Record Unemployment Numbers; Ventilator Shortages : Consider This from NPR 6.6 million Americans filed for unemployment benefits last week, doubling the record-setting numbers from the week before. The rapid increase has overwhelmed state offices.

Ventilators are a scare resource right now. While they are lifesaving for some, NPR's Jon Hamilton reports when it comes to COVID-19, they do not guarantee survival.

Plus, how to protect essential workers when ordering delivery and going to the grocery store.

Links:

The Indicator's episode on scarcity in the emergency room on Apple, Spotify and NPR One.

Camila Domonoske's reporting on grocery store worker safety.

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This episode was recorded and published as part of this podcast's former 'Coronavirus Daily' format.

Ventilator Shortages; 6.6 Million New Unemployment Claims

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KELLY MCEVERS, HOST:

Just real quick before we start the show - you're listening to this, so that probably means that a clear, calm and brief update on everything that's going on right now is important to you. And we work hard to do that every weekday. Now, we're asking for your help. Please, if you can, go to donate.npr.org/daily to find your local public radio station and support it. Everything helps. If you can sign up to be a sustaining member, that's the best - donate.npr.org/daily. Also, there's a link in our episode notes, and thanks.

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MCEVERS: 6.6 million Americans filed for unemployment benefits last week. That is a staggering number, and it is a record for the second week in a row. The week before, over 3 million claims were filed. That means at least 10 million Americans have lost their jobs in just the last two weeks.

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ANDREW CUOMO: We have about six days of ventilators in our stockpile.

MCEVERS: In New York, Governor Andrew Cuomo said his state could run low on ventilators over the next week.

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CUOMO: If the apex happens within that time frame, if the apex increases, if the apex is longer, we have an issue with ventilators.

MCEVERS: Coming up, why those ventilators do not guarantee survival and how we can all help to keep delivery and grocery store workers safe. This is CORONAVIRUS DAILY from NPR. I'm Kelly McEvers. Today is Thursday, April 2.

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UNIDENTIFIED REPORTER #1: I was just going - (unintelligible) to both of you, that number that we've been looking for just crossed. And you'll forgive me if my jaw is on the ground. U.S. weekly jobless claims total - 6.6 million versus 3.1 million expected.

MCEVERS: 6.6 million people.

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UNIDENTIFIED PERSON #1: An impact being felt all across the country right now as we're basically shut down.

MCEVERS: It is a number never seen before in the history of the Labor Department.

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UNIDENTIFIED REPORTER #2: These are numbers that we saw over the course of the entire Great Recession, and we don't know how many of these people are going to get back to work and how quickly...

MCEVERS: Because this happened so fast, the state offices that process unemployment claims have been overwhelmed.

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AUTOMATED VOICE #1: We are currently receiving more calls than we can answer.

AUTOMATED VOICE #2: All agents are busy servicing customers.

AUTOMATED VOICE #1: Please try again later.

AUTOMATED VOICE #3: Gracias.

AUTOMATED VOICE #4: Thank you for calling...

AUTOMATED VOICE #3: Adios.

MCEVERS: And the backlog of claims is almost certain to grow.

LYDIA BOUSSOUR: You're basically asking people to stay home and not go to work.

MCEVERS: Lydia Boussour at Oxford Economics says as many as another 10 million people might be laid off. That would be 20 million Americans in a matter of weeks.

BOUSSOUR: We wouldn't have think a few weeks ago that something like this would have been possible.

MCEVERS: There is a little bit of good news, right? Gig workers, self-employed people and freelancers are now eligible for unemployment under the economic relief act that passed last week. All that goes to say if you or someone you know has applied for benefits, it might take some time.

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UNIDENTIFIED PERSON #2: For faster service, use uionline@ebd.ca.gov/ui_...

MCEVERS: There are now more than 1 million cases of COVID-19 worldwide. And in so many ways, the story of this pandemic is scarcity - not enough tests, not enough masks, not enough hospital beds and not enough ventilators.

Jessica Van Voorhees is an emergency room doctor at NewYork-Presbyterian Methodist Hospital in Brooklyn, and she is seeing all that scarcity firsthand. She talked to Stacey Vanek Smith on The Indicator. It's NPR's daily podcast about business and the economy.

