that asked Congress for more resources in a letter Monday.Foster also said hospitals are preparing to move ventilators to hot spots of infection within multi-hospital systems and planning to bring older models back into use.
“We do have the capacity in an emergency to turn the switch on a lot of different things. We could change in a very short time,” said Brahim Ardolic, executive director of Staten Island University Hospital, which is part of a 22-hospital chain.
Surge in coronavirus patients threatens to swamp U.S. hospitals
Foster said she has not heard any American Hospital Association member hospital say it was not purchasing ventilators because of cost. “They want to be fully prepared to serve the needs of their community and to do so intelligently,” she said.Hospitals meanwhile are scrambling to buy as much personal protective equipment as they can for medical staff before the coming wave of infection, including disposable protective masks called N95 respirators, which are in short supply nationwide.On the front lines of one of the nation’s earliest outbreaks, J. Randall Curtis, a doctor in Seattle, has treated six coronavirus patients in the intensive care unit at Harborview Medical Center, three of them requiring ventilators (including one who died). He cited as unique in those patients’ care both the intense focus on infection control and also the heavy use of personal protective equipment for medical staff.The team managed the patients with the state-of-the-art ventilators, and he said more are available.
“Right now, we are mobilizing additional staff and cordoning off ICUs to take care of these patients, canceling surgeries, but we’re not exceeding capacity,” he said.
Nationally, the gap between demand and supply of ventilators could run into the tens of thousands, according to estimates. An analysis by the Society for Critical Care Medicine, citing figures developed for the American Hospital Association, said U.S. hospitals have 62,000 full-featured ventilators for advanced intensive care units with nearly 100,000 more with lesser capabilities. Contrast supply with potential demand: More than 900,000 patients may need ventilator care during the coronavirus pandemic, the analysis concluded.Keeping backup ventilators is impractical for most hospitals because of the need to service and maintain them and train additional staff during rare events when they are needed, said Lewis Kaplan, a trauma surgeon at the University of Pennsylvania and president of the Society of Critical Care Medicine.“It’s like taking military planes out of your boneyard,” he said. “There can be a variety of economic disincentives to be prepared for the worst thing that can happen."
Not all patients would be sick at once, so the shortfall may not be as dire as it may seem, Kaplan added. And many coronavirus patients can be adequately treated with older models of ventilators or less invasive modes of respiratory help, he said.
Medtronic, GE Healthcare, Becton Dickinson and Philips are among the largest producers of ventilators for the global market. Several large manufacturers said they are increasing manufacturing of medical supplies, including ventilators, but would not provide specific numbers.
“We are taking steps to increase our manufacturing capacity and output of equipment that is important in the diagnosis and treatment of covid-19 patients,” a spokeswoman for GE Healthcare said in a statement. Competition for supply could become an issue. With Europe’s governments placing massive orders, manufacturers also could face delays in obtaining spare parts because of supply-chain disruptions.
“A lot of these components for these ventilators are coming from other countries overseas, and some of the parts they need are creating a little bit of a backlog,” said Timothy R. Myers, chief business officer for the American Association for Respiratory Care, which represents health-care workers who specialize in ventilator treatment. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, confirmed Sunday the federal government’s emergency stockpile of medical supplies contains nearly 13,000 ventilators. To access those, hospitals are required to ask their state and local governments, which then ask the federal government to release supplies.
Secretary of Health and Human Services Alex Azar said Sunday at a news briefing at the White House that the government has barely heard from states about tapping the stockpile.
“We have received, so far, only, I think, one request for just several ventilators,” he said. In contrast to Fauci’s disclosure that the stockpile contains nearly 13,000, Azar said the number was not disclosed for national security reasons. Pressed by Sen. Patty Murray (D-Wash.) at a congressional hearing this month about the adequacy of supplies, Azar suggested a key reason for passage of an $8.3 billion emergency spending bill was to procure more equipment, including ventilators and personal protective equipment for health-care workers. Foster, of the American Hospital Association, said requests to obtain ventilators from the Strategic National Stockpile have not begun because the location of potential shortfalls is not yet known.
