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The Lead with Jake Tapper
Harvard Doctor Developing Point System to Help Hospitals Decide Which Patients Get Life-Saving Treatment; New York Hospital is Using Basic Parts to Convert CPAP Machines Into Ventilators. Aired 4:30-5p ET
Aired April 03, 2020 - 16:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
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[16:31:02]
JAKE TAPPER, CNN HOST: A grim and unimaginable reality that doctors across the country may face in a worst case scenario. Medical professionals tell CNN they hope it never comes to it but they're forced to develop a point system in the inevitability that hospitals need to decide which patients get lifesaving care and which don't.
It's a nightmare scenario, of course. It's not inevitable but it might happen.
CNN's Drew Griffin has taken a closer look now at how this protocol might work and how close we are to needing it.
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DREW GRIFFIN, CNN SENIOR INVESTIGATIVE CORRESPONDENT (voice-over): The horrifying pictures from inside New York hospitals show patients hooked up to the only machines keeping them alive. When the virus takes over the lungs, ventilators take over the breathing. Without them immediately when needed, the prognosis is dim.
MEGAN SCHLANSER, METRO DETROIT NURSE: It's bad. You can watch a patient go from breathing room air to 72 hours later, needing to be intubated.
GRIFFIN: So far, hospitals have kept pace, but barely. The situation so bleak, the U.S. government put out a video on treating two patients with one ventilator.
UNIDENTIFIED FEMALE: You obviously wouldn't do it unless you're in dire circumstances.
GRIFFIN: But the dire circumstances are here. States and the federal government are in a bidding war for ventilators made in China.
GOV. ANDREW CUOMO (D), NEW YORK: We can't get any more ventilators.
GRIFFIN: And it is time now to prepare for what may be the inevitable. This article in "The New England Journal of Medicine" was written to prepare doctors in the event they must choose who gets a lifesaving ventilator and who does not.
Robert Troug is one of the authors.
DR. ROBERT TROUG, DIRECTOR, HARVARD CENTER FOR BIOETHICS: I worked all weekend on helping of a number of them, and hospitals now -- many hospitals have these in place. So I think that it's going to be extremely difficult.
GRIFFIN (on camera): Unbelievably difficult for those physicians who have to make the call.
TROUG: That's right, and, of course, the families and patients as well. These are life and death decisions, and it's going to cause a tremendous amount of suffering if we get there.
GRIFFIN (on camera): The decision, who lives, who dies, would come down to a point system. The elderly, patients diagnosed with cancer, COPD, diabetes, any chronic lung or terminal illness would be eligible for care but score lower than those who are otherwise healthy with a potential longer life to live. The points would determine what's in the better interest of society, not just the individual.
TROUG: Everybody is eligible, but beyond that point, then it does come down to giving it so those people where we're either going save the most number of lives or the most number of life years. And yes, it does mean that people with other severe illness will receive a lower priority score.
GRIFFIN: In New Orleans, where the virus is predicted to get even worse, there are enough ventilators now, but within days, they could be out.
DR. JOSEPH KATNER, ASSSISTANT STATE HEALTH OFFICER, LOUSIANA DEPARTMENT OF HEALTH: And then after that, you begin having very challenging conversations about how you allocate the vents and you think about which patient would benefit the most, and that's a horrifying place for anyone to be in and it would certainly be a damning indictment for our country.
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GRIFFIN: And, Jake, what is infuriating about all this is it was predicted. CNN has found 10 government reports between 2003 and 2015 all predicting that if we faced a pandemic just like this, we would run out of ventilators and here we are -- Jake.
TAPPER: Drew Griffin, thank you so much.
One hospital found a way to convert other medical equipment into ventilator by using parts they already have.
Joining us for an exclusive interview to explain how all this works is Dr. Charles Powell. He's the chief of Mt. Sinai's pulmonary critical care and sleep division.
Dr. Powell, thanks so much for joining us. I understand you're using simple parts to help convert CPAP machines into ventilators.
[16:35:03]
Explain to what a CPAP machine is, how you came up with this, and show us how it works.
DR. CHARLES POWELL, CEO, MOUNT SINAI-NATIONAL JEWISH HEALTH RESPIRATORY INSTITUTE: Sure. Thanks so much, Jake.
