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The role of ventilators in treating COVID-19

One of the important pieces of medical equipment in this coronavirus outbreak are ventilators because the virus attacks respiratory cells causing fever, cough and shortness of breath.

The machines are in such demand that COVID-19 hot spots like New York City are in danger of running out of them. Local hospitals in southeast Iowa have a limited number of ventilators to treat patients with respiratory problems, such as those suffering from COVID-19.

Jefferson County Health Center CEO Bryan Hunger said his hospital has five ventilators, and he doesn’t expect anymore will be arriving soon because they are so badly needed elsewhere.

“The number of available ventilators is not enough. The larger facilities where the bulk of these [COVID-19] cases are occurring will get additional ventilators,” he said. “We have worked it out with our respiratory therapist so we are ready to support and care for these patients.”

Washington County has seen its number of COVID-19 cases climb to being tied for the fourth highest in the state at 52, behind just Linn, Johnson and Polk counties. Washington County Hospital and Clinics marketing and foundation director Amy Vetter said her hospital is treating patients diagnosed with COVID-19. She mentioned that the hospital has one ventilator, and added that in most cases, patients requiring a ventilator would be transferred to another facility.

The Union asked Vetter if WCHC could expect to receive more ventilators in the future.

“WCHC is in communications with surrounding hospitals to determine surge protocols and partnership,” Vetter said. “Our organization will work with other hospitals, our local emergency management system and state agency partners to request needed equipment and supplies.”

WCHC Hospitalist Dana Fowler explained how a ventilator helps a person breathe.

“When a patient develops acute respiratory distress syndrome (ARDS) from the Covid-19 infection, they may require advanced breathing support with a ventilator,” Fowler said. “ARDS is essentially severe inflammation throughout the lungs that interferes with the patient’s ability to exchange oxygen. While the lungs are healing, the ventilator supports the patient by assisting the breathing using protective ventilation strategies.”

Fowler said COVID-19 patients are monitored closely to see if they develop severe symptoms that would require breathing support.

“The hospitalists at WCHC are on-site 24/7 and available instantly for any concerns,” Fowler said. “If a patient is showing progression of symptoms that could require a need for more advanced support such as a ventilator or an Intensive Care Unit, the hospitalist contacts the appropriate teams at the University of Iowa or Mercy Hospital in Iowa City for transfer of these patients.”

Jefferson County Public Health Administrator Chris Estle said it’s not helpful to focus solely on the number of ventilators a hospital has. It is just one piece among many that are necessary to keep a person alive, not to mention the staff and medications that go with it.

“If a patient needs a ventilator, they will need lots of other support as well,” Estle said.

Dr. James Trent, medical director for public health for Jefferson County, added that just because a person is put on a ventilator does not mean they’ll recover.

“If you’re put on a ventilator, you’re sick enough to pass away from the illness,” he said. “When you’re on the ventilator, you’ll need ICU trained staff. It takes quite a community to take care of a person in ICU.”

Trent said there is much talk in the medical community to see what interventions can be done to keep patients off ventilators, in other words, to prevent them from deteriorating to the point where a ventilator is necessary. Trent explained that ventilators are used by people who get too tired from the work of breathing, or by people who are not getting enough oxygen in their lungs.

Estle remarked, “We need to stay home, wash our hands, and take this seriously. It’s the only way we’re going to stop people from being hospitalized for this virus.”