Ventilator Gate

'If you are vulnerable, like me, the information in this article may be terrifying. But this information is crucial if you and those you love are to stay safe.'

But we are in a race against time.

A great evil is unfolding now. Most people do not yet understand it.

In Britain, friends of mine are outraged to discover that the government is considering ordering that people with coronavirus over 75 will not be moved from care homes to hospitals. Other friends are outraged because they have serious illnesses, and NHS managers have written asking them to consider signing a Do Not Resuscitate (DNR) form.

In the US, many people are outraged as they discover that hospitals are planning to leave the elderly and those with underlying health conditions to die.


These people are right to be outraged. We are witnesses to evil. But the problem is not the decisions by hospitals. The problem is that the authorities in most countries have not ordered enough ventilators. And they have lied to us about that. And they are still not building enough ventilators, and they are lying to us about that.

A recent study by the respected Imperial College London coronavirus research group estimates that at the height of the epidemic in each high-income country, there will be an average of one ventilator for every seven patients who need one. In the low-income countries there will be an average on one ventilator for every twenty-five people who need one.

Ventilators are machines that pump oxygen into your lungs when you cannot breathe yourself. Covid-19 kills by filling up the lungs with liquid. If that happens, a ventilator may or may not save you. But it is the only thing that will.

When there are more patients with lungs filling up than ventilators, the doctors have to “triage”. They have to decide to treat some people with lungs filling up. The others will be sedated and cared for until they die.

Hospital staff in Lombardy in north Italy, in Madrid in Spain, in some hospitals in London and some in New York have already reached capacity. Many, if not most, city hospitals across the US and the UK will reach capacity too. When there are not enough ventilators, doctors and other health staff have to decide on what basis to choose who gets a ventilator and who does not.


Everywhere this happens, doctors have been deciding not to treat people over a certain age (which varies) and not to treat younger people with serious underlying conditions. The underlying conditions that matter are immune system problems, like diabetes and HIV, and breathing problems, like COPD and partial loss of lung function.

Then the doctors look at the other patients, and put the youngest and strongest on ventilators.

This is a terrible decision to make. I am 71. My partner is 75. One of my grown children has chronic lung problems. It’s still the right decision. It is the logic of all battlefield medicine.

The reason is simple. Seniors and those with serious conditions are far more likely to get really ill with coronavirus, and far more likely to die. People with coronavirus need an average of two weeks on a ventilator. Younger and fitter people will tie the machine up for less time, and one ventilator can save more lives.

But we are in a race against time.

Any decent adult would make the same decision. But no-one should have to make that decision.


It is not only doctors who will triage. The New York Times has published wonderful, terrible, moving photographs of the epidemic in Bergamo, Italy. In those photos you can see the faces of family members as they wait for the paramedics to decide whether to take their father or husband to hospital.

The US, UK and other governments have had plenty of warning. They did not start making ventilators. They lied to everyone about what was coming. They have now seen what happened in China, Italy and France. They are still not making ventilators. They are lying to us about that.

Everything about hospital supplies now is an empty promise wrapped around a lie inside a clusterf***.

Ten million people lost their jobs in the United States in the last two weeks. They lost their health insurance the same day. They want work. Ten different corporations say they will build ventilators. Factories sit empty in every city. The designs are public knowledge. And yet the government is doing – what? Waiting for procurement procedures?

The army should be in those factories now, issuing orders to every executive who is not down on the factory floor, hauling metal, phoning workers and begging them to come in right now. The unions should be storming the factories. The hospital workers and the patients’ families should be screaming on social media.

Intensive care

A certain number of deaths are already baked in because the governments did nothing about ventilators and lied to us. But massive public pressure can kick start the process. If there are not enough ventilators for New York or London, they can make enough for Swansea or Detroit.

If they do not make enough for those places, there is still time to force them to make enough for the poor countries with almost no ventilators where the epidemic is only just beginning.

People power has forced governments and states all over the world to lock down. People power can force governments to produce ventilators too. But we are in a race against time.

First, when the ventilators run out, it is not just the people with Covid-19 who die. The Economist magazine has been checking the death rates in the last month in cities at the centre of the epidemic in Italy, Spain and France. In each case, they found the death rate increased from normal, and the increase was more than double the number who died from Covid-19.

That is, other patients, with other diseases, who could not get operations, or chemotherapy, or an ambulance, or a hospital bed, or an intensive care bed, have died in the pandemic too.


There are governments who will tell you these deaths would happen anyway. But that’s another lie.

Second, some people say that there is no point in a lockdown because when governments end the lockdown, people will just get sick anyway. But the point in a lockdown is to keep the vulnerable from getting sick until there are enough ventilators and staff to treat them.

Third, if you are vulnerable, like me, like people I love, the information in this article may be terrifying. I know that. But this information is crucial if you and those you love are to stay safe.

Fourth, like everything else about this epidemic, like everything else about this toxic global system, the suffering in the poor countries is going to be infinitely worse.

Finally, when this is over, there will a reckoning with the people who have lied to us. And when this is over, we are not going back to “normality”. Our aim must be to create a world where human beings can take care of each other properly. A world where we fund our hospitals before we bail out our banks.

This Author

Jonathan Neale is a writer and climate jobs activist. He tweets at @NealeSayles. 

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