22 THENEWYORKER,M AY18, 2020
acceptable during peacetime, might
seem counterproductive during war-
time. And yet the devices must still
work, sustaining patients, sometimes
for weeks, without glitches or failures.
The Vermontilator is as simple a
ventilator as could be imagined: the first
prototype had seven parts. Even so, most
of the team’s time has been spent add-
ing safety valves, pressure regulators,
and alarms—safety features required
for an F.D.A. Emergency Use Autho-
rization. The M.I.T. E-Vent and the
Spiro Wave are more complicated. No
one working on the problem envies any-
one else’s chosen point along the com-
plexity curve. “That might be O.K. for
a very short-term stopgap measure,”
Bates said, of the bag-based models.
“But you could not have, generally
speaking, someone with bad COVID lung
injury on one of those things for hours
or days, because you would destroy the
lungs.” In turn, M.I.T. engineers, when
hearing about some of the more ama-
teurish bag-based projects, shake their
heads. Some respiratory experts insist
on the value of top-tier ventilators; a
doctor might find the CO 2 sensor in-
dispensable, or argue that she’s seen pa-
tients’ respiration improve when they’re
moved from old, stockpiled ventilators
to newer ones. “We’ve been amused at
what people have been inventing as
solutions,” Sharon Einav, the I.C.U.
specialist in Jerusalem, said. “It’s like
someone giving you a Fiat Punto when
you normally drive a Ferrari. But we’ve
not been in a situation where we’ve had
to triage patients.”
When the Spiro Wave was first imag-
ined, in early March, there were fewer
than a thousand confirmed coronavirus
cases in New York. By the fourth week
of March, there were twenty-six thou-
sand. Ventilators were being sought
from innumerable sources: Chinese
philanthropists, the governor of Ore-
gon. According to the Times, New York
State awarded an eighty-nine-million-
dollar contract to Yaron Oren-Pines, a
Silicon Valley engineer with no appar-
ent ventilator expertise, who claimed
that he could supply the machines; none
were delivered. (State representatives
said that they were acting on the ad-
vice of the federal government.) To in-
sure an adequate supply of ventilators,
some hospitals began experimentally
upgrading or modifying some of the
other breathing devices that they had
on hand. In early April, Cohen hosted
some I.C.U. doctors at Boyce Technol-
ogies, where the Spiro Wave was being
manufactured. “These guys were beat
to shit,” Cohen said. “They looked at
the devices.... They were just, like, ‘We
need this, guys.’ They just looked us all
in the eye. ‘When can we get it?’” Co-
hen’s team said that the ventilators could
be ready in four or five days; in the
meantime, the engineers would work
to polish their design.
By the time the Spiro Wave was ready
for production, however, cases in New
York had begun to decline. The night-
mare scenario—doctors triaging pa-
tients, providing ventilators to some but
not others—never came to pass; on the
other hand, many people died outside
hospitals, at home or in nursing homes,
without ever being put on a ventilator.
Officials are still trying to get an accu-
rate count of deaths caused by COVID-19.
Almost certainly, when such non-hos-
pital deaths are included, the count will
jump significantly.T
here is a difference between hold-
ing on and having enough. The
climactic language we have adopted
during the first phase of the pandemic—
waves, surges, peaks—may be mislead-
ing. The emergency continues. As
locked-down cities open up, the virus
will likely infect new people, many liv-
ing in places without the health-care
resources of big cities like New York
and Seattle. “When I hear New York
talking about the fact that they are down
the backside of the mountain, I know
they have been through hell,” Michael
Osterholm, the director of the Center
for Infectious Disease Research and
Policy, at the University of Minnesota,
said last month. “But they have to un-
derstand, that’s not the mountain. That
is the foothills. They have mountains
to go yet. We have a lot of people to
get infected before this is over.” G.M.
and Ford are still aiming to contribute
to the Strategic National Stockpile, a
bulwark against second waves in major
cities and a surge in rural cases. Spiro
Wave is turning its attention to global
distribution; Cohen and his team have
been talking with leading health-care
professionals in Ethiopia. “Those in theSouthern Hemisphere are only just
starting to feel it,” he said.
In Vermont, hospitals have avoided
becoming overwhelmed, and the curve
has flattened. But Bates and his team,
who anticipate receiving F.D.A. ap-
proval soon, are negotiating with the
state for a purchase order. The team is
contemplating a “Mark II” Vermonti-
lator, which would still deliver A.P.R.V.
but with more customizable settings.
Bates recently received an e-mail from
someone who works with the World
Bank in the Central African Repub-
lic—a country of more than five mil-
lion people, with only three ventilators.
“That opens up a whole new potential
for us,” he said. (In addition to venti-
lators, of course, the country would need
clinicians with the training to operate
them.) Whatever the result, he contin-
ued, the Vermontilator project has en-
abled him “to work with people at a
level of intensity that would never have
been possible without this crisis. And
so you find out just what is possible.”
The missions have launched, desti-
nations uncertain. No one can say for
sure where or when the ventilators will
be needed; no one knows which design
is best or more cost-effective or reli-
able. Researchers are still trying to figure
out how the virus does its damage. “If
you don’t understand the illness,” Einav
said, “even the most sophisticated ven-
tilator is not going to work.” Doctors
treating COVID-19 are exploring ways
to avoid intubating patients for as long
as possible, using different equipment
and techniques to support failing lungs.
The month of March—when the offi-
cial case count began skyrocketing
in New York, and when ventilator
projects at the University of Vermont,
M.I.T., New Lab, Ford, G.M., and
NASA began—already seems like the
distant past. But building quickly, in
advance of a murky future, may be what
we need to do in a pandemic. On Fri-
day, March 13th—the same day Bates
got the text message about A.P.R.V.—
Michael Ryan, the executive director
of health emergencies at the World
Health Organization, described the
most important lesson he’d learned
while fighting outbreaks of Ebola. “Be
fast. Have no regrets,” he said. “If you
need to be right before you move, you
will never win.”