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STACEY VANEK SMITH: How many ventilators do you guys have?

JESSICA VAN VOORHEES: Well, apparently our respiratory therapist has been gathering vents for a while and, like, prepping for this. And they were saying we had 55 patients on vents. And apparently, you know, we had 70 vents in the hospital.

VANEK SMITH: You have 70 vents?

VAN VOORHEES: Yeah, that's what they said.

VANEK SMITH: That's, like, only 15 ventilators left.

VAN VOORHEES: Right.

VANEK SMITH: That's kind of getting...

VAN VOORHEES: You're getting there. Right. It's like, how many...

VANEK SMITH: Yeah.

VAN VOORHEES: So I keep waiting for them to call downstairs and be like, OK, there are four left. Like, you have to choose. But it just hasn't happened yet.

VANEK SMITH: And then you have to start picking who the...

VAN VOORHEES: Yeah.

VANEK SMITH: ...People who really, really most need a ventilator are.

VAN VOORHEES: Yeah. And even maybe who to save, right? So, like, who has the most likelihood of surviving because you don't want to put someone on a vent that you think they won't survive. You know, do you save somebody who's younger because they have more years ahead of them, or do you save somebody who is middle-aged because they have knowledge and experience?

VANEK SMITH: That's not a call that you've had to make.

VAN VOORHEES: Never. No, never. And...

VANEK SMITH: But you're worried that you might have to start.

VAN VOORHEES: Might have to, yeah. In Italy, they certainly had to make those decisions because they didn't - they ran out of ventilators and then started to just choose younger people or whatever, you know? But they said it's hard because sometimes you're sort of like, these two are a tie. They're very similar.

VANEK SMITH: That's a horrible choice to have to make.

VAN VOORHEES: I know.

VANEK SMITH: That's really - that's - I mean, have you thought about that a lot or...

VAN VOORHEES: Well, it's really the concept of triage - you know, sorting patients into, like, more severe and less severe. You're trying to provide the most good for the greatest number. So I feel like I could actually make those decisions if I had to. And that's a good thing because you want somebody who could make that decision, right?

VANEK SMITH: But do you think that is coming with questions of resources, possibly - like ventilators and things like that?

VAN VOORHEES: Maybe. And they're doing creative things. Like, it turns out you can actually put more than one person on a ventilator. The machine itself is strong enough to give breaths to two, maybe even three people so that...

VANEK SMITH: Oh.

VAN VOORHEES: ...Which is kind of crazy. Like, I definitely have never seen that done before. But the respiratory therapists were saying that that's possible, and it effectively doubles the number of vents that you have...

VANEK SMITH: Yeah.

VAN VOORHEES: ...Which is crazy.

VANEK SMITH: Have you seen a lot of people dying from coronavirus?

VAN VOORHEES: Yeah, not ones that I've admitted to the hospital. Like, certainly, we're seeing people come in in cardiac arrest and not make it.

VANEK SMITH: Is it mostly very older people?

VAN VOORHEES: It's actually been a really broad range. So the patients coming in with coronavirus and needing oxygen - I've seen people in their 30s who have no health problems. So, like, we all know this is a really deadly virus. But I feel like - say you - 1% of the, you know, population that catches it, which I would say most of the population of New York City is going to catch it at some point - say 1% of people die. Well, that's a lot of people, right?

So I feel like the next wave that's going to be coming, which is really sad and we all kind of have to emotionally prepare for, is the wave of death that's coming. There's going to be this really, like, big national, like, bereavement. And people should be ready to know. I feel like we're still at that friend of a friend phase, and eventually, it's just going to get closer and closer to home. And everyone's going to know someone.

We haven't peaked yet. I'm going to be happy when we peak and things start going down because then at least, you know, it can't get any worse.

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MCEVERS: Jessica Van Voorhees on The Indicator. You can hear more of that conversation on that podcast and find a link to it in our episode notes.

So as health care workers in hard-hit areas stare down the possibility that they could run out of ventilators, it is worth saying those machines can be lifesaving for some critically ill patients, but not for all of them. Here's NPR's Jon Hamilton.

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JON HAMILTON: The intensive care units at Barnes-Jewish Hospital in St. Louis are filling up with coronavirus patients, and Dr. Tiffany Osborn has been caring for many of those who've been placed on ventilators to keep them alive.

