The global coronavirus outbreak
has pushed the U.S.
health care system to its brink.
Hospitals are already running out of
basic supplies like masks, eye
gear, gowns and ventilators.
Ventilators are key in helping keep
people with the most severe cases
of COVID-19 alive.
But with the number of infected
rising daily, there are not nearly
enough of them. And there's no
easy way to get more.
Are there enough ventilators
in this country?
In a worst case scenario, ventilators
would be one of the choke
points, if you will,
for effective response.
There are about 160,000 ventilators in
the United States now, and
there's another 12,000 or 13,000 in
a stockpile that are intended to
be used in emergencies.
But most hospitals say that this
will not be enough, especially if
coronavirus cases keep climbing.
And you're seeing hospitals across the
country sound the alarm and
say, is there a way that we can
get an emergency supply so that we
don't have to make the decisions
about who lives and who dies?
In 2005, the U.S. Department of
Health and Human Services estimated
that the U.S. would need 740,000
ventilators in a severe pandemic
like the Spanish flu of 1918.
That number is a far cry
from the 173,000 ventilators that it's
estimated we currently
have on hand.
Before the outbreak, ventilators accounted
for just $4.3 billion of
the $425.5 billion global
medical device market.
Ventilators are critical in treating the
most severe cases of the
coronavirus, where inflammation prevents people
from taking in enough
air on their own.
They work by blowing air through
a breathing tube that's placed in
the patient's windpipe, allowing oxygen
to flow into the lungs.
The reason for the shortage now is
because we are seeing cases of the
pandemic continue to climb
across the U.S.
and a lot of the models would suggest
that we're going to see a big
spike in the next couple of weeks.
Most people don't think that we've hit
a peak, yet, when it comes to
this this pandemic and a lot of
the patients who end up in the
hospital, do need to
be on a ventilator.
When the patients first come into
the hospital with severe conditions,
actually, you can use
a lower grade ventilator.
But in general, you need more of the
lower, t he less acute ones and
fewer of the critical care ones.
But obviously with the caveat that
the critical care ones are the
ones that's most needed when patients
are are in very severe
condition. We have already seen
this play out in Italy.
What we're seeing now in Italy
is that they lack ventilators and
doctors are in this crazy position
of deciding who to ventilate and
who not to ventilate.
They are rationing care.
We know from studies out of China,
for example, that about 17 percent
or so of coronavirus patients
actually require a ventilator.
So we're not talking about,
you know, a large capacity.
But when you look at the number
of people that are going to be
infected by coronavirus, that translates
to many, many people.
And that's why we're
worried about this.
Some of the biggest ventilator
manufacturers like Medtronic PLC,
Philips, Draegerwerk AG and Getinge are
racing to ramp up production.
Philips has said that the company
is looking to double the
ventilators that it makes per week
from 1,000 to 2,000 initially, but
hopes to achieve a fourfold
increase by the third quarter.
In a statement, Philips said
it is hiring additional manufacturing
employees, adding manufacturing lines
and instituting round-the-clock
shifts. Medtronic is transferring workers
from its other factories to
Galway, Ireland.
That's where the company makes
its Puritan line of ventilators.
Medtronic says it has already increased
production by more than 40
percent and has
doubled its capacity.
We're going to open source one of
our lower end ventilators in less
acute situations for others to make
as quickly as they can.
This this product is a little more
generic in form and can be
probably made a little more easily
than the one we make, which
requires many components.
And some of the components
require very precise manufacturing.
But smaller companies
are affected, too.
Ventec Life Systems in Washington says
that it's moving from its
typical production of 150 machines a
month to a 1,000 per month.
We are in a dire situation where no
hospital in the US can have enough
ventilators because this is I think
this is going to get really,
really bad. We're a major hospital
and we have, we are associated
with smaller hospitals
and referral hospitals.
So if a smaller hospital in
the surrounding area lacks capacity,
they're going to send those
patients to our hospital.
So we're going to
get overwhelmed pretty quickly.
Now, governments and individuals are
coming up with some
unconventional ways to stem
the ventilator shortage.
The U.K. government has turned
to a wartime solution, asking
manufacturers like vacuum company, Dyson,
and luxury car maker, Rolls
Royce, to produce
essential equipment.
President Trump has also encouraged
automakers to aid in the
production of ventilators.
But there have been conflicting messages
as to whether the president
is formally enforcing the
Defense Protection Act.
