18 THENEWYORKER,M AY18, 2020
the flow of air. She can adjust the “tidal
volume”—the total amount of air to be
delivered with each breath. She can
designate a target pressure, in which
case the ventilator delivers whatever
volume is required to generate it. (Imag-
ine filling a bicycle tire: you pump until
the tire is firm.) She can also select the
degree of PEEP, or positive end-expi-
ratory pressure—the amount of pres-
sure that’s left in the lungs at the end
of each exhalation. Higher PEEP pre-
vents the air sacs from collapsing. By
decreasing the duration of exhalation
and maintaining higher inspiratory
pressure, A.P.R.V., Bates’s preferred
ventilation style, does everything pos-
sible to avoid the Velcro effect.
The Vermontilator will likely cost
around one or two thousand dollars
when it ships—more than ten (or fifty)
dollars, but a fraction of the cost of a
full-fledged I.C.U. ventilator. It’s so in-
expensive because it’s a minimalist de-
vice made from around fifteen parts,
designed specifically for A.P.R.V. If the
Velcro effect is as central to COVID-
as Bates believes it to be, then this is a
sound approach. But clinicians and re-
searchers are still debating what kind
of lung damage the coronavirus causes;
they have come to recognize that it
affects patients in unpredictable ways.
“One of our mistakes at the beginning
of this mass-casualty event was fixa-
tion: you come in with an
idée fixe,” Sharon Einav, an
I.C.U. specialist in Jerusa-
lem who co-authored a set
of well-known guidelines
for critical-care surges, told
me. “People knew ARDS.
The intensive-care com-
munity has been discussing
ARDS for the last twenty
years. As time passes, we’re
discovering that this dis-
ease has something more
to it.” The Vermontilator is a bet on the
nature of the virus that may not pay off.
I
f we could produce more of the
high-end ventilators already in use
in hospitals, doctors could choose their
own settings. This is the cause now
taken up by Ford and General Motors,
which have each collaborated with a
ventilator-maker—G.E. Healthcare,
which licenses a design from Airon,
and Ventec, respectively—to scale up
manufacturing. In mid-March, Ford
kicked off Project Apollo, after the com-
pany learned about Airon’s design; a
personal introduction to representatives
at Ventec led Mary T. Barra, the C.E.O.
of G.M., to commit her company to
Project V.
Ventec’s VOCSN ventilator—the name
stands for “ventilator, oxygen, cough,
suction, and nebulizer”—was designed
to perform the functions of five devices
in one. “We are the first and only mul-
tifunction ventilator,” Chris Brooks, the
company’s chief strategy officer, told
me. (The VOCSN was approved by the
F.D.A. in 2017.) For G.M., Ventec has
created a simplified version, without the
cough, suction, and nebulizer functions,
known as the V+Pro. Even so, Brooks
sees it as a fighter jet in a race with prop
planes. “There’s been a lot of conversa-
tion over the past few weeks with the
shortage, a lot of very well-intentioned
individuals and groups and very smart
people, who have said, ‘Hey, we can cre-
ate a ventilator,’ and ‘Hey, we’ve devel-
oped a ventilator overnight, it’s a hun-
dred-dollar ventilator,’” he said. “There’s
a reason that there are very high-end,
very powerful and precise critical-care
I.C.U. ventilators. That truly is what
these patients need.”
On March 27th, in a tweet, President
Trump urged G.M. to “START MAK-
ING VENTILATORS,
NOW!!!!!!”; in a subse-
quent tweet, he invoked
the Defense Production
Act to compel the com-
pany to do what it had
started doing two weeks
earlier. Preparing to man-
ufacture ten thousand of
Ventec’s ventilators per
month, as G.M. plans to
do, has required a crash
effort. On March 19th,
G.M. flew six engineers to Bothell,
Washington, to study the VOCSN pro-
duction process. “We took a lot of
pictures and a lot of video,” Gerald
Johnson, G.M.’s head of global man-
ufacturing, told me. The VOCSN has
around seven hundred parts; the V+Pro,
around four hundred. By e-mailing lists
of parts to around seventy of its “Tier 1”
suppliers, G.M. was able to secure all
of them by the following weekend. The
scramble, Johnson said, was “miracu-
lous.” Suppliers had to adapt produc-
tion lines to new specifications; they
had to ask their own suppliers to do
the same. The most elusive part, a
special DC motor, is being shipped
from India, where it is being made in
a factory that had closed and had to
be reopened.
With the parts secured, a G.M. com-
ponent-manufacturing facility in Ko-
komo, Indiana, was retrofitted for ven-
tilators. Two hundred and fifty skilled
workers, recruited from within and out-
side G.M., began work after a week of
training. A few dozen Ventec engineers
are helping run the operation. At sta-
tions, each person takes on a sub-
assembly task—plugging in a hose,
mounting a circuit board with tiny
screws—and then passes a bucket con-
taining the incomplete ventilator to
someone else. “Because of the urgency
and speed, automation was kept down,”
Johnson said.
In mid-April, G.M. produced its
first five units. Later in the month, the
Kokomo plant and its trimmed-down
ventilator were approved under an
F.D.A. Emergency Use Authorization,
and the first shipments were made to
hospitals in Illinois and Indiana, at
around sixteen thousand dollars per
ventilator. (Ford is expected to begin
delivering its first Airon ventilators by
early July.) G.M. says that it is on pace
to produce thirty thousand ventilators
by the end of August.
B
etween the parsimonious minimal-
ism of the Vermontilator and the
maximalist ambition of Project Apollo
and Project V, some engineers have
ended up taking a middle path. In mid-
March, at around the same time that
Bates connected with Kittell and Sil-
ver to develop a prototype of the Ver-
montilator, Scott Cohen, a co-founder
of New Lab, a center for researchers
and startups in the Brooklyn Navy Yard,
began reading up on the global venti-
lator hackathon. A doctor in Detroit
had used a T-tube to split one ventila-
tor among two or four patients. At the
University of Florida, engineers were
using a sprinkler valve and PVC water
pipes to drive what looked like a wheezy
bellows. At Rice University, a bare-
bones ventilator was being built out of
