COVID-19 Death Toll Rises as Ventilator Production Struggles To Keep Up

03/31/2020
Ventilator

More ventilators are needed to keep up with the demands of the current COVID-19 pandemic. However, increasing production is more complicated than it might seem. Thousands of volunteers are donating their time and resources to fill in the gaps. Despite these efforts, the COVID-10 death toll continues to rise.

 

As the number of patients continues to spread, hardware enthusiasts and experts are lining up to report for duty around the world. Some volunteers are even responding to social media requests. Martin Serey, co-founder of Pomo, a medical equipment start-up company in Chile, stated that he responded to an Instagram post from his friend in Barcelona. He said he woke up one day and realized that people have the same problem around the world as the COVID-19 pandemic quickly ramped up. He stated that his company stopped developing prosthetic aid for stroke victims and switched to making ventilators.

 

Currently, there are not enough ventilators available for all the hospitals and patients that need them in the upcoming weeks. According to a report from Imperial College Londer, approximately 30% of patients hospitalized from COVID-19 are likely to need a ventilator (1). The report also indicated that the only way to avoid overwhelming intensive care units is to put a mandatory lockdown on the public that reduces 75% of social contact. Many countries have been doing just that.

 

However, others are slow to take initiative, and it may be putting the rest of the world in danger. It’s still unclear whether we can sustain an extended lockdown order over the next several months, which appears to be needed to keep residents safe. For this reason, many parts of the world are still in need of the breathing machines. According to New York Governor Andrew Cuomo, his state needs at least 30,000 units to keep up with the demands of healthcare centers (2)(3)(4).

 

Ventilators are not overly complicated machines to function. At their core, they are very sophisticated pumping machines. Ventilators work by controlling oxygen and air flow from a patient’s lungs when they cannot do this for themselves. However, ventilators are hard to design. It’s not their function that makes them hard to work with. It’s that they have to operate in a flawless method under lots of pressure when it matters the most. According to Colombian engineer Mauricio Toro, if a ventilator fails, the patient will very likely die. Toro was part of a group located in Medellin that completed a design for three different open-source ventilators.

 

As intensive care units continue to become overcrowded and doctors have more patients to care for, ventilators need to be 100% reliable. However, the only way to make ventilators reliable is through extensive training, and this takes time. In fact, it takes up to two years to test commercial manufacturers. Considering that the lives of COVID-19 patients cannot wait that long, ventilator production and reliability is something that we need now and not later. Additionally, research shows that it could take up to 18 months before we see a vaccine against COVID-19. This puts even more pressure on ventilator makers to perfect their product in a timely manner (5)(6).

Ventilators Are Needed Now

Health authorities and government officials are well aware of the dilemma. The United Kingdom government seeks to add 1,200 more ventilators to its healthcare systems in less than two weeks, and products that they will need 30,000 at the peak of the pandemic. To help fill the gaps in, the UK government has channeled the help of universities and non-health care industries to pull together during these war-like times.

Top medical equipment company Phillips stated that it is increasing the number of shifts, hiring more manufacturing employees, adding manufacturing lines, and shifting current employees to support ventilator demands immediately. Other large businesses are following their lead, even though capacity is strained due to the lockdown and crisis in China. Even Formula One race teams are assisting with ventilator production, while Dyson vacuum cleaner company received an order for 10,000 ventilators. Smiths Medical is helping by treating patients that are not as ill with continuous positive air pressure (CPAP) devices, which are usually involved in the treatment of sleep apnea. Production of CPAP devices from other companies is also taking off (7). 

Additionally, researchers and engineers are busy creating other solutions to the lack of ventilators. For example, a new machine that can attach to a ventilator called a Ventil is designed to treat two patients at the same time. This can help hospitals treat twice as many patients (8). However, while many higher income countries have the ability to pay for more ventilators, most do not. Even some high income countries may have a problem paying for these devices as the demand grows and the price of the machines continue to rise (9).

Can DIY Devices Be Used?

There are some devices that you can make at home. Ventilators are not one of them. This is because of the enormous responsibility they have. However, if hospitals reach the point where millions of people are dying because there are no ventilators available, then a DIY machine might be our only backup plan. This is according to Andrea Ippolito, an engineering lecturer at Cornell University. Ippolito also volunteers at a company called End Coronavirus, which is designed to oversee DIY ventilator efforts.

 

Additionally, thousands of volunteers, experts, and business owners around the world are creating their own open-source ventilators to help save lives. Manufacturers in Africa or South American could take relatively simple designs and build ventilators relatively quickly and for cheap using hardware that is already available. They won’t have to worry about licensing or copyright issues because all of the intellectual property is free to use for these projects.

However, these products are working at unprecedented speeds. In March 2020 alone, at least one dozen prototypes at different stages have been developed by teams all over the world. They are organizing their work on social media platforms and think they can help solve the bottleneck problem, especially in parts of the world that are less likely to respond to the crisis. Some are using very basic ventilator designs based on an ambu-bag, which is the kind that emergency teams use.

