On late Friday afternoon, President Donald J. Trump invoked the Defense Production Act to require automaker GM to manufacture ventilators to aid in the fight against COVID-19.
It’s the government’s latest effort in the struggle against the novel coronavirus, which has achieved a perfect balance of severity and contagiousness that’s overwhelming the material resources of modern medicine. Well before the feared peak in infections in the U.S., protective gear like respirators, gloves, and gowns are already scarce. All projections show that the coming surge of severe cases that require mechanical ventilators to keep patients breathing could far outstrip stocks of the complex machines.
The COVID-19 crisis demands stockpiles of supplies that just don’t exist in an era of lean manufacturing and just-in-time delivery. It demands local production of essential goods in an era of global markets. The looming surge of casualties will severely strain and quite possibly break many resources in the coming weeks and months. But the crisis may also force a long-term rethinking of how production works—from coalitions across giant industries to cooperation among garage-based innovators.
Retooling factories to build ventilators
While the makers of N95 masks, ventilators, and other gear are straining to ramp up production, other companies are stepping in, often with encouragement from their governments. In the U.S., GM and ventilator maker Ventec have just announced a deal to expand production to a GM factory in Kokomo, Indiana, with ventilator units rolling off the converted assembly line in as little as one month. Tesla has pledged to convert its New York State battery and solar panel factory over to ventilator manufacture. British appliance maker Dyson has announced a new ventilator design, but it’s unclear how soon units might actually reach patients.
A modern factory isn’t like a Star Trek replicator that can make anything equally well. But there are similarities between some types of operations. “If you think about what medical device manufacturers do, they use certain basic processes such as injection molding, laser cutting, machining, some 3D printing,” says Satyandra Gupta, director of the Center for Advanced Manufacturing at the University of Southern California. “Now if you think about a lot of appliance companies or automakers, they use similar kinds of processes.”
But there are also important differences, he says. Appliance makers probably won’t have experience with the medical-grade plastics that are required for a ventilator, and they don’t have the sterile manufacturing facilities that such equipment requires. Nor, of course, do they have all the complex, hard-won certifications from government authorities to make such equipment.
So even if a factory can’t make the conversion to produce whole ventilators or N95 masks, companies can still lend a hand. “We’re helping the experts,” says Ford spokesman Mike Levine. Ford recently announced a collaboration with both 3M and GE. With 3M, it’s working to simplify and speed up production of a device called a powered air-purifying respirator, or PAPR. It’s a piece of headgear that’s fed filtered air, allowing medical professionals to work in contaminant-laden environments. A new design that the companies are working on might incorporate the rechargeable batteries from power tools and the fans used to cool the seats in Ford F-150 pickup trucks.
“We’re looking at how we can make a ‘scrappy PAPR’ that works very similar to what they would normally make, but we can go a lot faster and help them scale up production,” says Levine. “Hopefully that would be at 3M facilities. But if we need to add additional capacity, we could potentially do that at Ford as well.”
With GE, the focus so far is on contributing ideas and influence. Levine says that the Ford and GE engineers are working together to try to simplify the design of GE’s ventilators to one that can be made faster and cheaper. Ford will also leverage its influence with its component suppliers to help source parts for the new GE ventilators.
In the near term, this kind of market power is one of the best things a company could contribute, says Larry Smith, director of Graduate Business Programs at Rider University in New Jersey. “Going out and helping one of the ventilator companies acquire more parts that they need to put them together, that seems like something that a big company with a lot of clout could actually help with,” says Smith, a former supply chain manager for a medical device manufacturer.
When in doubt, make more masks
While ventilators cause challenges, other items are much easier to churn out. Ford subsidiary Troy Design & Manufacturing makes plastic components for automobiles and was able to quickly shift to producing clear plastic face shields that protect healthcare workers from contaminants. The facility in Plymouth, Michigan, is set to produce 100,000 face shields per week.
The closer a product is to what a factory already makes, the more likely it is to shift into production. N95 respirators are the face masks most in demand, but they rely on blown polypropylene filter material that is very difficult to produce to the high standards required.
