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A new ventilator at the New York City Emergency Management Department warehouse in New York, Tuesday, March 24, 2020. Image Credit: New York Times

Dubai: One ventilator is one life saved.

That’s the maxim guiding the world’s top manufacturing companies as they join hands in a race against time to dramatically ramp up the production of ventilators to help hospitals during the coronavirus pandemic — connecting businesses as diverse as carmakers, vacuum cleaner manufacturers, aerospace engineers and government defence departments from the United states and United Kingdom to Italy, India and China.

Doctors being instructed to handle a ventilator at a hospital in Hamburg. Image Credit: AFP

As coronavirus-afflicted patients overwhelm hospitals around the world, many countries fear the situation will force them to adopt policies like in Italy, where an acute shortage of ventilators forced doctors to choose which patients get to use the potentially life-saving machines. However, health-care experts and ventilator manufacturers have also questioned whether goals to produce thousands of ventilators in collaboration with non-specialist companies on an unprecedented scale are realistic enough to meet the spiralling demand for the devices in the near future.

Why do hospitals around the world need so many ventilators?

A ventilator is a machine that helps patients with severe respiratory conditions — such as some of the most seriously ill Covid-19 patients — breathe as normally as possible. The devices offer gentle breathing assistance so that the patient’s lungs can rest while they fight the virus. But as cases surge, the number of ventilators needed has also jumped by astronomical margins. In the US, for instance, there are only about 160,000 ventilators available but as many as 740,000 could be needed soon, according to the Johns Hopkins Center for Health Security. “We expect to see countries trying to at least double their installed ventilator base to meet demand,” Andrew Thompson, analyst at London-based analytics company GlobalData, told Gulf News on Tuesday.

But how come there’s such an acute shortage?

About 14% of Covid-19 infected patients develop pneumonia — no one predicted this and no hospital would keep these many ventilators

- Dr Pradeep Kumar | GP - Emergency Medicine, Aster Hospital Al Qusais

According to Dr Pradeep Kumar, general practitioner — Emergency Medicine at Aster Hospital in Dubai’s Al Qusais, about 14 per cent of Covid-19 infected patients develop pneumonia — meaning lung infection that requires oxygen therapy most of the time. “Around 5 per cent of them develop severe conditions such as respiratory failure or Acute Respiratory Distress Syndrome (ARDS), and require ventilator support to sustain them until they have recovered from the condition. So assuming 1,000 people are infected by Covid-19, around 140 extra ventilators would be needed as a standby — which is an extreme situation. No one predicted this and no hospital would keep these many ventilators in their wards,” he told Gulf News.

What are companies and countries doing about it?

In the US, Ford Motor Co. and General Electric’s health-care division have announced a plan to produce 50,000 ventilators over the next 100 days. General Motors has said it plans to make ventilators at one of its factories in Indiana, with Ventec Life Systems, a traditional ventilator manufacturer, while Tesla has firmed up plans to make ventilators with Medtronic at a factory in New York.

This consortium brings together some of the world’s most innovative companies, working together to scale up production of ventilators

- Dick Elsy | Head of Ventilator Challenge UK Consortium

The British government, which initially had only 5,000 ventilators available in its National Health Service against a requirement of 30,000, has ordered more than 10,000 ventilators from a consortium of top aerospace, engineering and Formula One racing companies, with production to begin this week. “This consortium — which includes Airbus, BAE Systems, Ford and several Formula One teams — brings together some of the most innovative companies in the world, working together with incredible determination and energy to scale up production of much-needed ventilators,” Dick Elsy, the head of the consortium, told Gulf News.

In India, the government’s Defence Research and Development Organisation is in the process of developing affordable “multi-patient ventilators” in collaboration with medical equipment manufacturer Mahindra & Mahindra, wherein several patients can be supported by a single ventilator.

Image Credit: Gulf News

How can carmakers and plane manufacturers suddenly start making ventilators?

Well, this is not the first time for such collaborations to have happened. Ford built heavy bomber air planes and General Motors built amphibious assault craft during the Second World War, just as British industry stepped in to make Spitfire fighter jets. Governments have typically relied on the resourcefulness of industry manufacturers and their knowledge in crossover areas to address such critical shortages during national emergencies.

To have our ventilators built by other companies is an interesting idea, but it is not likely that this will help in the short term

- Jens Hallek | CEO of Hamilton Medical

British vacuum cleaner company Dyson, for instance, is banking on its knowledge of digital motors, battery packs, expertise in airflow and HEPA filters — which block fine particles but not air — to build a simple ventilator.

But ventilators are complex machines that use sophisticated software and specialised parts and the scale and scope of the current situation is unprecedented. “As the number of those infected starts to grow in almost every country, we expect a massive increase in demand. How much that demand will be in numbers is unpredictable,” Jens Hallek, CEO of Switzerland-based Hamilton Medical — one of the world’s largest ventilator manufacturers, told Gulf News on Tuesday.

Volunteers work on manufacturing ventilators for use during the coronavirus disease (COVID-19) outbreak, in Santa Cruz, Bolivia. Image Credit: Reuters

What has the UK consortium said about its unique project?

According to Elsy, who is also the CEO of High Value Manufacturing Catapult in the UK, the focus of the consortium is on production of a range of ventilator design options to meet the specifications for a Rapidly Manufactured Ventilator System (RMVS). “This is a fantastic example of UK engineering and technology companies, large and small, coming together to answer a critical national need. Every ventilator produced will save a life. The consortium are working on two existing device routes already in existence in the market so we don’t anticipate a protracted regulatory approval process. Equally, all the members of the consortium already operate in highly regulated industries. As such, we are confident that we can overcome any challenge in order to scale up the production of the two existing ventilator designs we are focused on producing,” he said.