So, we were fortunate to receive a generous donation of this home CPAP machines that are used for patients with sleep apnea, donations from the Tesla Company. So the question came, can we news these simple devices to ventilate a patient in one of our ICUs who has complications from COVID pneumonia?
And we have a very experienced and accomplished team of sleep physiologists here in Mount Sinai and they said, yes. And then we said, how? Then they started to explain it. It was really complicated.
So we just said, what it needs to do is X, Y, and Z in terms of ventilating a patient and what it needs to also do is avoid any spread of the virus. So they constructed a protocol in a simple circuit so when you take the little machine I just showed you and you hook it up to a test lung, it inflates the lung and it does it in a way so that the virus doesn't get moved around and doesn't get exposed to anybody in the area.
So we took that to the simulation lab, tested it, improved upon it, and it's been evaluated now in a clinical setting and it works. We now have received subsequent donations of similar machines and we'll be able to increase our ventilator supply to put us in position where we would be in very good shape to meet the need of anticipated surge of patients who are going to need ventilators.
TAPPER: So, as you say, medical patients are assembling them for hospitals to be able to use. How many ventilators have you been able to produce? Is this simple enough for hospitals across the country just to follow basic directions and make them themselves?
POWELL: Yes, the protocol is simple and the protocol is already been released widely and is available for anyone at any time. So with the appropriate supplies in hand -- and I just say that there is a shortage of supplies in some locations, similar to shortages of many supplies throughout the country. But with appropriate supplies in hand, any hospital can do it, following a protocol.
They don't have to use the exact same machine. They don't have to use the same circuit, just something similar that incorporates the filters that are incredibly important to prevent the spread of the virus and then that could be useful the supply using these very inexpensive, very available machines.
They don't work on every patient who needs it who has a COVID associated complications. Patients early on need a more conventional ventilator that's more powerful, but during the course of the illness, patients get better and when they do, they can be supported with a simpler device just like this.
TAPPER: So, you're also trying to cut down on the amount of gear that doctors and nurses need, so you also made the machines controllable from outside the patient's room, if need be.
POWELL: Yes. I want to clarify. This does not reduce the need to wear the proper amount of protective equipment when they're in the room.
TAPPER: Of course.
POWELL: But what it does do is reduce the number of times somebody may need to enter the room and be exposed with our ability to monitor and control the device from outside the room.
TAPPER: And you're working in the epicenter of the coronavirus in the U.S., in New York. Can you explain to us how bad it is on the front lines? And at Mount Sinai, how much worse you expect it to get?
POWELL: It's bad. It was the kind of event that maybe had been predicted but never was thought to be able to occur, and it's occurred. All the hospitals in the area have developed strategic plans, and those were developed months ago, and they have been in action several weeks now.
The goal of all strategic plans is to stay one step ahead, one step ahead of making sure we have the adequate personnel and equipment to take care of the surge of patients who are going to come to our hospitals. So the hospitals are overwhelmed in terms of volume, but by overwhelmed, I mean it just takes initiatives to take additional bed space, to bring in additional staff, to bring in additional supplies, to put us in a manageable position to handle the surge, which we have been able to do.
But really the main problem is volume. This is a volume crisis in terms of numbers of patients who need hospitalization for COVID-19. And the primary determinant of the volume is the doubling time, and that is affected directly by social distancing.
So what we have seen, to address your question of how long this is going to last, is that over the past several weeks the curve has flattened in New York in particular.
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Each day, the peak number of patients requiring hospitalization seems to decrease by 1,000 to 2,000, maybe a little bit more some days. So, that peak, we think if social distancing continues to be implemented and is effective is going to make the peak an area where this will continue to be manageable, albeit it will go on longer with a peak anticipated around mid to late April.
TAPPER: Well, God bless you and all the hospital workers and health- care workers at Mt. Sinai in New York. I really appreciate what you're doing and your ingenuity as well. Dr. Charles Powell, thank you so much.
POWELL: Thank you, Jake.
TAPPER: Coming up, one world leader uses the coronavirus pandemic as cover to give himself more power. The stunning move, next.
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TAPPER: In our world lead: Nearly 8 percent of the U.K.'s National Health Service staff is now sick.
