How to build a Better Respirator – Faster and Cheaper Robert Ferrand 3/21/2020
A Report to the CDC
The CDC is reporting that the Covid-19 Pandemic could require as many as 1,000,000 respirators. The US has 170,000 respirators in hospitals and another 8,000 in the strategic stock pile. We cannot get there from here, without a different strategy. This document outlines that “different” strategy to build thousands of respirators in a short amount of time. Coronavirus ventilator dependent mortality rates are high. However, ventilator dependent mortality rates are always high. “Positive Pressure” Respirators are damn dangerous, because they are “Invasive” and almost always do some damage. Among critically ill COVID-19 patients in China, the reported case fatality proportion was 49%. In a report from one hospital, 61.5% of critically ill patients with COVID-19 had died by day 28 of ICU admission. [9,15] Ventilator-associated pneumonia (VAP) is the most common lethal infection observed in patients who require treatment in intensive care units (ICUs).i The crude mortality rate for VAP has been cited to be as high as 70%. Those are similar rates to Coronavirus mortality. These respirators required knowledgeable trained critical-care nursing staff. There are 500,000 critical care nurses of which 250,000 work in ICU. There are an additional 100,000 Respiratory Therapists. If we could build enough the respirators there are enough knowledgeable personnel to operate these “Positive Pressure” respirators. Assuming that the parts can be sourced, in such a short term, when many companies are sourcing the same technically demanding parts…. The number of respirators that can be built is limited. Significantly, these Respirators cost $50,000 each. In this emergency they will cost even more. Most Importantly, Hospitals cannot afford the Millions of Dollars required for a piece of equipment that will then not be used after the crisis. There is another strategy. While “Positive Pressure” ventilation is the current preferred method, there is another way to provide mechanical ventilation – “Negative Pressure”. This was the preferred method in the last major epidemic – During the polio epidemic in the 1950’s negative pressure respirators saved countless lives. (Ed Roberts in his Iron Lung) This “Non-Invasive” technology may apply today, because it does not require Critical Care Nursing support.