The federal government has ordered the manufacture of 10,000 additional ventilators to bolster the national supply in case a resurgence of COVID-19 sends thousands of critically ill patients into intensive care later this year. But the real need may be in the Southern Hemisphere, where new cases of the disease are on the rise and strategies for cheaply making or adapting the critical-care devices could come into play in a way that has so far not been required in Canada.
The newly ordered ventilators, which are to be manufactured by Vexos Inc., an electronics company in Markham, Ont., are based on a design that was adapted for use in Canada by Nobel Prize winner Art McDonald and colleagues. The announcement by Prime Minister Justin Trudeau on Tuesday brings the total number of ventilators that Ottawa has said it will purchase from different sources to nearly 40,000.
“Canada needs to be ready for the second wave of COVID-19,” Dr. McDonald said, adding that the pandemic has highlighted the need for a national stockpile that could also become important during a future outbreak. “It’s clear that this is something that can arise and affects us."
Dr. McDonald, who is known for his work in particle physics, became involved in the ventilator project in March through collaborators in Italy during that country’s dire struggle with COVID-19. Fearing a shortage of ventilators while the disease raged, the Italian scientists developed a simplified, easy-to-manufacture ventilator that could be deployed as a stopgap measure if supplies of the crucial devices ran out.
As case counts began rising in Canada, Dr. McDonald and his team at Queen’s University in Kingston adapted the device using parts that could be sourced domestically.
Working with colleagues at SNOLAB and the Canadian Nuclear Laboratories in Ontario, as well as the TRIUMF particle accelerator in B.C., Dr. McDonald’s group produced a prototype in April. The unit was approved for emergency use by the U.S. Food and Drug Administration on May 1 and is now awaiting approval by Health Canada.
During the intervening weeks, as the pandemic approached 2,000 new COVID-19 cases a day in Canada and then receded to about 1,000 a day, most of which do not require intensive care, the country has managed to avoid a ventilator shortage. That could change if the virus surges back, potentially to higher levels in the fall. If domestic supplies are deemed sufficient, Canada would also be in a position to donate to countries that are now facing rising infections of COVID-19.
“There’s no doubt that there are parts of the world that are going to be in need going forward,” Dr. McDonald said.
The same thinking underlies recent studies led by two teams of researchers, one in Canada and one in the United States, to safely adapt ventilators for use with more than one patient in need of mechanical support for breathing. Both teams were motivated by COVID-19 and published their designs for ventilator sharing earlier this month in separate journals.
The idea has previously been studied as an emergency measure in cases in which hospitals are overwhelmed with critical patients, and it was notably used in Las Vegas after a mass shooting in 2017. But it is regarded as a last resort, in part because different patients typically require different ventilator settings.
The U.S. team, led by Shriya Srinivasan, a postdoctoral researcher at the Massachusetts Institute of Technology, showed how, with a few parts that are commonly found in hospital supplies, the airflow from a ventilator could be split in two while accommodating different settings for each patient.
Dr. Srinivasan said that while an emergency ventilator, like the kind adapted by Dr. McDonald’s team, would be a better alternative, “with supply-chain issues it’s just not clear that it would get to people by the time they need it.” The group has launched a not-for-profit effort dubbed Project Prana that aims to make kits available to hospitals in the developing world where there could be a rapid increase in demand for ventilators due to COVID-19.
Arthur Slutsky, a specialist in mechanical ventilation and a research scientist at St. Michael’s Hospital in Toronto, agreed that the idea is most relevant – and most likely to be used – in parts of the developing world where ventilators are in short supply even without a global pandemic to worry about.
Dr. Slutsky is a co-author on the Canadian study, which offers a somewhat different approach to ventilator sharing that would allow the settings between the two patients to be controlled automatically and protect one patient if the other were to become disconnected.
He added that because of COVID-19 there has been a growing public realization of the role of ventilators in intensive-care units and unprecedented attention to the issue of ventilator supplies during a public crisis.
“Anybody who is really, really sick, ends up on a ventilator,” he said.
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