The COVID-19 outbreak is presenting unprecedented challenges to our health care system. According to our best projections, combined with information on the ground, the availability of precious medical resources will be limited because of the numbers of patients and their severity of illness.

Among the most important resources will be mechanical ventilators, affiliated gases and disposables, and of course, qualified professionals to operate these devices.

In order to meet the growing demand, it is essential that we aggressively implement the following four overall measures:

• Rigorous adherence to all social distancing measures, including limitations on gatherings and travel. This is the best way to reduce demand.
• Guidelines to optimize the use of mechanical ventilators (Appendix A). This includes canceling elective surgeries, use of equipment from state regions not experiencing outbreaks, as well as transition of anesthesia machines and other respiratory devices for use as mechanical support for those in respiratory failure from COVID-19 and other diseases
• Judicious, data driven requests and usage of the Strategic National Stockpile of ventilators and equipment. There are significant resources in the SNS, but all states must be data driven in their requests based on the actual capacity for mechanical ventilation including anesthesia machine conversions. Thousands of supplemental ventilators have already been
  deployed around the country. In addition, the Mercy and the Comfort have deployed to the west and east coasts, respectively
• Increasing the capacity of the SNS through federal procurement. The SNS will receive at least an additional 20,000 mechanical ventilators by mid-May

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