COVID-19’s case count has crossed the million-mark globally as of 2nd April. British Medical Association (BMA) have given doctors bounded by the Hippocratic Oath, a ‘right to choose’ who can live due to National Heath Services’ (NHS) currently limited resources. The world clearly needs more hospitals with ventilators for the ailing and the potential patients. While the medical fraternity and the authorities try to understand what is needed in stabilizing the pandemic’s preparedness measures, do we?
Crux of the Matter
Breathe In, Breathe Out: How Can Ventilators Help ? According to the WHO, 80% of people diagnosed with the ongoing pandemic COVID-19, recover without needing hospitalisation in their self-quarantine period. However, one person in six becomes sick at a life threatening level and develops long term breathing difficulties due to ARDS (acute respiratory distress syndrome). When the severity increases and the virus tries to cause damage to the lungs, the body’s immune system detects this and expands blood vessels to allow the entry of more immune cells. This causes fluid to enter the lungs, making it harder to breathe, and causing the body’s oxygen levels to drop. A ventilator or a respirator is designed to pump oxygen into and out of the lungs of the ill person. Additionally, their respiratory system is made to relax while heat and moisture are added to the medical air being provided, in order to match the patient’s body temperature. By taking over the body, the machine helps the person fight back the infection, during and post-surgery.
Too Many Sick, Too Fewer Ventilators As overcrowding of ICUs is on a rapid rise, the reliability of the machines ought to be the top priority of ventilator manufacturers. Commercially this requires extensive testing of two years, which is a long period given the current circumstance in which the rolling out of a COVID-19 vaccine would reportedly take 18 months. So what to do when we need ventilators now, not later? Make makeshift, open-source ventilators. These DIY machines have relatively simpler designs and can be assembled quickly and cheaply using existing available hardware and infrastructure. The added bonus is that the intellectual property of these projects will be free to use, keeping licensing and copyright issues at bay for builders. Mauricio Toro, a Colombian engineer who joined a group that completed three different open-source ventilators says, “It’s not the function that is difficult to implement, it’s how it will maintain sterility over a stretched period of time.”
An hour ago, a team of 40+ medical experts & engineers from Israel released the #opensource blueprints for @AmboVent – a low-cost, medically tested #COVIDー19 ventilator device, made from off-the-shelf components, to answer worldwide #Coronavirus shortageshttps://t.co/g56MWM41Jt — Elad Ratson (@EladRatson) April 1, 2020
Thus, UK researchers at the University of East Anglia are planning to use 3D printing to speedily produce disposable ventilator parts that wouldn’t need any extra efforts in being cleaned. In the meantime, Oxford University and King’s College London launched project OxVent is aimed at developing prototype ventilators that would be similar to existing ones, minimizing the need to train medical professionals while operating on actual patients.
So what’s the action plan of Governments, Nationally and Internationally? The place where it all started, China is amidst speculations of a second wave of COVID-19, and is apparently ready to help our nation in the fight for manufacturing all parts of the ventilator. Their Ministry of Industry and Information Technology states that they have already provided over 1,700 invasive ventilators to aid foreign countries since March 19.
Coronavirus: Toaster-sized ventilator from India helps hospitals in virus fight https://t.co/dNaD9w9OWU — The Straits Times (@STcom) April 2, 2020
In the US, President Donald Trump had initially expressed doubt about the shortage of ventilators, slowing down the country’s preparedness mechanism. As per New York Times, there are about 170,000 ventilators being used in the States but the American Hospital Association estimates that 960,000 people will need them over the entire course of COVID-19. Currently, Elon Musk is in talks with Medtronic to produce its ventilators in one of its solar panel factories. GM has its agreement with Ventec and Ford is working with GE Healthcare, giving a promising acceleration to the present production scenario. Additionally, the White House has launched the COVID-19 High Performance Computing Consortium to provide researchers worldwide with access to the powerful computing resources. Participating Members include top universities, labs, and tech companies such as Amazon, Google, and Microsoft.
