Since the lockdown was announced on Mar 25, 2020, while all other types of business enquiries started fading-out, two things started happening at PrimedeQ:
- Up until 1st week of April, enquiries were pouring in, every single day, for ventilators. “We will pick any quantities, whatever numbers you have”, they said. This is now dying out. Looks like the Government has placed all the order they needed.
- On the other hand, enquiries for ventilator parts, especially from several engineering companies, for designing a “low cost” ventilator – this still continues every day.
Why this frenzy for ventilators? Everyone knows the answer to this. Governments across the globe were seized with a paranoia that we are going to see a rush of acute Covid-19 cases and the demand for ventilators is going to far outstrip supply.
I am told that all existing manufacturing capacity for ventilators in the country is booked till Sep-Oct this year. More interestingly, there are any number of start-ups and engineering companies announcing their intention to hit the market with “low-cost ventilators”!!!
I am quite sure the people who are least amused by all this frenzy for ventilators are the doctors and other care givers themselves. I recently read a post in Linkedin by a pained Physician saying “ICU management is more than just having ventilators…”
Now let us look at some facts and views:
How many Covid-19 positive cases really require ventilators?
Here is what WHO guidelines has to say about the % of Covid -19 cases needing ventilators…
“The most common diagnosis in severe COVID-19 patients is severe pneumonia. Although the majority of people with COVID-19 have uncomplicated or mild illness (81%), some will develop severe illness requiring oxygen therapy (14%) and approximately 5% will require intensive care unit treatment. Of those critically ill, most will require mechanical ventilation.”
In other words only about 5% Covid-19 cases seem to be going into what is called acute respiratory distress syndrome (ARDS), majority of whom (again not ALL) – an estimated 3% to 4% (of the total cases) may need ventilators. This means even if India hits 50000 Covid+ cases (At the time of writing this- India had 20052 cases), about 2000 may actually need ventilators. India already has about 60000 ventilators!
The interesting thing is, that above data shared through WHO guidelines are based on study of cases in China. However experience across the world including in India, on effectiveness of ventilators in saving critical COVID cases is not so good.
Are ventilators effective in COVID-19 treatment?
Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But in case of coronavirus patients put on ventilators, higher-than-normal death rates have been reported across many countries including China, USA and the United Kingdom, anywhere ranging from 66% – 86%. Even in India some hospitals reported >85%. It is seen that it is common for coronavirus patients to be on ventilator longer than normal and still pass away.
So much so that, healthcare professionals are wondering whether ventilators might actually make matters worse in certain patients. Experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the injured lungs.
Hence, increasingly, physicians are trying other measures first, avoiding intubating and mechanical ventilation as far as possible. The idea is to make the patients better without intubating them, so that their remaining lung capacity helps them recover and are more likely to have a better outcome. Other measures that are really helping are:
- Having patients lie in different positions — including prone, on their stomachs — to allow different parts of the lung to aerate better.
- Oxygen therapy through many other means like nose tubes, oxygen hoods, oxygen concentrators, cpap, bipap or other devices.
- Some doctors are experimenting with adding nitric oxide to the mix, to help improve blood flow and oxygen to the least damaged parts of the lungs.
- Latest we heard is Plasma Therapy which is actually under clinical trials, but so far proven to be useful.
What other equipment are required in ICU? Why aren’t we talking about them?
Every patient in the ICU is on patient monitor. Normally only 1 or 2/ 10 will need mechanical ventilation. In COVID-19 cases reaching ICU, may be 60-80% need ventilation, but not 100%. Pulse-oximeters are being regularly used to track blood oxygen levels regularly for COVID-19 patients.
Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients seem to have oxygen saturations as low as 50 percent. However, even though patients had been sick for a week or so with fever, cough, upset stomach and fatigue, they only became short of breath the day they came to the hospital. By this time, it may be very late, they are already in critical condition.
A pulse oximeter can provide early warning of the decreasing oxygen levels and prevent patients from getting too critical. It is being recommended that if you suspect you may be falling ill it may be a good idea to use pulse-oximeter at home to watch oxygen saturation levels.
Now, why is no one talking about patient monitors or pulse-oximeters shortage?
A ventilator costs anywhere between Rs 3-10 lakhs, while a patient monitor costs between Rs 25k to a lakh. A finger-tip pulse-oximeter costs only a couple of thousands of Rupees! A big order of hundreds and thousands of ventilators, thought to be required would be a lucrative BIG DEAL indeed. So it would seem everyone has jumped into manufacturing ventilators.
Are all these ventilators being produced really going to be used? Is there going to be glut of ventilators in the market post COVID and perhaps even during this phase? What do you think?