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Medical equipment at the Columbus Covid-2 Hospital, in Rome, on March 16, 2020.Marco Di Lauro/Getty Images

Demand is so great in Italy for pulmonary ventilators that the government has called in the military to help a local manufacturer ramp up production of the devices, which can mean the difference between life and death for the country’s thousands of COVID-19 patients.

Italy has the most pressing need for ventilators. By Wednesday evening, the country had recorded another shocking rise in positive COVID-19 tests. The total number of cases rose by 4,207 to 35,713; fatalities climbed by 475 to 2,978. If the pace continues, Italy will have half as many cases as China before the weekend.

About 30 military technicians started work this week at Siare Engineering International Group, a private electromedical supply company whose factory is near Bologna, in the hard-hit north-central part of the country. Italy is the European epicentre of the coronavirus outbreak, and Siare’s short-term goal is to double production to 500 ventilators a month – higher if possible.

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“All of a sudden, we found ourselves facing an operation of titanic proportions,” Gianluca Preziosa, the company’s founder and president, wrote on Facebook late last week.

Siare is the only Italian maker of ventilators and one of just four in Europe. Each is suddenly working flat out to meet demand.

Germany has put in an order for 10,000 ventilators to supplement the 25,000 already available. British Prime Minister Boris Johnson has asked companies such as automakers to retool their assembly lines to make ventilators and other emergency medical devices as the pandemic sweeps across Europe, putting hundreds of millions of people into lockdown and overwhelming hospital emergency wards.

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Ventilators pump oxygen into the infected lungs of COVID-19 patients who have trouble breathing. The bedside machines have been instrumental in saving the lives of people in critical condition. In Italy, about 9 per cent of those who test positive for the virus require intensive care. The fatality rate for patients in their 80s is almost 20 per cent and would be higher were it not for ventilators and the technicians who calibrate them to meet each patient’s needs.

Patient data supplied by Rome’s Lazzaro Spallanzani National Institute for Infectious Diseases, one of Europe’s leading research and disease-treatment centres, gives an indication of the value of the breathing machines. On Wednesday, the hospital reported it was treating 194 coronavirus patients and that 19 of them – 10 per cent – were on ventilators.

A study of Chinese coronavirus patients published last month by The Lancet medical journal said “mechanical ventilation is the main supportive treatment for critically ill patients.”

But the demand for ventilators among Italian hospitals is far greater than the supply, and critical-care doctors are finding themselves making triage decisions – in effect, rationing the use of the machines based on their judgment of patients’ survival chances.

In a Facebook post last week, Daniele Macchini, a doctor at the Humanitas Gavazzeni hospital in Bergamo, Lombardy, the northern Italian province with the single greatest number of COVID-19 cases – more than 4,300 at last count – wrote that the “tsunami” of patients means “every ventilator becomes like gold.”

As such, the Italian government has banned the export of ventilators, and other European countries, including Russia, have done the same. Italy has pleaded with other European Union countries for ventilators, protective clothing and other medical equipment, but received no response. China partly filled the gap with a commitment to supply Italy with 1,000 ventilators.

In an interview with the digital newspaper Bologna Today, Mr. Preziosa said, “We had 320 machines already sold and ready for delivery in Vietnam, India, Korea and the Philippines, but instead of sending them, we distributed them to [Italian] hospitals.”

North American hospitals are also scrambling for the machines. Canada has no manufacturer of hospital-grade ventilators – it imports them from Europe or the United States. Ontario is ordering 300. The U.S. has fewer than a dozen manufacturers and is seeking emergency supplies. At a news conference Wednesday, U.S. President Donald Trump said, “We are ordering thousands and thousands of ventilators.”

The machines can cost as much as US$50,000 apiece. The ones sold by Italy’s Siare cost the equivalent of US$18,500.

The U.S. Society for Critical Care Medicine this week forecast that 960,000 U.S. patients may need ventilators if COVID-19 spreads rapidly. But the country only has about 200,000 machines, and half of them may not be suited for critically ill COVID-19 patients, as they are older models. The society also said there is a shortage of technicians and therapists who know how to use the machines.

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