(CNN) In at least 10 government reports from 2003 to 2015, federal officials predicted the United States would experience a critical lack of ventilators and other lifesaving medical supplies if it faced a viral outbreak like the one currently sweeping the country.
The drumbeat of warnings undermines President Donald Trump's claim last week that "nobody in their wildest dreams" could have imagined the demand for ventilators that now exists. The demand is pushing hospitals to the brink in New York City and threatening to do so in parts of Washington state, California, Louisiana and beyond.
In addition, a 2017 study funded by the National Institutes of Health and the Centers for Disease Control and Prevention found that "substantial concern exists that intensive care units (ICUs) might have insufficient resources to treat all persons requiring ventilator support" and that even the supplies held in the so-called Strategic National Stockpile "might not suffice to meet demand during a severe public health emergency."
But federal agencies were underscoring the risks of insufficient ventilators and other equipment as far back as President George W. Bush's administration. In July 2003, a report by the Government Accountability Office noted that "few hospitals reported having the equipment and supplies needed to handle a large-scale infectious disease outbreak. Half the hospitals we surveyed had, for every 100 staffed beds, fewer than 6 ventilators, 3 or fewer personal protective equipment suits, and fewer than 4 isolation beds."
Many more reports pointing to the lack of ventilators followed, some in response to outbreaks such as avian flu or SARS:
"There has always been a concern about a respiratory illness, readily transmittable, emerging as an infectious disease," said Marcia Crosse, who worked at the GAO from 1983 to 2018, most recently as the director of health care.
During global outbreaks of H1N1, SARS and MERS, Crosse said, "we dodged the bullet time and again."
"But the CDC has been well aware, HHS has been well aware, the intelligence community has been well aware" of the risk, she added. "Of course, nobody would know the specific details, we didn't know it would be a coronavirus from China, but the threat of a respiratory illness was known."
On Tuesday, Gov. Andrew Cuomo predicted New York would need an additional 30.000 ventilators to effectively battle the pandemic. The Federal Emergency Management Agency has sent 4,000 ventilators so far, Cuomo said on Wednesday, adding that the state has purchased another 7,000 and is looking to buy more. On Friday, he confirmed that the state is now almost halfway to the number he expects it to need.
On Thursday night, in an interview with Fox News' Sean Hannity, Trump again minimized the urgency for additional medical supplies, saying "I don't believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they'll have two ventilators. And now all of a sudden, they're saying, 'Can we order 30,000 ventilators?'"
Ventilators typically cost at least $15,000, and though any major hospital would have more than two, they have historically kept on hand only what is needed to serve patients in conditions outside of a pandemic.
Dr. Steven Choi, chief quality officer for the Yale School of Medicine and the Yale New Haven Health system, said that diseases like coronavirus put unusual pressure on ventilator resources.
"People need to understand, though, that a typical adult patient normally stays in the ICU only for three to four days," he said. "What we're seeing in Covid-19 patients in Asia, Italy and the US is that when patients do end up being ill enough to be admitted to the ICU, they need to be intubated and remain on a ventilator for two to three weeks, which increases the demands for ICU beds and ventilators dramatically."
Major companies, including Ford and General Motors, are working to quickly manufacture additional ventilators. On Friday, Ventec Life Systems and General Motors announced a partnership expected to produce more than 10,000 ventilators per month starting as early as April.