“It is a wait-until-it’s-needed situation,” she said. “We don’t know which communities are going to be hard hit at any given time."
https://www.washingtonpost.com/health/2020/03/18/ventilator-shortage-hospital-icu-coronavirus/
#Pakistan - Out of control clerics
- Appeasement will make this the norm
This past Friday was the third consecutive week that Maulana Abdul Aziz, the illegal occupant and self-proclaimed khateeb of Islamabad’s Lal Masjid, invited and encouraged worshippers to pray standing close to each other in usual formation. But these are exceptional times with a highly contagious virus on the prowl looking for such gatherings to spread even more rapidly than it already is. Aziz is not your typical firebrand cleric and is constantly locking horns with law enforcement and intelligence agencies; ISI headquarters happen to be a stone’s throw from the infamous Lal Masjid, his stronghold. When he isn’t spewing hate through the loudspeaker, he is creating mischief in other ways. And why wouldn’t he? Since the Lal Masjid operation during the Musharraf years that he escaped disguised in a burqa, he has not faced the sort of restrictive sentencing that he deserves. Aziz has been charged for his latest transgressions as he was the week before as well. The charges include anti-state speech and violation of a ban on collective prayer, but his FIR remains sealed and no action can be taken until it is unsealed. This is in stark contrast to an incident in Karachi on the same day where a female police SHO, attempting to restrict a large gathering at a local mosque, was beaten up by a mob and pelted with stones. An FIR has been registered against the mosque’s management and others.
Religious sensitivities in Pakistan tend to take precedence over public safety. The most recent example of this is the TLP’s countrywide violent protests after the Supreme Court ordered the release of Aasia Bibi, who spent close to a decade behind bars under trumped-up blasphemy charges. The writ of the state was as absent back then as it is right now. But there wasn’t an ongoing global pandemic then, there is one now, and it is killing people on a daily basis. Appeasement of the actions of ignorant yet influential individuals, such as Maulana Aziz, will encourage more of his kind to do the same, leading indirectly to deaths. Most of Punjab’s over 2000 coronavirus cases include either attendees of the Tableeghi Jamaat in Lahore or pilgrims returning from Iran. These were avoidable cases, now they are the core cause of contagion in the province. It is criminal to allow out-of-control clerics to do as they please. Strict action must be taken, otherwise it will become the norm.
Amid COVID-19, a Governance Crisis Looms in Pakistan
Pakistan faces a likely ruling class reshuffle in due time—once the COVID–19 crisis clears.
Pakistan’s capital is rampant with speculation that the current government of Prime Minister Imran Khan is going to fall in the coming months. There are reasons to believe that these predictions may come true in the medium to long run. However, this is not likely to happen in the coming weeks or months.
From running a successful election campaign to putting together a government, the ruling Pakistan Tehreek-e-Insaaf (PTI) party’s leadership has had the unconditional support of a number of powerful institutions in the country, particularly the security establishment. Khan has been given space and autonomy to make decisions to revamp the country’s governance in a way that no other civilian prime minister in Pakistan’s history was able to do. Despite this, it’s not a secret anymore that Khan’s government has only complicated Pakistan’s economic and governance woes over the last 18 months.
Khan has taken the space afforded to him and turned it into a war machine against his political foes. Over the last year and a half, a vast number of political workers who have dared to question Khan’s governing performance have been put behind bars. Khan has used institutional support from various quarters to crush political opposition in the country.
However, this has had direct costs for the Pakistani parliament’s ability to function and deliver through an active legislative process. A number of observers describe the PTI’s legislative performance as “dismal and insufficient in taking the parliamentary process forward.” Khan, who promised to return respect to the parliament, has “attended only six out of 34 National Assembly sittings.” It’s not a surprise that Khan’s government passed more presidential ordinances than bills during its first year in power.
One of the key hindrances in this respect is Khan’s disregard and contempt for the political opposition. Last month, Khan refused to attend a parliamentary leaders meeting to discuss measures to tackle the COVID-19 outbreak in Pakistan. Besides, the delayed appointments of the Election Commission of Pakistan (ECP) members, belated legislation over the issue of military courts, the chief of army staff’s (COAS) extension matter, and other issues related to the parliament’s work are just some examples of where the prime minister has failed to provide leadership.
Moreover, beyond legislative hiccups, the current government’s interventions to improve the economy remain among its biggest failures. Arguably, several institutional stakeholders bought into Khan’s bluster about putting together an efficient team to deliver on the economic end. Unfortunately, even after 18 months in power, Khan is yet to find a team that can materialize his election promises. According to the latest report from the State Bank of Pakistan, the country’s entire debt has “has risen to Rs. 33.4 trillion” ($200 billion approximately). Even more appalling is the SBP’s forecast that the incumbent government is on track to “double the public debt by the end of its term in 2023.”
Complicating this issue is the incumbent government’s chaotic approach to dealing with the serious COVID-19 pandemic. So far, Khan has neither formed a clear and consistent strategy at the national level nor acted decisively in close coordination with the provinces to deal with the pandemic. All provinces in Pakistan are following different approaches and looking towards the federal government for leadership.
On Monday, Sindh province’s chief minister, Murad Ali Shah, said that the “lockdown has not been effective in curbing the spread of the coronavirus due to mixed signals from the federal government.” Last week, Baluchistan’s provincial government arrested doctors for protesting against the unavailability of personal protective equipment (PPE) in hospitals. In response to the civilian government’s fiasco, the Pakistan Army in a statement said that “emergency supplies of medical equipment, including PPE (Personal Protective Equipment) are being dispatched to Quetta” and promised that “doctors will get the equipment they need.”
