Building Ventilators: Should We Really?

The economic repercussions of the COVID-19 pandemic have been catastrophic for a variety of sectors. Yet it is safe to say that fighting against the spread of coronavirus has overnight become a lucrative business in itself. The outbreak has been financially undeniably beneficial within the field of medical equipment manufacturing. Multinationals and universities around the world found purpose in researching, designing and producing ‘pandemic-essentials’.

Fueled by the many uncertainties about this brand new-ish virus, there was a specific fear being repeatedly vocalized around April of 2020. Predictions about the role of ventilators during this health crisis were deemed necessary worldwide. A shortage of ventilators was assumed to be a serious global threat based off of these predictions.
Most of the affected countries fell in line to express serious doubt about being able to provide a sufficient amount of ventilators from the moment their national infection rates started to accelerate. This exact doubt was one of the leading topics in opting for worldwide lockdowns.

In this moment it has been 4,5 months since the WHO has recognized COVID-19 as a pandemic. Could this be a reasonable point to evaluate if these global predictions have been helpful, and verify their accuracy? Looking at the increase in demand for ventilators and the rise of open source ventilator projects around the world, there are at least some surprising insights to discuss.

First Things First: What Is A Ventilator?

A ventilator is a life support machine that is meant to help people who have severe trouble breathing.
It is a tool to ventilate hospital patients, typically those in critical condition. 
When intubating a patient a tube gets placed between a person's trachea and a ventilator which regulates their oxygen intake and breathing rate. This is a technique to help clear the trachea and open up air sacs in the lungs that otherwise might collapse.

When the pandemic hit, governments worldwide took to lockdowns and a reform of social structures.
This impacted global economy immensely, with arguably the most notable effects being seen in the categorization of basic societal needs as either essential or as non-essential.  
At this time ventilators had the reputation of being scarce and complicated to manufacture, alongside playing a key factor in the battle against COVID-19.

Projects centered around designing these machines seemed to instantly pop up around the world.
Resilient Society’s 'The Rise Of Ventilator Projects' is currently focusing on collecting and analysing these projects. Eventually a team of volunteers on the platform intend to present this analysis publically.

Rather Safe Than Sorry

Estimates on the effects and needs of the COVID-19 outbreak were widely made based on a worst case scenario point of view. This reaction is an understandable one in times of great uncertainty and high risk. In April of 2020 the prestigious New England Journal Of Medicine addressed what factors weighed into the predictions concerning the amount of ventilators needed. It would have to rely on multiple factors, including the number of Intensive Care Unit (ICU) patients who usually would not necessarily be intubated.

their article it is stated that these patients would be taken into the equation due to the probability of them getting intubated out of precaution when first being brought in. In making these estimations the poor circumstances affecting health care workers and COVID-19 positive patients in Italy were (globally) attributed to a shortage in ICU capacity, hospital supplies, and ventilators in particular.

Who Gets A Ventilator?

At this point in time It is important to note that ventilators are not an absolute necessity for people who were in contact with the COVID-19 virus. As we know now the vast majority of people who contacted the virus do not require medical attention. In fact, only the most severe cases (about 6% of COVID-19 positive patients*) are brought in to the IC. Respiratory failure is the main reason for this, which is when either the oxygen levels in the blood are too low or the carbon monoxide levels are too high. This makes it extremely hard and painful for patients to breathe properly, which is why they need intubation.

However, on average only 40%
of the 6% of COVID-19 positive patients will survive intubation.
And many of the survivers are left with additional issues, since this treatment is extremely invasive.
While the fear of ventilator shortages rested on the idea that intubation would play a huge role in fighting against the virus, in reality doctors agree now that ventilators should play as small of a role as possible in the treatment of patients.
In fact, it should be the very last thing they try, on only a select group of COVID-19 patients.

In hindsight, should ventilators indeed have been at the frontline of our internationally expressed concerns? Or could it be argued that the increase in demand for ventilators has unnecessarily deflected from the opportunity to address how governments facilitate health care in general?
One might wonder if the focus on ventilators was fueled by an actual need for them, or rather a collective panic move resulting from a systemic lack of emphasis put on the practical needs of hospitals all over the world.

*This is a location specific number for the United States.
In Wuhan, where the virus first came to light, only 3,5% of the patients needed intubation.