Do we have enough ventilators? ICU beds? Let’s look at two cases. Two ICUs serving two similar areas and alike in all ways except number of ventilators. They each have need of 100 ventilators for maximum capacity. The first ICU (ICU1) has 100, and the second ICU (ICU2) has 50. Both are at peak (100) demand.

ICU1 puts 100 patients on ventilators and 30 survive with 70 dead (That is the US rates at the moment. The world rate is 16/84).

ICU2 puts each patient on a ventilator, but with 50 in use, the incremental patient must receive a ventilator from an intubated patient, who presumably dies. Doctors would take the ventilator from a patient who has been on it for the longest time and shows the least likelihood of recovering.

All of the above are things that are facts, or can be reasonably assumed. Here is where the guesswork starts. What percentage of the living patients, who had ventilators taken away, would have died anyway? Anecdotal information suggests that almost all of the patients who are on ventilators for more than two weeks die. These are the ones who would be taken off of the ventilators to account for new patients.

What we know is that 50 patients at a time (half), who would otherwise have ventilators, would be deprived of them. Since these are the least likely to survive, I will guess that 3 of the 30 survivors would have come from this group. So 3 of 100, or 3% of those requiring ventilators, would die due to the lack of ventilators.

One study, that often cited, estimated that 900,000 US citizens would require ventilators during this crisis. Most of these would not happen at peak times, but assume half just to be conservative. That’s 450,000 people, and 3% of them would die due to the shortage. That’s 13,500 people we are saving due to flattening the curve.

I used ventilators for this example, but I believe it serves as stand-in for health care capacity as well. Although the 3% estimate would surely be somewhat higher when more than ventilators are considered. Double? Triple? The only way to save more than this is to flatten the curve so much that we prevent infections until after a vaccine. That is not economically acceptable. (Arguments that a price can’t be placed on lives are juvenile and not worthy of rebuttal, so please spare us them.) Therefore, unless the estimates above are radically wrong, we might not be saving very many by social distancing. If the ventilator patients were recovering at a 70% rate, instead of a 30% rate, it would be different.

I still think the right policy is to hold the line on social distancing - increasing it in some areas as the rates take off there - until an area shows 75% diminished infection rates (by more prevalent testing that is being implemented currently) then move to the current S Korean method of everyone back at work and school except those who can work at home. Still no large gatherings, but restaurants are open with diminished occupancy.

I am interested in any anecdotal information from ICU doctors and nurses that refute any of the assumptions here. If they are wrong - if doctors can’t somewhat accurately pick who are likely to die, then this example goes to pieces.