The EconomistMarch 28th 2020 International 552 through a tube inserted through an inci-
sion in the windpipe.
Ventilators need to be carefully adjust-
ed to suit each patient. This includes set-
ting the number of breaths the machine de-
livers per minute and the “tidal volume” of
air that flows back and forth as the patient
breathes in and out.
Ventilators can do other things too,
such as helping patients start to breathe on
their own. The most sophisticated ma-
chines, which can cost up to $50,000, are
packed with sensors and patient-care fea-
tures. But even when used by highly
trained staff, ventilators can cause serious
complications, such as overinflation of the
lungs, in some patients. In the hands of
amateurs they could be lethal.
Faster, faster
So what chance do science and industry
have of dramatically ramping up produc-
tion? The task is formidable. Some groups
have little or no experience in the medical
field and are trying to cram into a few
weeks processes of design, testing, approv-
al and manufacturing that usually take a
couple of years.
Yet that does not mean it is impossible.
It all depends on the options that are avail-
able, says Tim Minshall, head of the Insti-
tute for Manufacturing at the University of
Cambridge. At one end of the spectrum, he
says, existing ventilator producers can be
helped to make more machines. In the
middle are simpler designs for respirators
that might be more easily manufactured
and could be built by skilled companies
that regulators trust. Then there are new-
comers with prototypes but no direct expe-
rience in making medical equipment.
Behind all these efforts are companies,
groups and well-intentioned individuals
keen to make their open-source designs
freely available to anyone prepared to start
producing them. Hospitals and regulators
will, naturally enough, be cautious, want-
ing to ensure that equipment is safe and re-
liable, adds Professor Minshall. It is not
just the risk to patients and staff they are
worried about, but also legal liability. A
fast-track approval service, which some
countries are planning, would help.
Existing producers are stretching them-
selves. Hamilton Medical, a Swiss firm that
is one of the biggest manufacturers of ven-
tilators, usually turns out 220 machines a
week. After moving office workers onto the
production line, it hopes to double that by
the end of April. Siare Engineering in Italy
produces 160 ventilators a month and aims
to triple that with the help of army techni-
cians. Medtronic, an American firm with
its headquarters in Ireland, plans to more
than double its 250 employees making
ventilators at its Irish plant and move to
round-the-clock production. In America
Ventech Life Systems is collaborating withGeneral Motors to scale up ventilator pro-
duction, and Smiths Group, a British pro-
ducer, is looking to see if other firms might
be able to make its portable machines.
A number of industry groups have got
together in response to a request by the
British government for 5,000 new ventila-
tors as soon as possible (the country’s Na-
tional Health Service presently has access
to some 8,000), and more later, bringing
the total to 30,000. One group is led by
Meggitt, an aerospace firm based in Britain
that among other things also makes oxygen
systems for aircraft. Another group is led
by McLaren, a super-car-maker that runs a
Formula 1 team. Like others involved in
motorsport, McLaren is expert at proto-
typing and manufacturing things rapidly.
Other firms are getting involved. Dyson, a
British maker of vacuum cleaners, says it
has a potential order for 10,000 versions of
a ventilator it has developed.
Lots of academics are helping. Engin-
eers and doctors from the University of Ox-
ford and King’s College London hope to
have prototypes of a simple ventilator that
would cost less than £1,000 ($1,177) ap-
proved and working in trials at hospitals in
London and Oxford in about two weeks.
Like some others, the group is mechanis-
ing a device widely known as an Ambu (ar-
tificial manual breathing unit) bag. This
consists of a mask connected to a rubber
bag which, when squeezed by hand, pumps
air into the lungs. The bag self-inflates
when released. Oxygen can also be added to
the pumped air through a port in the de-
vice. Ambu bags are often used by para-
medics to resuscitate people and in emer-
gencies on hospital wards.
The group’s machine, called the OxVent,
places the Ambu bag in a sealed perspex
box. Compressed air from a hospital airline
is fed into the box to squeeze the bag andpump fresh air mixed with additional oxy-
gen into the patient through standard tub-
ing. This allows the device to be controlled
by a simple box of electronics with all the
essential adjustments needed for patient
care, says Mark Thompson, a member of
the Oxford team. The next step is to test for
reliability and to find ways to manufacture
the OxVent quickly. The group has already
been in touch with companies eager to
help. “It has been absolutely fantastic the
support we’ve been offered,” adds Profes-
sor Thompson.
A group at University College London
rallying ideas for making ventilators has
also got a huge response from around the
world, says Rebecca Shipley, a professor of
health-care engineering. Using proven de-
signs is probably the quickest way to get
into production, she reckons. Catherine
Holloway, a colleague who leads the Global
Disability Innovation Hub, an organisation
that promotes technologies to assist dis-
abled people, thinks that “no frills” ventila-
tor designs, already used in some poor
countries, might be adopted to boost
manufacturing capacity in richer regions.
At a very basic level, some designs could
be built at home. Among them is an open-
source ventilator developed by a collection
of engineers in Barcelona. The oxygen
machine, as it is called, uses a modified
windscreen-wiper motor to squeeze an
Ambu bag. Adjustments to the air volume
can be made by fitting different-sized
parts. But anyone trying to make one
should take care. “It is a device designed to
avoid life and death situations in emergen-
cy triages, not to replace other superior,
professional and much safer devices,” the
group cautions. Even so, as covid-19 con-
tinues to spread, and health-care systems
are swamped, some doctors may be so des-
perate that they take the risk. 7