Where is the resource bottleneck in taking care of coronavirus patients? It is heartbreaking and tragic watching the situation unfold in Italy and New York City. The torrent of coronavirus patients have completely overwhelmed the health care systems there, leading to shortages of personal protective equipment, beds, ventilators, and personnel. Pretty early on, the Society of Critical Care Medicine published a document on resource availability in the United States for this outbreak. It put together the number of ventilators, board-certified critical care physicians, and types of beds in every hospital in the country. When I read it at the time, I wasn't quite sure how to interpret all the data. It discussed strategies to expand intensive care beds, modify anesthesia machines to act as long term ventilators, and access the Strategic National Stockpile. As the last few weeks have unfolded, we have seen these resources stressed and depleted.

This is an unacceptable problem, and yet a reality we face. We are unprepared for a pandemic of this magnitude. As a consequence, patients are dying and will continue to die as a result of inability to deliver best care. Fortunately, where I am in the Bay Area, the situation is so far still manageable. Yet I worry every day that we will have a shortage of personal protective equipment, beds, ventilators, physicians, nurses, or respiratory therapists. In critical care, we often hit the boundaries of what we can do for a patient because of limitations in medical knowledge or therapeutics, but rarely because of limitations in resources. How do we wrestle with those ethics, to be in a situation where we would offer something in normal circumstances but cannot in these exigencies?

One particular concern is personal protective equipment. This has obviously flooded the news lately, but I think it worth exploring. The majority of us who enter this field - my classmates in medical school, my coresidents and cofellows, my colleagues today - do so to serve others, often at our own expense. Some things are expected of us; we sacrifice our sleep, skip meals, even suffer overdistended bladders on a regular basis. For ten months of intern year, I worked thirty hour shifts every four days through weekends and holidays. Spending seventy to eighty hours a week in the hospital, seldom encountering sunlight, facing emotional strain and psychological burnout, we suffered real and undeniable health and mental consequences.

These other sacrifices make it easy for us to tolerate suboptimal personal protective equipment, but this shouldn't be the case. The stories of mask shortages and N95 rationing at overwhelmed hospitals are unimaginable. We must protect our providers. This responsibility, I believe, falls not only on the hospital, health care system, and government, but also onto the general public. There is a sense of dismay and anger when I hear about non health care workers buying up all the masks on the market, and then sometimes selling them at a premium. Universal masking is a separate issue, but certainly does not require N95 respirators that should go to our doctors and nurses who put themselves in exquisite risk. If we do not protect them, there will be no one to take care of the rest of us when we get ill.

There is also no end in sight to this pandemic. We are in for the long haul. And though ventilators don't need to sleep, our workforce does. We will get tired, sick, burned out. We will need a day off, a shoulder to cry on, a friend to confide in. We still have to negotiate the crowds at Costco or find an Instacart slot. We still need to arrange for childcare. To this end, I think our health care workers are eventually going to be the bottleneck to managing this pandemic. With time, we will make beds and source equipment. It may take a company months to start churning out ventilators, but it took five years after medical school for me to become a board certified intensive care physician. If we run out of doctors, filling the personnel gap will not be simple. This is why it is incumbent on the system to protect and support us.