Instead of moving ventilators to the patients who need them, move the patients to the ventilators.

1. 11/13/2020 Operation Covid Airlift Would Be Medevac in Reverse - WSJ
https://www.wsj.com/articles/operation-covid-airlift-would-be-medevac-in-reverse-11585695115?emailToken=62e9f02d31e0671a055c3510f9a9a5752lk… 1/3
Operation Covid Airlift Would
Be Medevac in Reverse
Instead of moving ventilators to the patients who need them, move the patients to the
ventilators.
By Mitchell Blutt and Kevin G. Volpp
March 31, 2020 6:51 pm ET
Hospitals in New York, Italy and elsewhere are struggling to care for large numbers of Covid-19
patients. The roots of this problem are complex, but one possible solution lies in sorting out the
geographical mismatch between critical resources and the patients who need access to them. Instead
of moving ventilators and ventilator technicians to coronavirus hotspots where both are in short
supply, perhaps we could move patients to places with a surplus of ventilators and the medical staff
trained to operate them.
Estimates of the proportion of Covid-positive patients who require hospitalization and intensive-
care-level support including ventilators vary based on the proportion of the population that is tested.
But it is clear that hospitals in New York are at risk of having neither enough equipment nor enough
trained personnel to care for everyone who may soon need a ventilator to survive.
A ventilator is stored in New York’s Emergency Management Warehouse for distribution, March 24.
PHOTO: CAITLIN OCHS/REUTERS

2. 11/13/2020 Operation Covid Airlift Would Be Medevac in Reverse - WSJ
https://www.wsj.com/articles/operation-covid-airlift-would-be-medevac-in-reverse-11585695115?emailToken=62e9f02d31e0671a055c3510f9a9a5752lk… 2/3
Gov. Andrew Cuomo has begged and bargained for more ventilators and attempted to recruit
additional medical personnel to manage them. But obtaining sufficient ventilators will be
meaningless without enough trained technicians to run them, and vice versa. Even if ventilators
could run by themselves, it may take weeks or months to supply New York with the numbers it
needs. Lives will be lost in the process.
Call it Operation Covid Airlift. Most of those who develop Covid-19 symptoms severe enough to
require hospitalization have the time for an emergency flight from New York City to a region with
unused capacity. State or national health authorities should provide daily updates of available ICU
beds and ventilators. Patients who are stable but at high risk for requiring intubation over the next
several days could be moved from New York-based hospitals to other regions that are fully ready to
care for them. Alternatively, patients who are already intubated on ventilators and are stable enough
to be transported could be moved to hospitals with available ICU capacity.
This could work a variety of ways. It’s common for hospitals in rural or isolated locations to transfer
patients who need higher-level care to major academic centers by airplane or helicopter. Perhaps the
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3. 11/13/2020 Operation Covid Airlift Would Be Medevac in Reverse - WSJ
https://www.wsj.com/articles/operation-covid-airlift-would-be-medevac-in-reverse-11585695115?emailToken=62e9f02d31e0671a055c3510f9a9a5752lk… 3/3
solution to the looming crisis is to run this system in reverse. Patients in high-prevalence locations
could be flown to places where there is plenty of available capacity to treat them.
It might also be possible to fly patients with less acute symptoms using slightly repurposed civilian
airplanes, many of which are currently grounded. As the mismatch between patient need and critical-
care support diminishes in the New York region, Operation Covid Airlift could move patients from
other hot zones to regions with open capacity, eventually including New York as the crisis there
eases and other hotspots emerge.
Some may resist this proposal out of fear that moving infected patients around the country would
risk further spread of the virus to places less equipped to handle an outbreak. But these patients
would be properly isolated with protective equipment to diminish that risk, and hospitals that aren’t
overcrowded will manage this crisis better. In fact, going from ambulance to plane to ambulance to
hospital would create far less contagion risk than the type of spread that is likely happening in many
communities already.
Family members may also balk at being geographically separated from loved ones who are ill, but
current protocols already restrict hospital visits with Covid-19 patients and others during the
outbreak. If everyone understands that regional relocation is what it takes to save lives, families
could find it easier to cope with the physical distance.
Receiving-hospital communities might worry that there won’t be enough beds for sick locals if they
accept too many relocated patients. Projections such as the Penn Medicine Covid-19 Hospital Impact
Model for Epidemics can help forecast likely capacity constraints many weeks in advance using real-
time data.
None of this is ideal or without risk, but we are in a world of second-best options. It is worth
considering whether an approach like this could, on balance, be beneficial. There would be risks
involved in transporting critically ill patients. There are also risks involved in having your hospital
run out of ventilators.
Dr. Blutt is CEO of Consonance Capital, a professor at Weill Cornell Medical Center and advisory
board chairman of the Penn Center for Health Incentives and Behavioral Economics. Dr. Volpp is a
professor at the University of Pennsylvania’s Perelman School of Medicine and the Wharton School
and director of the Penn Center.