- The Washington Times - Thursday, April 16, 2020

New York, which just weeks ago was pleading with the feds to help it find 40,000 ventilators to handle a projected flood of critically ill COVID-19 patients, now says things are going so well it’s shipping hundreds of ventilators to other states.

Hospital beds nationwide were projected to top out at nearly 225,000 on their peak day amid the coronavirus crisis. Instead, they peaked at less than a third of that.

Beds in intensive care units are also far less in demand than prognosticators had warned.

It’s all good news, as America appears to be avoiding doomsday coronavirus scenarios, but it’s spurring questions about why the initial numbers were so far off.

Pessimists say there was never enough understanding of the disease, and prognosticators and policymakers were operating in the dark, guessing at what was going to happen and using imperfect data to make decisions that could turn out to have been completely wrong.



Others counter that it turns out the country is far better at social distancing than expected and the virus’ spread has slowed because of that.

Experts said both factors were at play.

Even when New York Gov. Andrew Cuomo was demanding tens of thousands of ventilators for his state alone, the models said the entire country would need no more than about 25,000 at peak.

In reality, things topped out at a peak last week of about 15,000 ventilators nationally, with New York needing only about 5,200.

Things have improved so rapidly that Mr. Cuomo said this week New York is sending 100 of its ventilators to Michigan, 50 to Maryland and 100 to New Jersey.

The governor said models that had projected a significantly more dire situation and greater need for such vital equipment at the peak of the crisis had assumed higher rates of spread.

“If their rate of spread actually happened, we would [have] been in a much, much worse situation,” he said. “We slowed the infection by our actions and that’s why we’re in a better position today.”

There are several different models, but the one the White House had been using, from the Institute for Health Metrics and Evaluation at the University of Washington, predicted in late March a nationwide peak demand of nearly 225,000 hospital beds for COVID-19 patients.

By last week that projection had been cut to 140,000 beds. In reality, fewer than 60,000 were being used for COVID-19 patients at the peak, the IHME now says. The model showed a similar trajectory for ICU beds and ventilators.

Total deaths, which had been projected to reach nearly 82,000 by August, are now projected at fewer than 70,000 in IHME’s latest data, which assumes full social distancing measures will last through May.

IHME didn’t respond to inquiries from The Washington Times.

The success stories are playing out in states across the country.

South Dakota says it’s gone from a projected peak of 10,000 hospital beds to just 2,500.

IHME says Oregon has yet to hit its peak, but it’s on pace for just half of the 500 deaths projected a couple of weeks ago.

The governor there was so satisfied that last week she ordered the 140 ventilators the Federal Emergency Management Agency had earmarked for her state to go instead to New York. Washington Gov. Jay Inslee returned 400 of the 500 ventilators FEMA sent his state.

The national stockpile, which was down to about 6,900 ventilators on Sunday, was back up to more than 8,700 on Wednesday, according to FEMA numbers.

Dr. Anand Parekh, a former deputy assistant secretary at the U.S. Health Department and now chief medical adviser at the Bipartisan Policy Center, said the drop in demand for ventilators is likely due to social distancing managing to flatten the curve, reducing the peak need for intensive care and medical equipment.

“Interestingly enough, some clinicians are speculating that perhaps we are overusing ventilators in this particular pandemic and that we need to be more judicious in who we place on ventilators versus using other less-invasive ventilation,” he said.

Models are only as good as their inputs, and Kevin Pham, a medical doctor and former graduate fellow for health policy at the Heritage Foundation, said models were initially built off of what researchers knew about COVID-19 from other countries such as Italy and China.

But each of those outbreaks had their own idiosyncrasies. In China, welding shut apartment buildings may have affected the spread, while in Italy forcing people to quarantine in multi-generational homes could have increased risk to the elderly beyond what it’s been in the U.S., he said.

Now that U.S. data has been added in, models such as the IHME show a very different picture.

“The models were off by a fairly spectacular margin in this case, but we can only work with what we know, and at the time these models were first created, what we knew mostly came from the hardest-hit places in the world,” Dr. Pham said.

Policymakers may have intuitively known that projections of 2 million dead Americans were unlikely but “they had to choose between a gut intuition and a mathematically derived projection.”

It’s not surprising they went on the high end.

“You can be forgiven for overestimating need but not for guessing low,” Dr. Pham said.

Yotam Ophir, a professor at the University of Buffalo, said the problems with modeling aren’t unique to epidemiology. He compared it to weather forecasting, which is also based on likelihoods and past performance.

Just as people struggle with how to act in a forecast with a 40% chance of rain, so policymakers are making major decisions while grappling with large confidence intervals, based on the factors Dr. Pham identified.

“Models always include uncertainty and can never predict the exact numbers, and models are also changing with circumstances,” Mr. Ophir said.

Some analysts say the problem isn’t with the models but rather the policymakers — and average Americans — who are looking to them for guidance, without understanding the limits of the data.

The biggest danger may be that folks get complacent too quickly, ignoring the models that suggest an echo-boom of COVID-19 infections later, if social distancing is relaxed too far or too fast, and if a strong testing, tracking and isolation regime isn’t in place.

Dr. Parekh said policymakers need to plan for a rebound of cases.

“I think it’s critical that we continue the manufacturing and stockpiling of ventilators given that this is still the first wave of the pandemic and we don’t quite know what might come next,” he said.

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