A few have died, including 36-year-old nurse and mother of three Areema Nasreen, who passed away this morning.
In Italy, 73 doctors and 24 nurses have died from coronavirus, Madrid now turning its third ice rink into a makeshift morgue to handle the overwhelming number of bodies.
And, In Hungary, autocratic Prime Minister Viktor Orban is taking full advantage of the chaos caused by the pandemic.
And, as CNN's Nic Robertson reports, Orban is using it as cover for a blatant power grab.
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NIC ROBERTSON, CNN INTERNATIONAL DIPLOMATIC EDITOR (voice-over): Unfolding on national TV, an apparent blatant power grab.
Hungary's autocratic Prime Minister Viktor Orban, using COVID-19 as apparent cover, wins a vote giving him power to rule by decree, powers he says he needs to speed COVID response decision-making.
"Some of our important decisions have been overturned," he says. "Our defense ship has been leaked, and this leak has been patched today."
But there is no time limit on the sweeping reforms that effectively allow him to lock up journalists who criticize him for up to five years. Perhaps as shocking, the European Union's initial tepid reaction, a page-long written response, not even mentioning Hungary by name, only later toughened.
ERIC MAMER, SPOKESPERSON, EUROPEAN COMMISSION: Any emergency measures must be limited to what is necessary and strictly proportionate. They must not last indefinitely.
ROBERTSON: All across Europe, police forces and armies are getting new powers. Interpreting the limits is a hot-button issue.
In the U.K., one regional force was criticized for using a drone to film a couple driving to a beauty spot to walk their dog and shaming them by posting it online. MARTIN HEWITT, NATIONAL POLICE CHIEFS' COUNCIL: There have been some
incidents that I -- we wouldn't have -- want to have happened. People are trying to understand how to work in this very new environment.
ROBERTSON (on camera): We are all asking ourselves those same questions, how much freedom to give up for how long and under whose control.
What Orban is doing in Hungary, however, goes way beyond that debate. Europe's most illiberal democracy has just lurched towards a Russia- style autocracy.
(voice-over): Since he came to power a decade ago, Orban has been straining against Europe democratic values, refusing to take in migrants during the 2015 crisis, more recently hollowing out Hungary's judiciary, over time, turning the country into a one-party state, all this when truth about the coronavirus pandemic is at a premium.
MAMER: Now it is more important than ever that journalists are able to do their job freely and precisely, so as to counter disinformation and to ensure that our citizens have access to crucial information.
ROBERTSON: Orban's timing is perhaps not surprising. Only a few weeks ago, Russia's Putin extended his own rule until 2036, as the world is distracted by the pandemic, both men reaping personal gain.
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ROBERTSON: Now, the European Union does have some leverage over Orban, because he gets a lot of European Union funding. They're not seeming to use it just yet.
And an update here in the U.K., Jake. Another British nurse, Aimee O'Rourke, 39 years old, like Areema Nasreen you mentioned before, also a mother of three. Four doctors are now dead. Two more health workers have died as well, we learned this evening.
So all of this arriving probably on Hungary's doorstep soon. And, yes, there are leaders who will take advantage of all that suffering, Jake.
TAPPER: All right, Nic Robertson, thank you so much.
In military news today, a remarkable show of support and solidarity.
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UNIDENTIFIED NAVY SAILORS: Captain Crozier! Captain Crozier!
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TAPPER: They're chanting "Captain Crozier."
Sailors from the USS Theodore Roosevelt giving a hero's send-off to Captain Brett Crozier, after he was relieved of his command. [16:50:03]
In an effort to save the lives of his sailors, Captain Crozier sounded the alarm about a coronavirus outbreak on the aircraft carrier and the need to get to port as soon as possible in a memo to Navy leadership, which eventually got leaked to the media.
CNN's Pentagon correspondent Barbara Starr joins me now to discuss.
And, Barbara, Captain Crozier, he's not accused of leaking the memo to the media. So why was he relieved of command?
BARBARA STARR, CNN PENTAGON CORRESPONDENT: Well, fired, to put it bluntly, of course, Jake.
The Navy is making the case that he was relieved of command because he went around the chain of command, that he sent this letter without going to his nearest boss, who they say was just down the hall in the carrier they were on, and discussing his worries and concerns, and that he sent this letter, this memo about those worries about his sailors far and wide, and that he shouldn't have done that.
