16 THENEWYORKER,M AY18, 2020
Labs have scrambled to design easy-to-build ventilators—all with trade-offs.
CORONAVIRUS CHRONICLES
BREATHING ROOM
Engineers take on the ventilator shortage.
By James Somers
ILLUSTRATION BY DAVID PLUNKERT
O
n Monday, March 9th, Jake Kit-
tell, a research engineer and ma-
chinist who builds scientific equip-
ment for the University of Vermont,
in Burlington, came into work fired
up. Approaching another engineer,
Carl Silver, he said, “We gotta build a
ventilator.”
“That sounds great,” Silver replied.
“What do we know about ventilators?”
Neither had ever seen one. But the
coronavirus pandemic, once an abstrac-
tion, had recently made itself felt in Se-
attle, New York, and other American
cities, and doctors had warned that a
shortage of ventilators could hasten the
deaths of thousands. “You feel like you
want to do something,” Silver recalled.
The next week, Kittell e-mailed an-
other professor at the university, Jason
Bates, with whom they had worked in
the past, and whom they knew to be a
lung expert. We have a shop, he wrote.
Can we build a ventilator?
Well, sure, Bates thought. He’d been
working on the same problem for the
previous four days.
Bates has wispy white hair and speaks
with lucid, cheery confidence. Origi-
nally from England, he is a professor
of medicine and of biomedical engi-
neering, and teaches in both the uni-
versity’s engineering department and
its medical school. The author of “Lung
Mechanics: An Inverse Modeling Ap-
proach,” he is one of the world’s fore-
most experts on ventilator-induced lung
injury, or VILI. Earlier in his career, at
McGill University, in Montreal, Bates
and his team invented a computer-
controlled ventilator for mice that is
still used by researchers. By tuning the
machine’s settings and seeing how a
mouse’s lungs react under pressure,
scientists can study the physiology of
lung disease. They can also explore
how different styles of ventilation—
in which air is moved into and out
of the lungs at various volumes, pres-
sures, and rhythms—can help or hurt
a damaged lung.
The previous Friday, March 13th,
Bates had heard from Matt Kinsey, a
pulmonologist at the University of Ver-
mont medical school. A COVID-19 pa-
tient there had been placed on a ven-
tilator, and the physician in charge had
decided to use a technique known as
airway pressure release ventilation, or
A.P.R.V., in which the device delivers
near-constant air pressure, with an oc-
casional quick release. (Try taking a
long, slow breath in, then puffing out,
quickly but gently; repeat.) Kinsey
passed on a text message from the phy-
sician: “APRV is da bomb for covid.”
Bates said, “I was intrigued by this be-
cause I’d been studying A.P.R.V. and
trying to figure out how to optimally
deliver it.” He suspected that COVID-
19 inflicted more damage when the lungs
were swinging between full inflation
and full deflation, and had come to be-
lieve that A.P.R.V., by avoiding those
extremes, was probably the gentlest ven-
tilation strategy for those suffering from
the disease. Now his theory was being
put to the test.
The ventilators used in today’s
I.C.U.s are expensive, in large part be-
cause they are configurable. Newer mod-
els have touch screens that allow clini-
cians to change and track dozens of
parameters, carefully adjusting how
breaths are delivered. Bates began won-
dering whether it might be possible to
build a pared-down ventilator that did
nothing but provide A.P.R.V., to be
used when the supply of fancier venti-
lators ran out. A typical I.C.U. venti-
lator costs between twenty-five thou-
sand and fifty thousand dollars. Bates
replied to Kittell’s e-mail with a docu-