TIFFANY OSBORN: It's very concerning to see how many patients who require ventilation do not make it out of the hospital, how many of them die.

HAMILTON: Osborn is a critical care specialist at Washington University School of Medicine. She says doctors in China and Europe and elsewhere in the U.S. are reporting death rates from about 50% to more than 80%.

OSBORN: We're not sure how much help ventilators are going to be. They may help keep somebody alive in the short term. We're not sure if it's going to help keep someone alive in the long term.

HAMILTON: Patients end up on a ventilator when their lungs can no longer deliver enough oxygen to keep the body going. Osborn says it's an extreme measure.

OSBORN: We give sedation so that the person goes to sleep, and then we provide a paralytic that stops their breathing.

HAMILTON: Next, they insert a long plastic tube through the trachea and vocal cords. That allows the machine to deliver puffs of highly oxygenated air to the lungs.

OSBORN: The ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs.

HAMILTON: And Osborn says coronavirus patients often need dangerously high levels of both pressure and oxygen because their lungs have so much inflammation. Also, ventilators create a path for a wide range of infections to reach the lungs.

Dr. Negin Hajizadeh is a pulmonary critical care doctor at Hofstra/Northwell School of Medicine in New York. She says ventilators work really well for patients with common forms of pneumonia.

NEGIN HAJIZADEH: We treat patients for several days. And then we get the antibiotics into the body, and the patient recovers. Unfortunately, with this COVID-associated pneumonia, there are no treatments that we know work for sure.

HAMILTON: So Hajizadeh, who spoke to me from just outside of an intensive care unit, says ventilators are of limited value.

HAJIZADEH: We have had several patients between the hospitals across the Northwell health system that have come off of the breathing machine, but the vast majority are unable to.

HAMILTON: Hajizadeh says one reason is that the coronavirus often does a lot more lung damage than, say, the flu.

HAJIZADEH: There is fluid and other toxic chemical cytokines, we call them, raging throughout the lung tissue.

HAMILTON: She says in some patients, the damage is so bad that even ventilation won't help. So they've tried an even more extreme measure called ECMO, which delivers oxygen directly to a patient's bloodstream.

HAJIZADEH: Remember, ECMO, too, is a life-supporting treatment. So it's a bridge while we are allowing the lung to heal itself from a pneumonia.

HAMILTON: If it can. Dr. Tiffany Osborn says that what doctors are learning about severe coronavirus infections should make it crystal clear why we all need to take steps to keep the virus from spreading.

OSBORN: I know that at times it gets frustrating, but it's really important not just for yourself and your family but for the other people that you care about to shelter in place until this is over.

HAMILTON: Osborn should know. When she's not at the hospital, she's living in a camper to avoid putting her family at risk.

MCEVERS: That was NPR's Jon Hamilton.

And before we go, just a couple of notes on food. The coronavirus is spread primarily through respiratory droplets. And that means if you're getting takeout, the biggest risk to you and to your delivery worker is contact. Many restaurants are taking extra precautions, such as no-contact delivery or pickup. And once you have your food, you will want to throw away any packaging. According to the CDC, it is possible to get sick from touching a surface that has the virus on it. And before you eat, make sure to wash your hands thoroughly and tip your delivery person thoroughly, too. As for the grocery store, we should think of those workers as well.

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AMANDA CASABURRI: A lot of our customers are coming in in masks, and I appreciate that. And I like to think it's not just for their own health, but it's for ours.

MCEVERS: Amanda Casaburri works at Kroger near Fort Worth. She talked to NPR's Camila Domonoske. And she said when she's restocking dry goods, she is constantly thinking about every surface she touches.

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CASABURRI: My biggest fear is getting sick and passing it to someone else.

MCEVERS: Casaburri says she sees some shoppers lingering in the aisles, and that makes her worry.

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CASABURRI: I just wish everyone would take it a little bit more seriously.

MCEVERS: So she has some strong advice. Bring a list, get in, get out and go home.

For more news on the coronavirus, you can stay up to date on your local public radio station. And if you like your news on demand, download the NPR One app. You will find podcasts and a mix of local, national and international news.

I'm Kelly McEvers. Thanks for listening. We will be back with more tomorrow.

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