So while specialist manufacturers like 3M and Honeywell are working to ramp up N95 production, the federal government has been enlisting textile makers to make a lower-grade mask as a stopgap measure. A coalition of eight textile companies, including Hanesbrands and Fruit of the Loom, recently joined with the U.S. Department of Health and Human Services to begin producing what are colloquially called “HHS-certified” masks.
“We’re an underwear company, not a technical mask maker,” says Matt Hall, chief communications officer for Hanesbrands. The company aims to produce up to 75 million masks of three-ply jersey cotton, the same material used in T-shirts, according to a design provided by the federal government. The entire coalition may produce over 300 million masks, he says. Hanes is coating the fabric in the same antimicrobial treatment it uses to fight odor in undergarments.
These masks aren’t able to fully filter out virus contamination the way an N95 can for frontline COVID-19 medical responders, but they can provide some level of protection for medical workers dealing with the general public where there is the possibility of infected patients. In other words, they’re better than nothing.
The White House worked to fast-track FDA approval of the masks so that they carry the authority of a medically certified design that can be used in hospitals. “We didn’t want to be in the business of making stuff that’s not certified,” says Bayard Winthrop, CEO and founder of American Giant, another apparel maker in the coalition.
“Masks aren’t complicated from a needlework standpoint,” he says. But still there is a chokepoint—the binding machines that are required to attach elastic to the masks. American Giant is one of the rare textile makers that manufactures in the United States, with two facilities in North Carolina. (Hanes, for instance, has facilities in Central America and the Dominican Republic.) But the binding machine it needs is produced abroad. It’s one of countless examples of reliance on foreign products that have emerged as the U.S. competes with countries around the world for the same critical supplies.
Another possible solution to the mask shortage is to conserve the material that goes into them. In place of an entire disposable mask made from blown polypropylene, the Open PPE Project (together with the group Helpful Engineering) is developing an open-source design for a reusable plastic mask with a small polypropylene filter component that can be changed out in lieu of tossing the entire mask.
Though the project is open-source, that doesn’t mean the standards are lower. “It is incredibly important that this sort of stuff is subject to rigorous quality control and production supervision,” says Matt Parlmer, a software engineer who’s heading up the effort. “And that’s not something that’s possible for someone that’s operating out of a basement.”
If the seal around the mask isn’t perfect, the filtration it offers won’t do much good. So he’s targeting conventional manufacturing faculties that make injection-molded plastics. Parlmer says he has already established a relationship with one facility in Grand Rapids, Michigan, where he lives. He won’t name the factory or exactly when production will start but says “it’s going to be on the order of weeks.”
When hand sanitizer is more valuable than booze
When medical equipment is in short supply, one thing the U.S. does produce a lot of is alcohol. The same ethanol made for booze can also go into hand sanitizer—which has become more precious than high-grade gin or bourbon lately. The one requirement is that the spirits be at least 60% alcohol, or 120 proof. “One of the products we make is 153-proof brandy,” says Mike Pierce, cofounder of Oakland Spirits in California. “We do sell this product that actually can be used to kill COVID-19.”
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We were already scaling our ‘Hand Sanity’ Hand-sanatizer this Monday when Melinda Drayton from @oaklandfirefighters got in touch asking if we could help fill a supply gap with their 500 badass firefighters and paramedics. It took us a couple days to get it right (all that really matters is it’s 63% ABV, who cares if it’s runny) but we were able to pass off a bunch Wednesday and then resupply them yesterday. We were also able to make little personal bottles for the East Bay unsheltered community (pic #4). Thanks @libbyschaaf ‘s office for the connect and @operationdignity for all you do. This slow moving but rapidly escalating crisis has changed everything. But at least we’re all in it together and we all feel like we’re on the same team. Finally. Stay strong, vigilant, and take care of each other.
Pierce combined high-proof alcohol stock with aloe and other ingredients to make an artisanal hand sanitizer for his family, and made a whimsical post about it on Instagram in early March. “The next day I got an email from the deputy fire chief of Oakland,” he says. “And she’s like, ‘Listen, I have 500 employees that are interfacing on the frontlines of this health crisis, and we do not have enough hand sanitizer. Could you make us some?'” Within a week, Pierce had mixed up and donated about 9 gallons to the fire department. He made smaller batches for a local hospital and an assistance program for the homeless.