The federal government’s lack of will to lay down a clear national strategy has created rifts among the central and provincial governments. Khan’s ministers have been accusing the provinces of not handling the crisis aptly while the provinces blame the federal government for not cooperating or supporting them adequately. Maleeha Lodhi, Pakistan’s former ambassador to the United Nations (UN), has recommended that Khan’s policy decisions should be “guided by the evolving medical science on the pandemic by giving a lead role to medical specialists who understand this, not generalist bureaucrats.”
The widespread confusion has brought pressure on the government from quarters that should stay away from matters of governance. Last week, the Supreme Court’s top judge criticized Khan by saying, “The government is just calling in meetings whereas no work is being done on the ground.” He further noted that “the public has been left at the mercy of God.” On Monday, the court ordered the federal government to remove the special assistant to the prime minister on health, Zafar Mirza, from his post for not taking sufficient measures to contain the COVID-19 pandemic.
On the political front, opposition parties have found an opening that may not have been available to them for a year. After Khan’s recent dismissal of some of his ministers who were involved in a corruption scandal, the PTI stands more divided than it was ever before. There are reports of forward blocks being formed within the PTI to undermine the federal government. Last week, two senior leaders of the Pakistan Muslim League Nawaz (PML-N), the main opposition party, met with the Punjab Assembly Speaker Chaudhry Pervaiz Elahi, Khan’s ally and coalition partner. This should have “sounded alarm bells within the PTI which is already experiencing fissures in its fold.” Going forward, a coalition of the PML-N and PML-Q to end PTI’s rule in Punjab cannot be ruled out.
Above everything, there is growing distress within key institutions when it comes to Khan’s ability to govern effectively. Pakistan’s policymaking circles should be thinking about the post-Khan era as economic and governance risks grow countrywide. Arguably, the working of the parliament is something that could be bypassed by institutions that matter, but when it comes to the economy, only limited missteps will be tolerated. In Khan’s case, the leeway for mistakes may have already passed.
However, the important question is what happens next? Contrary to all predictions of Khan’s government going down in a matter of weeks, nothing is expected to change in the coming weeks or months. This is due to two reasons.
First, Pakistan is in the midst of a national crisis and the last thing anyone wants to do is to send the government packing, which could start another crisis. Second, it is unclear which party or leader can fill the void if Khan’s government collapses.
The available options of leaders and parties don’t inspire confidence, and there are no candidates that have not been tried before by institutions that make the final call in Pakistan. Hypothetically, if someone can step-in in the midst of a looming economic and political crisis, it has to be the PML-N. However, the party’s leadership remains at loggerheads with several national institutions, including critically the security establishment. At this point, it’s unclear how the issues that have divided both actors for decades can be resolved now. Certainly, the national security establishment wouldn’t want to build another alliance with the PML-N on a weak footing. It’s not something that either side would want at this point.
These prevailing circumstances may buy some time for Khan. However, it’s only a matter of time before his house is dislodged. From here onward, opposition parties, the PTI’s disgruntled allies, existing fissures within the party’s ranks, and growing concerns within key institutions will only continue to make Khan’s job at the top difficult.
When the COVID-19 crisis is over, expect a major reshuffle in ruling circles.
