* Widespread shortage of equipment including gloves and masks * Cuomo: administration is ‘scouring the globe’ for suppliesNew York is preparing to ration its ventilators for sick coronavirus patients as a major disaster was declared in the city as it struggles to cope with the deadly outbreak.The disaster declaration comes as New York prepares guidance on how to deploy vital ventilators amid a widespread shortage of key equipment that also includes masks and surgical gloves, and medical supplies such as blood.The draft guidance on ventilators, prepared by a state taskforce in 2015 for a possible influenza pandemic, has reportedly been updated for the coronavirus crisis, though new guidelines have not been finalized.According to Sam Gorovitz, a professor of philosophy at Syracuse University and member of the taskforce, the revisions to the ventilator allocation guidelines include the formation of designated triage committees to determine which critically ill patients will or will not receive life-supporting respiration.Gorovitz told the Guardian he is “100% certain” that New York health administrators will face ethical decision-making in the near future about whom to ventilate – just as it is now making decisions about the allocation of masks and protective equipment.“Consider a patient, 85 years old, on a ventilator, out of hospice care. Along comes a 45-year-old, with a family, and in fundamentally good health and a good prospect of full recovery from coronavirus if treated with the best available treatment.“Is it not only acceptable but ethically necessary to take grandpa off the ventilator and switch him to palliative care, wipe away the tears, and switch the ventilator to the younger patient?” he said.“These decisions are already being faced with regard to protective equipment that are inadequately supplied,” Gorovitz said. “That’s not the same as ventilator allocations, but everyone knows it’s coming and those decisions are likely being made right now.”At a press conference on Saturday New York state governor Andrew Cuomo said that his administration was “literally scouring the globe looking for medical supplies”.Cuomo added that New York is doing more tests than China or South Korea, calling the 45,000 tests to date a “great accomplishment.”The announcement came as New York state recorded 10,000 infections. Forty to 80% of New Yorkers, or 7.8 million to 15 million people, would likely be affected by the virus in the end, Cuomo said.“You don’t have to wait til the end of the movie to know what happens,” he said, saying that the measures being taken would ease pressure on medical facilities and allow the authorities to cope with the influx of the infected.The Trump administration late Friday issued a major disaster declaration for New York, the center of the US coronavirus outbreak, as infections spike across New York City to 5,000 as one person an hour dies from the coronavirus.The emergency declaration was issued by the Federal Emergency Management Agency (Fema) to allow the state to access billions of dollars in aid from the disaster relief fund, as the number of confirmed New York cases soar.“With no time to waste, the administration heeded the call and approved the nation’s first major disaster declaration in response to the coronavirus, right here in New York,” Senate minority leader Chuck Schumer said in a statement.“With more and more cases confirmed here each day, it’s imperative that the federal government does everything within its power to stem the spread of the deadly coronavirus.”The disaster declaration allows for the US military to be called in, and the US Army Corps of Engineers may take over hotels, sports arenas, college dormitories and other buildings as needed.Under the declaration, Fema will be authorized to send its personnel and resources to set up mobile coronavirus testing centers, disinfect public facilities, and provide the state with medical supplies that are in high demand such as masks, gloves and surgical gowns.The vast Jacob Javits convention center on the west side of Manhattan could be used as a makeshift hospital, state officials have said.New Yorkers are already living under shutdown conditions that from Sunday night will see all residents, except for certain vital professions, expected to stay at home. Only a few vital businesses – like supermarkets and pharmacies – will remain open and citizens will be asked to only venture outside on vital tasks and not in groups.On Friday, New York mayor Bill de Blasio said: ‘We constitute 30 percent of the cases in the US and 70 per cent of the cases in New York State. Whether we like it or not, we are the epicenter.’New York certainly needs help: it has become the main focus of the epidemic in the US, outstripping the original “hot zone” of Washington state.New York state has about 6,000 intensive care unit ventilators, and state health officials fear the pandemic will overwhelm the roughly 3,000 ICU beds available.With cases of coronavirus in the state spiking from around 800 to 8,000 in a week, Andrew Cuomo, New York’s governor, has estimated that the state may require 30,000 ventilators to meet demand.“It’s ventilators, ventilators, ventilators. That is the greatest need,” Cuomo told reporters on Friday after ordering a statewide shutdown of non-essential businesses. He also directed health facilities to turn over any non-essential ventilators to the department of health.“We will purchase it from you if you could lend it to us. But we need ventilators, and anyone who has them now please call the New York state department of health,” he said.Warnings of a ventilator shortage comes two days after Trump invoked wartime powers to harness private business to slow the spread of coronavirus to a manageable infection curve.But in New York and other major metropolitan areas, a shortage of basic masks and scrubs is threatening the effort even as testing ramps up.In Los Angeles, health officials are instructing doctors to only test sick people if a diagnosis would change how they would be treated, according to the LA Times.The LA Times reports that the county health department sent a letter to doctors this week saying they should only administer tests if “a diagnostic result will change clinical management or inform public health response”.The decision is part of a shift “from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the paper.
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