MARCH 22 | 4,812 NEW CASES | 2,043 HOSPITALIZED | 38 DEATHS
“We will overcome this and America will be greater for it, and my hope is that New York is going to lead the way forward—and together, we will.”
NOTHING WAS EASY, AND THERE wasn’t a moment to breathe. Even if we had some good news to share in the briefing in the morning—where I had found some sliver of light in the grim statistics to share—as soon as I got back to the operational table, the ugly reality of our situation would slap me in the face once again. To avoid the tidal wave crashing on our hospital system in a few weeks, we had to get the viral transmission rate down, but none of the experts thought we’d be able to get it to a manageable level. We had to double—if not triple—testing capacity to have any shot at controlling the virus and quickly create tens of thousands of new hospital beds. All of which would be a feat to rival Jesus’s loaves and fishes.
And then there was the issue of ventilators. I had never heard so much about ventilators and never wish to again. They are complicated pieces of technology and cost about $15,000 each, pre-COVID. Every hospital had some, but no hospital had many. In the normal course of business, they are not used that often. In total, statewide we normally have approximately four thousand ventilators, and by this point in the crisis, due to our purchasing efforts, we had between five thousand and six thousand.
It didn’t take long for me to figure out that this was not just a New York problem. Every state in the country needed ventilators, but New York needed them the most urgently. The American companies that made ventilators were overwhelmed and could not increase supply quickly enough to come close to meeting the demand.
The main manufacturer of ventilators is China, but obviously China also had a tremendous need for ventilators. Besides that, every country and every state was trying to buy ventilators from China. The cost for a ventilator ran as high as $50,000. Competing states were bidding against one another to acquire the scarce resources. I had conversations with other governors about the situation, which we all agreed was ridiculous, but we had no choice.
Experts estimated that we would need at least an additional thirty thousand for the ICU beds. The federal government theoretically had an emergency stockpile of medical supplies including ventilators, and so the states, especially those with the worst caseloads, deluged the federal government with requests for ventilators. But, as we soon figured out, the federal stockpile had only about ten thousand ventilators—for the entire nation.
On this point, President Trump got very defensive once again. He took the request for ventilators as a personal attack. In this hyper-partisan environment, the blame game was in full swing. In reality no one was to blame for not having an ample supply of ventilators. No one could have predicted this virus and its particular effect on the respiratory system that would require the specific type of equipment.
Trump mocked my request for thirty thousand ventilators during a phone interview with Sean Hannity. Never mind that we were both using the same projection models and therefore had the same numbers. I could sense the president’s position was hardening. He saw this as a no-win situation and more and more took to denying the problem. COVID was “just like the flu.” COVID would “magically disappear.” The “warm weather will kill the virus.” The president responded as if these requests for ventilators, hospital beds, and testing were all political attacks.
When the NBC White House correspondent Peter Alexander asked him what he would say to Americans who were scared, he shot back, “I say that you’re a terrible reporter…I think that’s a very nasty question.”
For me the situation was simple. Either we could provide hospital beds with ventilators, or more people would die. Either we could persuade people to stay home and reduce the viral transmission rate, or more people would die.
I called everyone I knew with contacts in China to help us buy more ventilators. At the same time, I asked engineers and medical technology experts to figure out other options. Northwell Health designed a conversion of BiPAP machines, which are normally attached to a mask that goes over the face to provide oxygen, so that they could be used as ventilators. This would increase our capacity by about six thousand.
One design firm created modifications so that one ventilator could serve two patients. An emergency physician in Detroit named Dr. Charlene Babcock had posted a video on YouTube that showed how to split ventilators so that they could serve four patients instead of just one, so my team tracked her down at the hospital where she worked, and I called her. We were getting messages from people saying, “I’ve got a guy who has a guy who has ventilators.” We chased down every lead and dealt with anyone who would talk to us, including the Chinese and Qatari governments.
In the worst-case scenario we would have to use manually operated rubber bags. This is what you would see in the old movies: patients in beds with plastic covering over their noses and mouths attached to rubber bags being squeezed by people sitting next to the beds to assist inhalation and exhalation. We purchased six thousand of the bags, and we explored training members of the National Guard to manually operate them, which is harder to do than you might think. We tested it and it was too difficult for one person to squeeze for more than an hour, so next we talked to people about making machines that could squeeze them automatically. I tried to squeeze the bag for