We have extra FDA-approved ventilators. Will ship to hospitals worldwide within Tesla delivery regions. Device & shipping cost are free. Only requirement is that the vents are needed immediately for patients, not stored in a warehouse. Please me or @Tesla know. — Elon Musk (@elonmusk) March 31, 2020
India Inc Steps Up to Give Govt Breathing Space Center for Disease Dynamics, Economics and Policy has estimated the demand for ventilators in India to surge to 1 million by July 2020, while the present availability is between 30,000 – 50,000. Ashok Patel, CEO and Director of Max Ventilators states that Ventilators are an amalgamation of a host of technologies and components sourced from various countries. Additionally, personal protective equipment for health workers is required on a priority basis. However, with the pandemic restricting even imports from Europe, India has realized that there needs to be a localization of both parts production and shared design. Mysuru-based manufacturer Skanray Technologies in collaboration with Niti Aayog and DRDO aims to manufacture 100,000 ventilators in two months. Further, the Ministry of Health and Family Welfare has requested PSUs and Bharat Electronics Limited (BEL) to supply 10,000 ventilators and 30,000 ventilators within their stipulated deadline. Indian automobile giant Mahindra has decided to repurpose its mechanical manufacturing expertise for production of ventillators. Their RnD team came up with a prototype in 48 hours and the company is working with the government to hasten the production. Meanwhile, Tata has also stepped in and is planning to help in Mahindra’s efforts, supported by DRDO. Meanwhile students and professors from various universities and colleges like IIT Guwahati and IIT Hyderabad are working on cheaper and faster-to-produce alternatives as well.
Mahindra’s in-house effort for affordable respiratory device is near fruition. Video shows a working model. Packaging yet to be done. Testing started. Looking for ideas on what to call it? Will go fo approvals soon @PMOIndia @drharshvardhan @MahindraRise pic.twitter.com/Z2T5fsyDCb — Pawan K Goenka (@GoenkaPk) March 30, 2020
Race Against Time: Can We Do It? Global manufacturers in about every industry, ranging from fashion to food and automobiles, have taken the initiative to shift operations to help combat this crisis along with millions of willing volunteers. If we are all in this together, surely there is hope for our recovery, with as little mental and physical damage as possible. The common goal only being: create more (ventilators), save more (lives)
The dream teams worldwide, living through sleepless nights just to save us
Curiopedia
Working of ventilators – A ventilator uses pressure to blow air into the lungs, which is known as positive pressure. The amount of oxygen the patient receives can be controlled through a monitor connected to the ventilator. If the patient’s condition is particularly fragile, the monitor will be set up to send an alarm to the caregiver, indicating an increase in air pressure. One end of the tube is inserted into the patient’s windpipe and the other end is attached to the ventilator. The breathing tube serves as an airway by letting air and oxygen from the ventilator flow into the lungs. Caregivers also need to learn how to provide suctioning to prevent mucus from blocking the tubes. More Info
Basic mechanical ventilation mechanism
The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. The oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today. These include the principles of medical confidentiality and non-maleficence. As the seminal articulation of certain principles that continue to guide and inform medical practice, the ancient text is of more than historic and symbolic value. Swearing a modified form of the oath remains a rite of passage for medical graduates in many countries. More Info
https://twitter.com/mhdksafa/status/1245369174387576832
Curated Coverage
Bloomberg – The Importance of a Ventilator to Covid-19 Patients
Livemint – Local ventilators need of the hour to prepare for COVID-19
The Guardian – How ventilators work and why they are so important in saving people with coronavirus
New York Times – At the Top of the Covid-19 Curve, How Do Hospitals Decide Who Gets Treatment?
F100 Journal – A review of open source ventilators for COVID-19 and future pandemics
Vox – Trump isn’t making America’s ventilator shortage any easier
BBC News – Coronavirus: India’s race to build a low-cost ventilator to save Covid-19 patients
Money Control – Automobile manufacturers asked to make ventilators: Health Ministry
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