Colin Keogh is an expert in 3D printing at the University College Dublin. He has been leading a team that is dedicated to developing community-sourced and open-sourced designs. His team has already released their first prototype that works by channeling ambu-bags (10). He stated that they are looking for low-cost emergency ventilator systems that can be used as a backup or last resort. The company hopes that doctors can use it when they are short on other critical devices.

Pomo’s Serey’s has a similar idea. They are using an ambu-bag that moves air through a level powered by a small motor that is programmed for different paces and pressures. The operator can control the supply and air pressure. Although the design is more expensive than Keogh’s, it does not require any 3D printing materials. It also uses string. Engineers could make a stand for the device using aluminum. An electric motor could be found at hardware stores or mechanic shops for easy construction. 

Other companies are taking initiative, too. Researchers from King’s College London and Oxford University created OxVent, which is a team of people involved in making ventilator prototypes that are not as advanced as the ones used in hospitals. However, these devices could nonetheless meet safety requirements when there is a shortage of hospital-grade machines (11).  OxVent uses materials that are readily available and can be built rather quickly in university workshops.

These machines are not intended to replace hospital-grade ventilators. However, they could be a good option when the disease peaks and no other machines are available. They are meant to provide an option for respiratory support when hospitals are out of standard machines in hopes of saving lives. The team at OxVent uses parts that are already used by the NHS, open-source software companies, and generic electronics. Their goal is to be able to produce prototypes with materials that are readily available on the market so people can build the device locally and quickly.

Testing Remains The Problem With DIY Devices

One of the biggest problems that these prototypes face is testing. The MHRA and FDA have issued standard processes that ventilators and similar devices must go through to treat COVID-19 patients. OxVent is preparing to go through these tests, but time is important.

Other companies think it will take too long to test their products, so they are working on a work-around. For example, the End Coronavirus group is working on developing an “iron lung.” This machine would help stimulate the pressure and airflow of a real lung. They hope that their products can go through enough testing so that doctors can use them on patients, even if it’s only as a last resort. The team at End Coronavirus believes that if doctors have to choose between a ventilator run with an iron lung or nothing at all, they will choose the iron lung.

Another problem that these companies face is getting the materials they need. The materials should be able to handle extensive wear without spreading infection or breaking. They need to be able to undergo different cleaning methods, such as UV or chemicals. These requirements can disrupt the process design as they make engineering choices more complicated. Medellin engineer Toro stated that the wrong material can be a fire hazard and exposure to oxygen can ruin some material choices.

This makes it tricky to pick the right material and designs. While 3D printing itself creates sterile devices, the plastic can be very porous, which makes it hard to clean after it’s printed. This makes 3D printing the best choice for creating disposable items, but they shouldn’t be used to replace entire machines or conventional parts. If engineers and designers are able to deal with all of these problems, they still must make a product that is easy for healthcare workers to use. They need to be as close to the real thing as possible or they must be easy to learn. Timing is essential during this pandemic, and there is not much time available for hospitals to train staff how to operate new ventilators so that they can save lives (12).

The OxVent team plans to work around this by creating a very simplified version of what is already available in hospitals. Their goal is to make a product that is easy for healthcare workers to use. However, this is easier said than done for most companies. One report indicated that out of 20 projects, only one was found to be doctor-friendly enough to be used in hospital settings (13). Yet another problem that these companies face is finding and managing enough volunteers to make thousands of these devices. Many volunteers have a lot of knowledge, but it is still hard to manage these teams in a way that keeps everyone safe from spreading the virus.

The good news is that many DIY makers and open-source software companies already have a lot of experience with self-organizing teams. For this reason, they are more likely to be successful in delivering a reliable product. These problems also tend to be secondary compared to the primary goal of every company, which is to create devices that save lives. Most companies strive to help, and this makes volunteers more likely to cooperate by coming together. They’re putting in thousands of hours with little to no sleep and putting the rest of their lives aside because they know it could be someone’s life on the line.

 

 

References

1.     https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

2.     https://www.bbc.com/news/world-latin-america-52080830

3.     https://www.bbc.com/future/article/20200324-covid-19-how-social-distancing-can-beat-coronavirus

4.     https://www.bbc.com/news/world-us-canada-52012048

5.     https://www.bbc.com/news/technology-51909812

6.     https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext

7.     https://www.bbc.com/news/health-52087002

8.     https://www.alphagalileo.org/en-gb/Item-Display/ItemId/190860?returnurl=https://www.alphagalileo.org/en-gb/Item-Display/ItemId/190860

9.     https://www.bbc.com/news/uk-52074862

10.  https://techcrunch.com/2020/03/19/open-source-project-spins-up-3d-printed-ventilator-validation-prototype-in-just-one-week/

11.  https://www.ndcn.ox.ac.uk/news/oxford-and-king2019s-developing-prototype-for-rapidly-deployable-ventilator

12.  https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/

13.  https://github.com/PubInv/covid19-vent-list