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.