The statute forces manufacturers to
produce scarce materials deemed
"essential to the national defense."
This includes face masks and
ventilators. But for now, Trump
is encouraging local governments to
act. First of all, the governors are
supposed to be doing a lot of
this work and they are doing
a lot of this work.
Federal governments is not supposed to
be out there buying vast
amounts of items and then shipping.
You know, we're not shipping clerk.
A number of governors and
mayors have criticized the administration
for not doing enough to help
local communities deal with the pandemic.
FEMA says we're
sending 400 ventilators.
Really? What am I going to, what
am I going to do with 400
ventilators? When I need 30,000.
You pick the 26,000 people who are
going to die because you only sent
400 ventilators. The Federal Defense
Procurement Act can actually
help companies because the federal government
can say, look, I need
you to go into this business.
I will contract with you today
for X number of ventilators.
Here is the startup
capital you need.
Only the federal government
has that power.
And not to exercise that
power is inexplicable to me.
The federal government
has been absent.
So, for example, we've repeatedly asked
the secretary of Health and
Human Services to
get us ventilators.
We need 15,000 ventilators and
we need them right away.
I would like to see 100,000 ventilators
being built in a couple of
weeks on a federal level, but states
alone trying to figure out how
to do this, is not a good solution.
An individual hospital trying to figure out
how to do this is not a
good solution. Without a federal law
in place to nationalize the
purchase of medical supplies, s tates
are having to compete with
other states for supplies and
dealing with price gouging.
I think the federal government
should order factories to manufacture
masks, gowns, ventilators, the
essential medical equipment that's
going to make the difference
between life and death.
Even ventilator manufacturers are asking
for more clarity from the
government when it comes to
determining how to allocate the
ventilators they produce.
So right now, every week we go
through an equity analysis of where the
greatest need is, depending on, you
know, how many patients have been
diagnosed and what
state they're in.
And we kind of try
to prioritize it that way.
But we're also sort of proposing that
they, that in the United States
there is a centralized body through
FEMA who can do the allocation
and then they can
move these ventilators around.
That will be a much more efficient
process than us trying to do it.
The US is not the first country
to experience these shortages, and it
won't be the last. Some
equipment manufacturers are saying that
America is towards the back of the
queue when it comes to accessing
these ventilators because they have already
been sold and in use in
other countries. That needed
them before we did.
On Sunday, Trump announced in a tweet
that GM, Ford and Tesla have
been given the go
ahead to make ventilators.
But it seems that many
of these automotive manufacturers are
partnering with medical device
companies rather than producing
ventilators on their own.
And the details of these
partnerships have been vague.
GM has announced that it is
leveraging its logistics, purchasing and
manufacturing expertise to help
Ventec Life Systems.
Meanwhile, Ford is partnering with
GE in manufacturing ventilators,
though the company has not said
where they will be manufactured.
In a tweet, Elon Musk said
that he purchased 1,255 ventilators from
China and was shipping them to L.A.
Tesla is also partnering with Medtronic
to build some less complex
ventilators. We're also opening up with
other partners who have come
forward. And Tesla is one that I
think people have heard about, where
one of our ventilators will
be made by them.
And they're fast on track to
try to make that as well.
And they're doing that in parallel
while we're focusing on the
product that we, that is our largest
volume product, which is the PB
980. The car companies had already
planned to suspend auto production
at their plants in an effort
to safeguard their employees from the
coronavirus. Some automotive experts seem
confident they can handle
the volume. What we're talking about
here is by automotive standards,
relatively relatively low
volume manufacturing.
We're talking about initially maybe a
couple of hundred units a day,
you know, not fourteen, fifteen thousand
a day like the big
automakers produce.
And all these automakers have
conventional shops where they make
their own tooling and they make
prototype parts which are kind of
divorced from the
big manufacturing plants.
And those prototype shops are manned
by highly skilled workers who
can read drawings and read
computer printouts and make things.
And the tooling for the type of
thing we're talking about like a
ventilator that doesn't have like
3,000 parts, like an automobile
does. It probably has
a couple of dozen.
And they're all relatively simple.
It will look like an automotive assembly
line in the 20s or 30s.
So it'll be relatively primitive.
It'll be on reusable equipment.
It'll involve a lot of human labor.
But the job will get done.
