Ventilators, masks, and tests are in short supply.


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As of this writing, the United States is attempting to navigate a range of urgent pandemic-related issues. The governors of 21 states have issued statewide stay-at-home orders to reduce the spread of coronavirus disease 2019 (COVID-19), and officials in 15 additional states have ordered similar city- or countywide shutdowns.


Although the first U.S. cases of locally transmitted COVID-19appeared in Seattle, New York City has rapidly become the epicenter of the country's outbreak.


An urgent need for supplies and equipment. Nurses and physicians in states currently hardest hit by the pandemic (New York, California, Washington) report severe shortages of personal protective equipment. In many hospitals, staff are using one droplet mask or N95 respirator for an entire shift. Ventilators are in short supply, and some hospitals are beginning to employ a protocol of shared ventilators when two patients require similar ventilator settings.


Lack of testing availability. A lack of diagnostic tests has hampered the U.S. response to the coronavirus from the beginning. As of this writing, the United States has performed fewer than one-third as many COVID-19 tests as South Korea, despite a population more than six times as large. The lack of testing has greatly hampered containment of the virus. In addition, asymptomatic individuals are almost certainly spreading the virus. An article in the March 26 Morbidity and Mortality Weekly Report noted that nearly half of those testing positive for the virus in a cruise ship outbreak were asymptomatic.


Death rates affected by available care. Best estimates at this time are that the death rate may be about 1%-about 10 times the rate of seasonal flu-though this rate can vary widely depending on the care available and, most importantly, on whether a health care system is overwhelmed with cases. In China, where the worst of the pandemic seems to be past, the countrywide death rate has been reported to have been around 0.7%. But in Wuhan, where the pandemic began and quickly exploded, the World Health Organization reports the death rate was 5.8%.


Impact on the economy. Stay-at-home orders across much of the United States have had severe economic impacts. During the week of March 23, more than 3 million people filed unemployment claims (compared with the highest previous one-week total of 695,000 claims in October 1982).


The economic consequences of the pandemic have led some, including President Trump, to call for an end to social distancing and a quick "reopening" of the country. They backed down, however, after epidemiologists and other public health professionals convinced them that only severe limits on person-to-person contact can slow the tide of new cases.


For more timely updates, see our blog, Off the Charts, at http://ajnoffthecharts.com. -Betsy Todd, MPH, RN, clinical editor