The unit was full, Dr. Jose Orsini told her, adding, “And it’s going to get worse.”
Dr. de Souza dreads that possibility, haunted by accounts of Italian doctors denying lifesaving resources to older adults or providing inadequate care at overrun hospitals. “I’m asking myself if that’s where we’re going,” she said on Wednesday night. Some patients who were screened and went home have since returned with difficulty breathing, needing to be put on ventilators. “It’s getting really, really more difficult every day.”
The intensive care unit had 18 staffed beds, and it added six more Wednesday night. All are full and about two-thirds of the patients are confirmed or suspected to have coronavirus, according to Dr. James Gasperino, director of critical care services at the hospital.
He said eight more could be made immediately available in the surgical intensive care unit, and more still could be opened up, with additional staffing, in operating rooms, the surgical recovery area and a former intermediate care unit on a different floor.
Patients with the coronavirus who develop pneumonia can often require two to three weeks on a ventilator. “The intensity level is higher,” Dr. Gasperino said. “It’s harder to oxygenate than your typical flu patient who’s sick.” He added, “The staff is anxious.” So far none of the coronavirus patients requiring ventilators have recovered enough not to need one, although several younger patients were rapidly improving, he said.
Another patient, Dr. Gasperino said, went into cardiac arrest Sunday night, and he and his team were able to bring the person back to life. Four coronavirus patients at the hospital have died, including some whose families opted to withdraw life support.
This week the hospital counted up all the ventilators it had, including anesthesia machines used during surgeries. It found 61 in total. “We’re looking to purchase new ventilators,” Dr. Gasperino said. “We’re looking at one ventilator for two patients,” which some experts believe would be risky and difficult. He said they would need to simulate the process to make sure it worked.
While he hoped to avoid the worst-case scenario, Dr. Gasperino said he and the head of the ethics committee were planning to draft a guideline on how the hospital might ration ventilators, based on published recommendations.