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

As the coronavirus pandemic appears near a peak in parts of the U.S., hospitals are training medical staff on how to run ventilators while companies and doctors are retrofitting devices in case facilities run out of the breathing machines.

In New York City, doctors at Mount 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 a Connecticut-California agreement, Xerox Holdings and Vortran Medical Technology plan 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 science at the Massachusetts Institute of Technology.

Ventilators and respiratory therapists are in short supply at some hospitals as coronavirus patients 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 use one 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.

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

In New York City, the domestic epicenter of the crisis, the 4,009 coronavirus deaths and thousands of hospitalizations have 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 toll from COVID-19 in 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 has ordered until the end of April. "Let's not get complacent."

How does a ventilator work? This course teaches the basics in 2-5 hours

With such warnings in mind, a foundation of former Google chief executive officer Eric Schmidt recently reached 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 works into a free, online course on the edX platform. The education company 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 vocabulary that 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 questions in an online forum, Agarwal said.

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

Mount Sinai in New York City retrofits sleep apnea units to treat coronavirus patients

Facing the possibility of running out of ventilators, doctors and health care experts at Mount Sinai Health System in 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 has retrofitted about 30 of the units so far by tweaking the electronics and replacing the mask with 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.

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 cases peak across the nation and facilities run short on ventilators. The retrofitted units could also prove useful in Africa, India and other parts of the world where ventilators are scarce, Rapoport said.

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

Xerox, Vortan partner to produce single-use, disposable resuscitators

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

In a collaboration announced Monday, 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 tag for an intensive care unit ventilator – if one can be found.

"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 air and can be used with a compressor.

Each unit is designed to be used once for a patient in the early stages of respiratory diseases. A COVID-19 patient could 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 to 150,000 to 200,000 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.