Similar stories have played out at distilleries large and small across the U.S. and globally. And the government has been uncharacteristically quick to offer encouragement. In mid-March, the U.S. Treasury Department informed distillers that they did not need to receive a special permit to make hand sanitizer, or the alcohol that goes into hand sanitizer, and that they would not face alcoholic beverage taxes as long as they followed some basic formula guidelines. (Such regulatory reforms to encourage hand sanitizer production are also included in the federal government’s $2 trillion relief bill.)
“It was the most nimble I’ve ever seen a government agency act,” Pierce says. “That’s kind of the time we live in, I guess.”
From 3D printing to a low-tech “worst-case scenario”
Ramped-up production of basic products like face shields, cotton masks, and hand sanitizer is a bright spot in the darkening landscape of the COVID-19 pandemic. But while they offer some relief on the margins of the crisis, these products can’t address the frontlines, where the lack of ventilators could soon be dire concerns.
“What we’re looking at is definitely a mismatch between ventilator supply and ventilator needs,” says Matt Fields, an emergency physician at Thomas Jefferson University Hospital in Philadelphia who’s on the task force to determine a rationing policy at his hospital. “A lot of my colleagues in New York are already sharing stories with me about rationing ventilators,” says Fields.
With even the most aggressive efforts to ramp up ventilator production taking weeks or months to scale, a desperate search for substitute technology is now ongoing. Innovators have seized on the bag valve mask, commonly known as an ambu-bag. Fields says these hand-pump ventilators are already plentiful in the medical industry. Stocked in emergency rooms and on ambulances, they are used to provide short-term treatment to patients before they can get to a ventilator machine. A team at MIT just introduced a small open-source device design called E-Vent that mechanically pumps an ambu-bag for a kind of jerry-rigged ventilator. It’s been submitted to the FDA for rapid, emergency review.
But even the fastest review and building process won’t be quick enough for the surge in ventilator demand that’s coming in just a few weeks, says Fields. He’s cofounded a group called Rescue Ventilation that is planning for the ultimate low-tech contingency. They are training teams to manually run ambu-bags, in shifts, for perhaps days at a time per patient until they can get on a real mechanical ventilator. “There’s a shortage of ventilators but not a shortage of people,” Fields says, noting that medical students or people who work on now-cancelled elective surgeries could be recruited. “We don’t think this is ideal. This is a worst-case scenario,” he says.
Fields’s plan requires some maker modification, which comes naturally to him. In addition to treating patients, Fields also serves as research director of the Heath Design Lab at Thomas Jefferson University, where he and his students work on new design concepts. Because ambu-bags aren’t made with infectious patients in mind, Rescue Ventilation has designed a pair of adapters for attaching 3M HEPA filters to the outflow tubes. The adapters can be made in any 3D printer, says Fields.
Matt Fields, Rescue Ventilation
We don’t think this is ideal. This is a worst-case scenario.”
3D printing is at the heart of a response effort spearheaded by the organization Tikkun Olam Makers. Founded in Israel, TOM has communities around the world designing and making open-source 3D-printed items for what founder Gidi Grinstein calls “the bottom of the pyramid—the disabled, elderly, and poor.” One popular item, for instance, is a $60 prosthetic arm that takes adapters for different activities like slicing vegetables or even playing the violin. For COVID-19, TOM members have been building a well-documented collection of the best ideas for medical and other devices, such as plans for 3D-printed face shields and even a design for a makeshift ventilator.
COVID-19 will strain industry like no challenge since perhaps World War II. But it’s a very different kind of challenge in a very different economic, social, and technological era. There will be some equivalents to the great tank and warship factories of the 1940s. GM’s popup ventilator factory draws a clear analogy to those efforts of the past. But today’s crisis response is more varied. A digitized, virtual workforce allows companies like Ford and 3M to quickly collaborate on new respirator concepts, for instance. Cooperation, pooling of resources, and division of labor will be at least as important as establishing make-it-all factories.
And advances like ubiquitous computing and 3D printing have brought the means of production to the masses, allowing anyone with interest and creativity to contribute novel ideas to solve vexing problems. Today’s industrial response to global crisis has grown both deeper and broader than in decades past. Just as World War II remade U.S. industry for generations, COVID-19 is already reshaping our industry of the future.