They also say that this resulted in a loss of confidence in his ability to command. Words that had been used include emotional. They say they're unsure that he could have gone ahead with proper decision- making in combat.
But look at what happened on that deck. Those hundreds of sailors turned up because word swept through the ship about when he was leaving. They didn't just show up. They wanted to give him the send- off and the loyalty that they felt for him when he expressed his worries about all of them.
TAPPER: Barbara, is this the end of Captain Crozier's military career?
STARR: Well, he's been -- quote -- "reassigned."
So we will see what happens. But, right now, two investigations look likely. The Navy's already said they're going to look into it. And now several members, Democratic members of Congress, are asking the Pentagon's inspector general to look into the circumstances surrounding him being relieved of duty.
One of the big questions is, how did COVID get aboard the ship? They have had a port call in Vietnam. Who agreed to that port call? And Did Captain Crozier think that port call was a good idea? Is that what brought this all about? That's going to be one of the big questions, Jake.
TAPPER: All right, a story we're going to keep on top of.
Barbara Starr at the Pentagon, thank you so much.
Louisiana is quickly becoming one of the coronavirus hot spots, with over 10,000 cases. This Sunday morning on CNN's "STATE OF THE UNION," I'm going to talk to Governor John Bel Edwards about what Louisiana is doing. This is at 9:00 a.m. and noon Eastern on Sunday, along with other guests.
Please join us then.
More than 56,000 people have died from coronavirus worldwide, from a prolific playwright to beloved musicians, authors, doctors. We're going to remember some of the lives lost.
That's next.
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TAPPER: The inspirational words of Bill Withers' classic "Lean on Me."
Today, we learned that we lost Withers. The singer/songwriter, whose songs includes such classics as "Ain't No Sunshine" and "Lovely Day," passed away from heart complications, his family says.
Artists, heroes and everyday people taken by COVID-19 are filling the obituary pages. These are men and women who helped shape American culture, as remembered by CNN's Tom Foreman.
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TOM FOREMAN, CNN CORRESPONDENT (voice-over): When Ellis Marsalis played with his musical sons, Branford, Wynton, Delfeayo, and Jason, it was jazz royalty at work. Now the virus has racked their hometown of New Orleans, taking Ellis away.
FLOYD CARDOZ, CHEF: I grew up in Bombay.
FOREMAN: When chef Floyd Cardoz stepped into his New York kitchen, he brought the flavors of India with him and a special spirit too.
CARDOZ: I believe that if you want to cook, you got to be happy. Happy people make good food.
FOREMAN: And when Dr. James T. Goodrich went into the operating room to separate conjoined twins, he came out with a bond of his own.
DR. JAMES T. GOODRICH, SURGEON: You got to think after a while they kind of like become your own kids. In a sense, you don't really have to have your own.
FOREMAN: The number of famous and influential folks falling to COVID- 19 is steadily growing. Many have been musicians, including Adam Schlesinger, Alan Merrill, who wrote "I Love Rock 'n' Roll," Wallace Roney, and Joe Diffie.
MARK BLUM, ACTOR: Where is the man from the backwoods?
FOREMAN: Actor Mark Blum and playwright Terrence McNally are gone, journalist Maria Mercader too.
In one Manhattan hospital, the staff celebrates every COVID-19 patient well enough to go home. And most people who get the virus do survive. Still, so many have fallen, taking their important work with them.
Sociologists and author William Helmreich walked every street in New York to better understand the human condition. Lorena Borjas came from Mexico to become an outspoken American activist for transgender rights.
Rabbi Romi Cohn survived the Holocaust, but, at 91, did not survive this. Minister Ronnie Hampton, renowned for his community outreach down South, is gone as well.
PASTOR RONNIE HAMPTON, NEW VISION COMMUNITY CHURCH: I want you to know that my faith has never wavered.
FOREMAN: And Janice Preschel ran a New Jersey food pantry, a job she continued by phone, even as she lay dying in her hospital bed.
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FOREMAN: None of these folks is more important, of course, than any of the thousands of other Americans who have passed.
But they are big reminders of how the human geography of our nation is changing -- Jake.
TAPPER: Tom Foreman, thank you so much.
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