وزیر اعلی سندھ کا کل دن 12سے 3بجے تک سخت لاک ڈاؤن کا اعلان
وزیر اعلیٰ سندھ سید مراد علی شاہ نے کل دن 12 سے 3 بجے تک سخت لاک ڈاؤن کا اعلان کیا ہے، وزیراعلیٰ سندھ کی درخواست پر علماء نے مکمل تعاون کی یقین دہانی کرادی۔
مفتی منیب الرحمان نے کہا ہے علماء اور عوام تعاون کریں تاکہ کل کوئی ناخوشگوار واقعہ نا ہو۔
ترجمان وزیر اعلیٰ کا کہنا ہے کہ وزیر اعلیٰ سندھ سے علما کرام نے ملاقات کی ہے۔
ترجمان وزیراعلیٰ سندھ کے مطابق مفتی منیب الرحمٰن کی زیر قیادت علمائے کرام کے وفد وزیراعلیٰ سندھ سید مراد علی شاہ سے ملاقات کی۔
وفد کے اراکین میں، مفتی عابد مبارک، مفتی رفیع رحمٰن، مفتی عابد سعید، عبدالوحید، ڈاکٹر عبدالباری، ڈاکٹر عدیل، ڈاکٹر سعید اور دیگر شامل تھے۔
وزیر اعلیٰ سندھ کی معاونت وزیر مذہبی امور ناصر شاہ اور وزیر تعلیم سعید غنی نے کی۔
وزیراعلیٰ سندھ نے کوروناوائرس پر قابو پانے کے لئے غیر مشروط تعاون پر علمائے کرام کا شکریہ ادا کیا۔
انہوں نے کہا کہ میں چاہتا ہوں کہ آپ جمعہ کے دن 12 بجے سے سہ پہر 3 بجے تک مکمل لاک ڈاؤن کرنے کے لئے ہماری مدد کریں۔
علماء کرام نے کہا کہ وہ کورونا وائرس کی جاری صورتحال سے آگاہ ہیں، لہٰذا انہوں نے حکومت کی حمایت کی ہے اور آئندہ بھی حکومت کے ساتھ تعاون کریں گے۔
وزیر اعلیٰ سندھ سید مراد علی شاہ اور مفتی منیب الرحمن نے ملاقات کے پیغامات لوگوں پر تعاون کرنے کے لیے زور دیا۔
مفتی منیب الرحمان کا کہنا تھا کہ آئمہ کرام اور عوام سے کہتا ہوں کہ وہ حسب معمول تعاون کریں، تاکہ کل کا دن خوشگوار گزرے اور کوئی ناخوشگوار واقعہ نا ہو۔
وزیر اعلیٰ سندھ سید مراد علی شاہ نے آئی جی پولیس مشتاق مہر کو ہدایت کی کہ وہ جمعہ کے دن دوپہر 12 بجے سے سہ پہر 3 بجے تک مکمل لاک ڈاؤن کو یقینی بنانے کے لیے تمام تر ضروری انتظامات کریں۔
کراچی میں کورونا سے بڑے پیمانے پر اموات کی خبریں غلط نکلیں
کراچی میں کورونا وائرس سے بڑے پیمانے پر اموات کی خبر غلط نکلی، شہر قائد میں ایک خاتون کے علاوہ کوئی بھی شخص کورونا وائرس کی وجہ سے ہلاک نہیں ہوا۔
واضح رہے کہ یہ افواہیں گردش کر رہی تھیں کہ شہر قائد میں 15 مارچ سے 13 اپریل تک ہونے والی 759 اموات کورونا وائرس کی وجہ سے ہوئی ہیں۔
تاہم جیو نیوز کی ایک تحقیقاتی رپورٹ میں یہ بات سامنے آئی ہے کہ یہ تمام اموات کورونا کی وجہ سے نہیں ہوئیں بلکہ ان کی وجہ موت کچھ اور ہے۔
جیو نیوز نے ایدھی ہومز میں غسل دی گئی میتوں کے لواحقین سے رابطہ کرلیا، جن میں یہ پتہ لگا ہے کہ 31 مارچ کو انتقال کر جانے والی خاتون کے علاوہ کسی کی وجہ موت کورونا نہیں تھی۔
ایدھی ہومز میں 15 مارچ سے 31 مارچ تک 371 میتوں کو غسل دیا گیا جن میں 249 مرد اور 121خواتین تھیں۔
ان تمام متوفی افراد کے لواحقین کا کہنا ہے کہ ان کے پیارے پہلے سے ہی کسی نہ کسی عارضے میں مبتلا تھے۔
مذکورہ لواحقین کے پاس مرنے والوں کے ڈیتھ سرٹیفکیٹ بھی موجود ہیں جن میں واضح طور پر ان کی موت کی وجہ لکھا ہوا ہے۔
لواحقین کے مطابق ان میں سے اکثر افراد کا انتقال دل کا دورہ یا فالج کے اٹیک سے ہوا۔
کچھ لوگ کینسر، جگر اور گردے کی بیماریوں کے باعث انتقال کرگئے جبکہ ان میں ایک شخص ایسا ہے جو گلے میں چھالیہ پھنس جانے کی وجہ سے انتقال کر گیا تھا۔
تحقیقاتی رپورٹ کے مطابق 15 مارچ سے 31 مارچ تک غسل دی گئی میتوں میں اکثر کی عمر 50 سال سے زیادہ تھی جبکہ 358 افراد کی عمر 41 سے 88 سال کے درمیان تھی۔
دوسری جانب یکم اپریل سے 13 اپریل تک ایدھی کے 3 سرد خانوں میں 388 میتیں لائی گئیں جن میں سب سے زیادہ میتین ایدھی ہوم سہراب گوٹھ میں لائی گئیں۔
ان 13 دنوں میں 25 میتیں موسیٰ لین کے سرد خانے میں لائی گئیں، کورنگی سینٹر میں 64 میتیں لائی گئیں۔
رواں ماہ شہر میں ان 13 دنوں میں مرنے والوں میں 212 مرد اور 176 خواتین تھیں۔