More lifesaving ventilators are available. Hospitals just can’t afford them.

Mechanical ventilators, which help patients breathe or breathe for them, are considered critical to the nation’s effort to contain the worst effects of the pandemic, and avoid a crisis like the one Italy is facing. But depending on how bad the coronavirus pandemic gets in the United States, individual cities could come up thousands of ventilators short as patients flood hospitals, researchers say.

“It’s a challenge for states, local governments and hospital administrators to allocate tens of millions of dollars to something when they don’t know if they need it or not,” said Chris Kiple, chief executive of Ventec Life Systems, a small ventilator manufacturer in Washington state. “But if they don’t do it, they are going to be caught flat-footed and facilities are going to be faced with not enough ventilators to meet demand.”

Ventilator manufacturers could achieve, within a few months, a significant boost in production from about 50,000 units a year currently, said Julie Letwat, a health-care lawyer with McGuireWoods in Chicago who is monitoring the industry. But orders have not been flooding in, she said, because most hospitals can’t afford to significantly increase inventory of the expensive equipment for a relatively short-term event.

“The risk is that they’ll never be used, and hospitals can’t eat the cost,” she said. “Most hospitals in this country are not profitable.”

Ventilators range from $25,000 for a basic model up to $50,000 for a machine used in the most advanced intensive care units. Buying them also requires additional large investments in staff and training. Letwat said federal government investment would be the surest way to boost supply.

Governors and local health authorities have been worrying about an insufficient supply of ventilators in hospitals and have been calling on the Trump administration to move aggressively to solve the problem.

Other governments have rushed to stock up on ventilators. The United Kingdom has asked Rolls-Royce Holdings, which makes jet engines, and other heavy manufacturers to begin making ventilators. Germany ordered 10,000 ventilators with Dragerwerk AG, which Dow Jones said was the company’s largest order ever.

In the United States, by contrast, Trump told state officials on a conference call that states and local governments should procure their own equipment. “Respirators, ventilators, all of the equipment — try getting it yourselves,” Trump told the governors, according to the New York Times, which first reported the call.

The Trump administration also has barely begun to release up to 13,000 older ventilator models that are cached around the country in the federal Strategic National Stockpile, saying state officials have not even started requesting them. On Tuesday, the Defense Department said it will contribute an additional 2,000 ventilators to the effort.

Maryland Gov. Larry Hogan (R), chairman of the National Governors Association, said that leaders nationwide are scrambling to secure ventilators to prepare hospitals for a surge of coronavirus patients, but that there are simply not enough available.

“There is a problem with supplies and ventilators,” Hogan said Monday. “There’s not enough supplies. The states don’t have enough. The federal government doesn’t have enough. They’re not getting distributed fast enough. And that’s a problem for all of us.”

Hospital officials do not yet know how many patients will need ventilator care in the United States, or whether the system will be overwhelmed. They say they are in a race against the spread of the virus, hoping that measures to keep people in their homes will reduce the size of the short-term spike in those seeking care.

“We have heard from our members that they will have enough ventilators,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, which was one of three organizations that asked Congress for more resources in the letter Monday. “Knowing exactly what is enough is hard at the moment.”

Hospitals are canceling elective surgeries — freeing up ventilators that would otherwise be used on sedated patients getting hip replacements, for instance — and preparing to move ventilators to hot spots of infection within multi-hospital systems. They are also planning to bring some older models back into use.

“We do have the capacity in an emergency to turn the switch on a lot of different things. We could change in a very short time,” said Brahim Ardolic, executive director of Staten Island University Hospital, which is part of a 22-hospital chain.

Foster said she has not heard any American Hospital Association member hospital say it was not purchasing ventilators because of cost. “They want to be fully prepared to serve the needs of their community and to do so intelligently,” she said.

The situation stands in high contrast to the scramble by hospitals to buy as much personal protective equipment as they can for medical staff before the coming wave of infection, including disposable protective masks called N95 respirators, which are in short supply nationwide.

On the front lines of one of the nation’s earliest outbreaks, J. Randall Curtis, a doctor in Seattle, has treated six coronavirus patients in the intensive care unit at Harborview Medical Center, three of them requiring ventilators (including one who died). He said the unique thing about their care has been the intense focus on infection control and the heavy use of personal protective equipment for medical staff.

The team has managed the patients with the state-of-the-art ventilators it has on hand, and has more available, he said.

“Right now, we are mobilizing additional staff, and cordoning off ICUs to take care of these patients, canceling surgeries, but we’re not exceeding capacity,” he said.

Nationally, the gap between demand and supply of ventilators could run into the tens of thousands, according to estimates. An analysis by the Society for Critical Care Medicine, citing figures developed for the American Hospital Association, said U.S. hospitals have 62,000 full-featured ventilators for advanced intensive care units, with nearly 100,000 more ventilators of lesser capability.

Contrast that with the potential demand: More than 900,000 patients may need ventilator care during the coronavirus pandemic, the analysis concluded.

Keeping a large supply of backup ventilators on hand is impractical for most individual hospitals, because of the need to service and maintain them and train additional staff during those rare events when they are needed, said Lewis Kaplan, a trauma surgeon at the University of Pennsylvania and president of the Society of Critical Care Medicine.

“It’s like taking military planes out of your boneyard,” he said. “There can be a variety of economic disincentives to be prepared for the worst thing that can happen.”

Not all patients would be sick at once, so the shortfall may not be as dire as it may seem, Kaplan added. And many coronavirus patients can be adequately treated with older models of ventilators or less invasive modes of respiratory help, he said.

Medtronic, GE Healthcare, Becton Dickenson and Philips are among the largest producers of ventilators for the global market. Several large manufacturers said they are increasing manufacturing of medical supplies, including ventilators, but would not provide specific numbers.

“We are taking steps to increase our manufacturing capacity and output of equipment that is important in the diagnosis and treatment of covid-19 patients,” a spokeswoman for GE Healthcare said in a statement.

Competition for supply could become an issue. With Europe’s governments placing massive orders, manufacturers could also face delays in obtaining spare parts because of supply-chain disruptions.

“A lot of these components for these ventilators are coming from other countries overseas, and some of the parts they need are creating a little bit of a backlog,” said Timothy R. Myers, chief business officer of the American Association for Respiratory Care, which represents health-care workers who specialize in ventilator treatment.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Sunday that the federal government’s emergency stockpile of medical supplies contains nearly 13,000 ventilators. To access those, hospitals are required to ask their state and local governments, which then ask the federal government to release supplies.

Secretary of Health and Human Services Alex Azar said Sunday at a news briefing at the White House that the government has barely heard from states about tapping the stockpile.

“We have received, so far, only, I think, one request for just several ventilators,” he said. In contrast to Fauci’s disclosure that the stockpile contains nearly 13,000, Azar said the number was not disclosed for national security reasons.

Pressed by Sen. Patty Murray (D-Wash.) at a congressional hearing this month about the adequacy of supplies, Azar suggested that a key reason for passage of an $8.3 billion emergency spending bill was to procure more equipment, including ventilators and personal protective equipment for health-care workers.

Foster, of the American Hospital Association, said requests to obtain ventilators from the Strategic National Stockpile have not begun because the location of potential shortfalls is not yet known.

“It is a wait-until-it’s-needed situation,” she said. “We don’t know which communities are going to be hard hit at any given time.”

Erin Cox contributed to this report.

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