A May 2003 GAO report found that "few hospitals have adequate medical equipment, such as the ventilators that are often needed for respiratory infections ... to handle the large increases in the number of patients that may result" from an infectious disease outbreak.
A November 2005 Congressional Research Service report cautioned about a possible H5N1 avian flu pandemic: "If this strain were to launch a pandemic ... large numbers of victims may require intensive care and ventilatory support, likely exceeding national capacity to provide this level of care."
That same month, the Department for Health and Human Services published a Pandemic Influenza Plan, which said: "Despite planning and preparedness, however, in a severe pandemic it is possible that shortages, for example of mechanical ventilators, will occur and medical care standards may need to be adjusted to most effectively provide care and save as many lives as possible."
A July 2006 report by the Congressional Budget Office sent to Senate leaders stated, "CBO's December assessment noted that the United States has approximately 100,000 ventilators, with three-quarters of them in use on any given day. According to HHS, a severe influenza pandemic like the one in 1918 would require 750,000 ventilators to treat victims."
The Defense Department in its August 2006 Implementation Plan for Pandemic Influenza: "Considerable demand for ventilators is likely, especially in the event that the pandemic occurs before a vaccine is available. Where feasible, consideration should be given to stockpiling instead of "just-in-time" acquisition of adequate numbers of ventilators, antiviral drugs, and other medical supplies including Personal Protective Equipment (PPE).
In November 2007, an Interior Department pandemic influenza plan stated: "Health care facilities will likely (be) overwhelmed, creating a shortage of hospital staff, beds, ventilators, and other supplies.
A 2009 Occupational Safety and Health Administration publication noted: "Healthcare facilities can be overwhelmed, creating a shortage of hospital staff, beds, ventilators and other supplies.
An August 2009 report by the Executive Office to the President related to preparations for a H1N1 outbreak said: "During the peak, 1 or 2 out of every 2,000 Americans might be hospitalized. Cases requiring mechanical ventilation or intensive care could reach 10 to 25 per 100,000 population, requiring 50 to 100 percent or more of the total ICU capacity available in the United States and placing great stress on a system that normally operates at 80 percent of capacity."
A 2015 study by researchers from the Department of Health and Human Services and Center for Disease Control and Prevention modeled the need for ventilators during an influenza outbreak, calculating that "an additional 7000 to 11,000 ventilators will be needed, averting a pandemic total of 35,000 to 55,000 deaths. A 30% CAR [clinical attack rate], high severity scenario, will need approximately 35,000 to 60,500 additional ventilators, averting a pandemic total 178,000 to 308,000 deaths."
"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.