Cuomo: Nobody in the World Bought Ventilators for Spanish Flu-Size Pandemic

Melanie Arter | March 25, 2020 | 6:12pm EDT
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(Photo by Gary Gershoff/Getty Images)
(Photo by Gary Gershoff/Getty Images)

( - New York Gov. Andrew Cuomo said Wednesday that no state - not even the federal government - bought enough ventilators to respond to a pandemic the size of the Spanish flu.

At Wednesday’s press briefing, Cuomo was also asked why the state didn’t follow a 2015 recommendation to buy tens of thousands of ventilators in case a pandemic on the scale of the 1918 Spanish flu occurs.


“There was a report in 2015 where the state suggested, or a task force suggested maybe New York should increase its stockpile. Any reason that that wasn't done?” a reporter asked.

“That's not the fact, and you know it. Read the fact-checkers on it. There was an advisory commission called law and the life -- life and the law, that had a chart in 2015 that said, if you had the 1918 Spanish flu pandemic, you may need ‘X’ number of ventilators,” the governor said. 

“There is no state in the United States that bought ventilators for the 1918 Spanish flu pandemic. The federal government did not buy ventilators for the 1918 Spanish flu pandemic. Nobody in the world bought ventilators in preparation for a 1918 Spanish flu pandemic,” he said.

When asked how the state plans to decide who gets a ventilator, Cuomo said he has no anticipation of having to prioritize ventilator usage.

“Our goal is to have a ventilator for anyone who needs one,” he said. 

As previously reported, President Donald Trump said Tuesday during the Fox News virtual town hall that Cuomo “rejected buying recommended 16,000 ventilators in 2015 for a pandemic, established death panels and lotteries instead.”

Former New York Lt. Gov. Betsy McCaughey wrote an op-ed for the New York Post on March 19, 2020, saying that the state “could have chosen to buy more ventilators to back up the supplies hospitals maintain” but instead, it put together a task force to ration the ventilators they already had.

Several years ago, after learning that the Empire State’s stockpile of medical equipment had 16,000 fewer ventilators than the 18,000 New Yorkers would need in a severe pandemic, state public-health leaders came to a fork in the road.   

They could have chosen to buy more ventilators to back up the supplies hospitals maintain. ­Instead, the health commissioner, Howard Zucker, assembled a task force for rationing the ventilators they already had.

In 2015, that task force came up with rules that will be imposed when ventilators run short. ­Patients assigned a red code will have highest access, and other ­patients will be assigned green, yellow or blue (the worst), ­depending on a “triage officer’s” decision.

In truth, a death officer. Let’s not sugar-coat it. It won’t be up to your own doctor.

The New York State Task Force on Life and the Law New York State Department of Health released Ventilator Allocation Guidelines in November 2015 warning that “a severe influenza pandemic on the scale of the 1918 influenza outbreak will significantly strain medical resources, including ventilators.”

In such a case, “89,610 influenza patients will require ventilators in New York State and there will not be enough ventilators in the State to meet the demand” in the case of “a severe 6-week outbreak.

“A clinical ventilator allocation protocol will need to be implemented to ensure that ventilators are allocated in the most efficient manner to support the goal of saving the greatest number of lives,” the report said.

The 2015 report outlines what protocols will be used to determine ventilator allocation:

In 2007, the New York State Task Force on Life and the Law (the Task Force) and the New York State Department of Health (the Department of Health) released draft ventilator allocation guidelines for adults. New York’s innovative guidelines were among the first of their kind to be released in the United States and have been widely cited and followed by other states. Since then, the Department of Health and the Task Force have made extensive public education and outreach efforts and have solicited comments from various stakeholders and the Task Force reexamined and revised the adult guidelines (Adult Guidelines). 

The primary goal of the Guidelines is to save the most lives in an influenza pandemic where there are a limited number of available ventilators. To accomplish this goal, patients for whom ventilator therapy would most likely be lifesaving are prioritized. The Guidelines define survival by examining a patient’s short-term likelihood of surviving the acute medical episode and not by focusing on whether the patient may survive a given illness or disease in the longterm (e.g., years after the pandemic). Patients with the highest likelihood of survival without medical intervention, along with patients with the smallest likelihood of survival with medical intervention, have the lowest level of access to ventilator therapy. Thus, patients who are most likely to survive without the ventilator, together with patients who will most likely survive with ventilator therapy, increase the overall number of survivors. 

There are five components of the ethical framework that underlie the Adult Guidelines. The duty to care is the fundamental obligation for providers to care for patients. The duty to steward resources is the need to responsibly manage resources during periods of true scarcity. The duty to plan is the responsibility of government to plan for a foreseeable crisis. Distributive justice requires that an allocation system is applied broadly and consistently to be fair to all. Transparency ensures that the process of developing a clinical ventilator allocation protocol is open to feedback and revision, which helps promote public trust in the Adult Guidelines. 

In order to maintain a clinician’s duty to care, a patient’s attending physician does not determine whether his/her patient receives (or continues) with ventilator therapy; instead a triage officer or triage committee makes the decision. While the attending physician interacts with and conducts the clinical evaluation of a patient, a triage officer or triage committee does not have any direct contact with the patient. Instead, a triage officer or triage committee examines the data provided by the attending physician and makes the decision about a patient’s level of access to a ventilator. The decision to use a triage officer or committee is left to each acute care facility (i.e., hospital) because available resources will differ at each site. 



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