During the Fox News coronavirus town hall Tuesday, President Trump claimed that New York Gov. Andrew Cuomo had refused to buy 16,000 ventilators for epidemic preparedness in 2015.
“New York Gov. Cuomo rejected buying recommended 16,000 ventilators in 2015 for the pandemic—for a pandemic, established death panels and lotteries instead,” Trump read from notes. He appears to have been reading the headline of an article published Sunday by Gateway Pundit, a frequent amplifier of false and misleading information, which used an article by Betsy McCaughey, lieutenant governor of New York from 1995 to 1998, as the basis for the piece.
Trump continued: “[Cuomo] had a chance to buy in 2015, 16,000 ventilators at a very low price and he turned it down.”
“He had 16,000 ventilators that he could have had at a great price and he didn’t buy them,” he said again at another point.
The president’s claims contained an element of truth, but misrepresented aspects of the ventilator situation in New York in 2015: while Cuomo’s Department of Health released a report on allocating ventilators in the case of a shortage, the guidelines were an update of those established in 2008, several years before Cuomo was first elected governor. The 2008 report came to the same conclusion as the one from 2015, stating that a plan for allocation during a severe pandemic was necessary regardless of how many ventilators New York had due to a lack of trained personnel to operate the machines.
McCaughey’s piece claims that Cuomo commissioned the 2015 task force “after learning that the state’s stockpile of medical equipment had 16,000 fewer ventilators than New Yorkers would need in a severe pandemic.” However the 2015 update was deemed necessary not because Cuomo realized there was a ventilator shortfall, as McCaughey implies, but because the 2008 report did not establish protocols for ventilator allocation for children. The revised guidelines ensure that children are given priority over adults.
The 2015 report, titled “Ventilator Allocation Guidelines,” was prepared by the New York State Task Force on Life and the Law, and outlines what ventilator demand would be for the state during a pandemic and what the government’s response for allocating the machines would be if a severe enough pandemic resulted in a shortfall.
In the event of a moderate pandemic, the guidelines estimated 97,791 New Yorkers would be admitted to the hospital, 10,896 of whom would need ventilator treatment. However, these numbers are cumulative, and the task force projected only 2,264 patients would require ventilators simultaneously at the peak of the pandemic. In most outcomes, New York hospitals would be able to handle peak ventilator requirements due to the ventilators already present in their facilities as well as the state’s 1,750 ventilator stockpile.
It was for a severe pandemic that the task force said 16,000 ventilators. That scenario projected 804,247 hospitalizations with a cumulative 89,610 cases necessitating ventilator treatment. At the pandemic’s peak, 18,619 patients would simultaneously need a ventilator. The task force worked from the assumption that during any non-pandemic week, 85 percent of ventilators would be in use, leading to the conclusion that a severe pandemic would leave 15,783 fewer ventilators than necessary during the peak. The report states: “If an influenza pandemic on the scale of the 1918 pandemic were to occur, it is possible that New York would face a significant shortage of ventilators. Because influenza pandemics are unpredictable and their impact unknown in advance of the pandemic, officials must consider and plan for a worst-case scenario.”
Gov. Cuomo has, in fact, said the state needs even more than the 15,783 shortfall predicted by the task force. “What am I going to do with 400 ventilators when I need 30,000?” Cuomo said after the Trump administration sent New York 400 ventilators from the federal government’s stockpile.
However, access shortages would still occur with the necessary number of ventilators. The task force noted: “Even if the vast number of ventilators needed were purchased, a sufficient number of trained staff would not be available to operate them.” The 2008 report similarly states: “Even if the vast number of ventilators needed for a disaster of that scale were purchased, a sufficient number of trained staff would not be available to operate them. If the most severe forecast becomes a reality, New York State and the rest of the country will need to confront the rationing of ventilators.”
With a shortage all but guaranteed, in 2008 the New York State Task Force on Life and the Law established protocols for deciding who would receive ventilator treatment, seeking to maximize the survival rate for patients. The first consideration established by the guidelines for health care providers, is the likelihood of survival. Patients are categorized as green, meaning they do not require ventilator treatment; red, meaning they have “the highest priority for ventilator therapy because they are most likely to recover with treatment (and likely to not recover without it) and have a moderate risk of mortality;” yellow, meaning they “are very sick, and their likelihood of survival is intermediate and/or uncertain” even with ventilator treatment; and blue, who are “those who have a medical condition on the exclusion criteria list or those who have a high risk of mortality.”
The 2015 guidelines keep these categories in place and add further groupings by age: infants less than 28 months old, children up to 18, and adults 18 and older. Specific guidelines for each age group are outlined in different chapters of the report.
The color determinations for patients would be made not by the attending physicians, but a triage officer committee, the “death panels” mentioned by Trump. This protocol was established in the 2008 report, not in 2015 under Gov. Cuomo.
In general, during a ventilator shortage, green and blue patients would be the first to be denied treatment, while red patients would be prioritized. The 2015 report adds information on what is to be done in instances where a group of patients in need of ventilator treatment have about the same odds of survival: “a randomization process, such as a lottery, is used each time a ventilator becomes available because there are no other evidence-based clinical factors available to consider.”
A lottery system may also be used to decide which patients are disconnected from a ventilator if a red patient comes along and there are no available units. Only blue or yellow patients whose health is not improving would be disconnected in such a case. Randomization processes would be employed only among groups of patients that are all in the same age group. In instances of mixed age groups, individuals in younger age groups take priority.
Gov. Cuomo’s director of communications, Dani Lever, issued a statement, saying, “[President Trump] obviously didn’t read the document he’s citing — this was a 5 year old advisory task force report, which never recommended the State procure ventilators — it merely referenced that New York wouldn’t be equipped with enough ventilators for a 1918 flu pandemic. No one is, including Mr. Trump.”
Trump provided no evidence to support his claim that Cuomo could have had the ventilators “at a very low price” in 2015 and that Cuomo “turned it down.” The 2015 report does not make any reference to Cuomo having an opportunity to purchase ventilators at a low price and there is nothing to indicate that Cuomo had the opportunity to buy 16,000 ventilators, at a “great price” or otherwise, and turned it down.
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