Engineers at Rice University Danny Blacker and Fernando Cruz work to create a low cost ventilator that they designed and which they hope can be used to treat coronavirus disease (COVID-19) patients in Houston, Texas. Image Credit: Reuters

How are the world’s largest makers of ventilators poised to cope with this?

While most major manufacturers of ventilators around the world have boosted their production on a war-footing, they will only be able to make the devices by the hundreds at a time when doctors and hospitals need them by the thousands. “Since the start of the outbreak in China, we have massively increased our capacity for producing ventilators. Production has continued through the weekends and we have added a second shift to ensure the highest possible output of ventilators in a short space of time,” said Hallek.

According to Bob White, executive vice-president of US ventilator manufacturer Medtronic, the current demands of global healthcare system has far outstripped supply, and no single company will be able to fill it. “We have ramped up production of our high-performance ventilators by more than 40 per cent, are operating our production lines 24/7, and are on our way to doubling output,” White told Gulf News.

The current demands of the global health care system has far outstripped supply of ventilators, and no single company will be able to fill it

- Bob White | Executive vice-president, Medtronic

Despite those efforts, analysts expect most major manufacturers to struggle due to shortage of production capacity and specialist components. “That’s the reason why companies such as Smiths are turning to Siemens and others to expand production of selected existing devices. There might be sufficient components if there is a reduced range of devices on offer,” said Thompson of GlobalData.

How realistic are the global goals to make hundreds of thousands of ventilators?

While cross-industry collaborations have gained a war-time traction, setting up new production lines for a life-saving device is no simple task. And not all ventilators are alike — some are more complex than others to build. Which is why some manufacturers such as carmakers are likely to struggle to produce such high-end ventilators quickly and goals by governments and companies to make thousands of them in one week might be unrealistic.

Image Credit: Gulf News

“To have our ventilators built by other companies is an interesting idea, but it is not likely that this will help in the short term,” said Hallek of Hamilton Medical. “The materials and the components needed to build a ventilator are highly specific. If another manufacturer would use the same parts from the same suppliers we are using, our whole supply chain would get under even more pressure. So, they would have to re-invent the whole supply chain too. Short term, it is probably easier and more efficient to extend the production facilities that already exist. However, we are evaluating options to cooperate with other companies in terms of producing and assembling some components to increase our output,” he said.

What are governments doing to facilitate this?

Various nations are doing their best to help non-specialised makers by invoking war-time measures or easing rules. US President Donald Trump last week invoked the Defence Production Act — that requires companies to “accept, perform, and prioritise” federal contracts for ventilators — to help expedite things. Separately, the US Food and Drug Administration implemented drastic regulatory changes to allow carmakers and other non-medical manufacturers to quickly take up such tasks. “If you want to help expand production of ventilators to save lives in this pandemic, we are going to work with you to sweep every possible barrier out of your way,” the agency said in a statement.

Emergency medical staff and nurses wearing protective suits, help while transferring a patient with coronavirus disease (COVID-19) to Masih Daneshvari Hospital, in Tehran, Iran. Image Credit: Reuters

What are the challenges facing such unprecedented collaboration?

According to Vafa Jamali, vice-president at Medtronic, production and assembly of high-end ventilators are best left to traditional manufacturers, since their key components are usually made in-house by experienced workers. If there is a flaw in production, “it would be a catastrophe if you got those devices out en masse and could cause a lot of damage in the patients that are most acute”, he told CNN.

An undated handout image released by University College London, shows components, including a mask, of the Continuous Positive Airway Pressure, breathing aid, developed in less than a week by mechanical engineers, doctors and the Mercedes Formula 1 team in conjunction with UCL. Image Credit:

According to Thompson of GlobalData, knowledge of existing specified devices may be difficult to transfer to other production lines. “New simplified devices specified by governments, with the right prime contractors who have experience of urgent requirements with short delivery times — such as defence companies — may succeed,” he said.

Some companies are trying to work around such challenges by empowering their collaborators or even competitors. “Medtronic has made public ventilation design specification to accelerate efforts to increase global ventilation production. We are assisting other manufacturers, across industries, to make more ventilators to help patients as quickly as possible,” White said.

Medical staff members check a ventilator in protective suits at the care unit of the new COVID-19 infected patients inside the Koranyi National Institute of Pulmonology in Budapest, Hungary. Image Credit: AP

Ford — the carmaker who introduced mass production to the industry — has similarly announced it was working with GE Healthcare to increase the production of ventilators. Jim Baumbick, vice-president in charge of all of Ford’s vehicle product lines, told reporters that the company had identified efficiencies for GE’s production processes to increase output in coming weeks and helped it find additional parts suppliers so that GE doesn’t face bottlenecks in its supply chain.


Ventilators needed soon in the US

> Ford Motor Co and General Electric together plan to produce 50,000 ventilators over the next 100 days, and aim to continue making about 30,000 ventilators a month once the initial amount is out.

> General Motors is working with ventilator maker Ventec Life Systems to produce 10,000 units a month, with first deliveries expected in April.

> The Pentagon has ordered an additional 8,000 ventilators from Zoll, Combat Medical, Hamilton Medical and VyAire, with delivery of the first 1,400 by early May.

> Britain has ordered 10,000 ventilators from a consortium of leading aerospace, engineering and Formula One racing companies. The 27 strong Ventilator Challenge UK consortium includes Airbus, BAE Systems, Rolls-Royce, Mercedes and McLaren.

> The UK has also ordered a newly-designed model from the vacuum cleaner company Dyson that will need to be approved by its health regulator.