‘Scotch tape and baling wire’: How some hospitals and companies are responding to meet America’s ventilator shortage – USA TODAY

VUMC engineers created a simple ventilator designed in a way that anyone can replicate as the fight against the coronavirus continues. Nashville Tennessean

As thecoronavirus pandemic appears near a peakin parts of the U.S., hospitals aretraining medical staff on how to run ventilators while companies and doctors are retrofitting devices in casefacilities run out of the breathing machines.

In New York City, doctors atMount Sinai Health System have repurposed machines used to treat sleep apnea to help some COVID-19 patients when ventilators are in short supply.

In Massachusetts, the online education company edX has launched a special class to teach medical professionals who don't specialize in critical care how to operate ventilators.

And in aConnecticut-Californiaagreement,Xerox Holdings and Vortran Medical Technologyplan to produce single-use, disposable ventilators.

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"Everything has to be done at warp speed right now. Hopefully, it will help deal with the crisis," said Anant Agarwal, the founder and chief executive officer of edX and a professor of electrical engineering and computer scienceat the Massachusetts Institute of Technology.

Ventilators and respiratory therapists arein short supply at some hospitals as coronaviruspatients fill newly expanded intensive care units.

Hospitals in several states have sought the machines from federal and state stockpiles. Some in New York City have said they plan to useone ventilator to help two COVID-19 patients at a time, which can be risky.

In emergency on-the-job training, hospitals have asked doctors and nurses to help oversee ventilators even though they haven't been deeply trained in respiratory therapy.

Thesemoves come asthe coronavirus crisis may be nearing a turning point. Thenumber of confirmed COVID-19 cases in the U.S. rose to about 400,000, with nearly 13,000deaths as of Wednesday morning, according to Johns Hopkins University data.

New York Governor Andrew Cuomo said Thursday the state is 'splitting' existing ventilators and converting anesthesia machines to ventilators to meet patient needs. Cuomo said the practice is 'not ideal', but believes it will easy the load. (March 26) AP Domestic

In New York City, the domestic epicenter of the crisis, the 4,009coronavirus deaths and thousands of hospitalizationshave strained health care systems to the breaking point.

New York Gov. Andrew Cuomo said Tuesday that hospitalizations, intensive care unit admissions and intubations of patients for ventilators have dropped statewide. However, he announced 731 new deaths, the largest one-day tollfrom COVID-19in the state. That means it's too early to declare the worst is over.

"We have to keep doing it," said Cuomo, referring to the shutdown of all but essential businesses and social distancing he hasordered until the end of April. "Let's not get complacent."

With such warnings in mind, a foundation of former Google chief executive officerEric Schmidt recentlyreached out to Dr. Susan Wilcox,co-author of a textbook called "Mechanical Ventilation in Emergency Medicine."

Wilcox, an emergency physician at Massachusetts General Hospital and an associate professor at Harvard Medical School, distilled the basics of how a ventilator worksinto a free, online course on the edX platform. The educationcompany was co-founded in 2011 by Harvard University and the Massachusetts Institute of Technology.

'On-the-job emergency training':Hospitals may run low on staff to run ventilators for coronavirus patients

The course is designed for medical professionals who have little or no background in critical care and managing gravely ill patients on ventilators. The course can be completed in two to five hours, Agarwal said.

"The purpose is not to turn anyone into a full-fledged respiratory therapist or emergency care doctor," Wilcox said. "It gives them a foundation about how a respirator works, and the vocabularythat allows them to better collaborate with their hospital colleagues."

Monday afternoon, hours after the class debuted, more than 3,000 participants were taking the course and exchanging comments and questionsin an online forum, Agarwal said.

"We can offer the course as long as it's needed," he said.

Facing the possibility of running out of ventilators,doctors and health care experts at Mount Sinai Health Systemin New York City devised a way to retrofit more than 1,000 breathing machines donated by Tesla and a second benefactor.

The units, closely related to CPAP units used to treat sleep apnea,are known generically as bi-level machines because they provide a form of assisted breathing with alternating high and low pressure,said Dr. David Rapoport, the director of Mount Sinai's Sleep Medicine Research Program.

The team hasretrofitted about 30 of the units so far by tweaking the electronicsand replacing the maskwith a connection for a breathing tube.The team added a monitor that enables hospital staffers to check the system, as well as an alarm to alert them to problems.

Ambulance workers clean a gurney at Mount Sinai Hospital amid the coronavirus pandemic on April 01, 2020 in New York City. Hospitals in New York City, the nation's current epicenter of the COVID-19 outbreak, are facing shortages of beds, ventilators and protective equipment for medical staff.(Photo: Spencer Platt, Getty Images)

Rapoport said the MacGyvered units are designed for COVID-19 patients who aren't the worst off,freeing up full-scale ventilators for the most critical cases.

"It's really a Scotch tape and baling wire operation that has been made as safe as possible," Rapoport said, explaining they could be used when Mount Sinai hospitals are "down to our last few ventilators."

As of Tuesday, that time had not arrived. But the medical team is ready, having tested the retrofitted units on two patients Monday with good results, Rapoport said.

Teams at Northwell Health, New York's largest healthcare provider, and in Berkeley, California, developed similar workarounds, he said.

The teams are sharing their designs online so other hospitals can use them as coronavirus casespeakacross the nationand facilities run short on ventilators. The retrofitted units could also prove useful in Africa, Indiaand other parts of the world where ventilators are scarce, Rapoport said.

"There's been extraordinary openness and communication in the scientificcommunity," he said. "Everybody is sharing."

Xerox, best known for its office copying machines, is pairing up with Vortran to produce a device forthe current pandemic and future disasters.

In a collaboration announcedMonday, Xerox plans to produce single-use, disposable resuscitators designed by Vortran for use as backup ventilators during disease outbreaks, mass casualty events and other disasters.The units cost roughly $120 each, far less than the $10,000-plus price tagfor an intensive care unit ventilator if one can be found.

Xerox Corp. signage stands outside the company's headquarters in Norwalk, Connecticut, U.S., on Friday, Jan. 29, 2016. Xerox Corp. is rewinding the clock, splitting off a services business it acquired a little more than five years ago -- the latest tech giant taking drastic action to cope with a rapidly changing marketplace.(Photo: Douglas Healey, Bloomberg)

"It's a much simpler, low-cost device," said Vortran co-founder and chief executive officer Dr. Gordon Wong in an email. The devices provide a constant flow of airand can be used with a compressor.

Each unit is designed to be used once for a patientin the early stages of respiratory diseases. A COVID-19 patientcould be supported for up to 30 days on the unit, Wong said.

The machines have been used in the U.S. and around the world. The companies plan to produce 40,000 of the machines in April, ramping up to150,000 to200,000 a month by June.

"We want to help make sure doctors, nurses and paramedics on the front lines have the resources they need to help the rising number of patients with COVID-19,"John Visentin, Xerox's vice chairman and chief executive officer, said in a company statement.

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'Scotch tape and baling wire': How some hospitals and companies are responding to meet America's ventilator shortage - USA TODAY