Lutz said that assuming carmakers can
get the parts, they would be
able to start producing ventilators in
10 days to two weeks.
But medical experts say it
may not be that simple.
It's not something, you know, they can just
give GM a plan of and that
they can start producing it. But I
do think that using workers from,
let's say, automakers and so on to
come help GE and these other
companies in a limited fashion
to build more ventilators could
really, really help. There are over
100 of these smaller component
parts that go into a ventilator.
And across the world as this becomes
a global pandemic, many of these
supplies are going to be stretched.
Because it won't just be the
United States that needs these parts.
Even if a car company has
experience producing air filtration devices,
there is a significant gap between what
that might look like and how
a ventilator functions.
It is a very,
very complicated machine.
When you are intubated, right, and
you're on a ventilator, you are
either conscious or not.
And the machine senses exactly how
much pressure and how much volume
of air to put into your lungs so
as to give you enough oxygen, but
not to damage your lungs
by expanding them too much.
It's a very complicated sensing
process that it goes through.
So it's not something that's
easy to kind of develop.
And beyond technical specifications, the
entire process of producing a
ventilator is usually tightly regulated
and involves sometimes years
long testing periods.
But the FDA is relaxing some
of these restrictions, saying that
manufacturers that would normally need
FDA clearance to modify a
ventilator could now do it
without an agency review.
In theory, this should
help speed up production.
But with ventilators ranging from $25,000
for the basic models to
$50,000 for those used in intensive
care units, the question then
becomes can hospitals afford them?
A lot of hospitals are holding
off on ordering ventilators because of
the financial implications of this.
And again, I think this is
an issue with smaller hospitals.
This could bankrupt many
of those smaller hospitals.
And if they don't come into use, right,
w hat are they going to do
with all this after? Besides
the upfront cost, ventilators also
require a large investment from
hospitals in staff and training.
Right now, it needs a trained
medical team, a respiratory therapist, a
nurse and some kind of doctor.
That's usually a pulmonologist.
So a lot of resources for
one ventilator and for one patient.
The Do-It-Yourself community has also taken
up the charge to create
more ventilators in light
of the shortage.
There's a lot of designs out there
that I've seen from developing a
DIY device that squeezes a bag to
give breaths to a patient, to how
do we use one ventilator, jerry rig
it so it ventilates four patients
instead of one patient.
I've never used any of these
before, but I'm impressed with the
enthusiasm.
In Italy, a group of
engineers 3D printed replacement ventilator
valves after the manufacturer couldn't
provide them and the regional
hospital ran out. Printer maker, HP,
has also said that it would
pitch in and use its 3D
printer technology to build things like
ventilator valves, breathing filters
and face mask clasps.
Something that we've also seen is, some
of these 3D printing start ups
that are helping to make
emergency ventilators, different reusable
parts. I think that will have a
part to play if things get really,
really bad. But these parts are
often protected by both intellectual
property laws and
manufacturing regulations.
So they have to be reverse
engineered before they can be produced.
In Ireland, a group of over
300 engineers, designers and tech
founders banded together to
design an easy-to-build, emergency
ventilator. Another more hands-on approach
that's been discussed is
to use human volunteers, whether
they be medical students, nursing
students or someone from the
military to manually ventilate for
patients. It may sound crazy, but it's
been, it's been done before in
the 1952 Copenhagen polio crisis.
They had medical student volunteers
ventilating patients by hand and
in some very little resource
countries, that, unfortunately, is what
happens. Ku and his team
at Thomas Jefferson University Hospital
hoped to use this as a
backup plan, especially since using human
ventilators would put those individuals at
risk of infection as well.
We've been working on how to make
that process as safe as possible for
the human ventilator.
That you want to make sure
they're in full on protective gear.
And the bag actually is used
to ventilate the patient with 3D
printing and connection piece to put on
top of that bag to prevent
the coronavirus from leaking out.
Where the U.S. finds itself n ow
is the result of many things.
But one of them is
undoubtedly lack of planning.
We don't have ventilators because we
did not anticipate and plan
accordingly. I think we should
have been testing months ago.
Testing is not going
to contain COVID-19.
It's already spread.
It's uncontainable, right now.
And if we don't prepare right now,
we're going to be screwed in a
couple of weeks. The storm is coming
and you can't just make a
ventilator overnight or on demand.
So we need to start building right
now today for where we're going to
be in a couple of weeks.
I can't stress this enough.
