On April 25, India reported more than 349,000 new COVID-19 cases—more than any other country has on a single day of the pandemic so far. More than 2,000 people in India are dying of the disease each day. In many hospitals, doctors have run out of critical supplies like oxygen and ventilators. Desperate family members are pleading for help on Instagram and Twitter.
In other parts of the world, volunteers are racing to find solutions. “Things have started to escalate in the past few days,” says Chakshu Saharan, a U.K.-based tech entrepreneur originally from India. “Every day we’re now getting worse news.” Saharan helped launch a new project called Help India Breathe that is raising money to ship ventilators to India, along with CPAP (continuous positive airway pressure) machines, a noninvasive tool that can help patients breathe.
The need for ventilators—which seemed so intense at the start of the pandemic—is not as acute today. As doctors’ understanding of how to treat COVID-19 improved over time, they realized that they could sometimes use CPAP machines, or try other breathing treatments like flipping patients onto their stomachs, rather than turning to invasive ventilators. Some drugs used to treat COVID-19, such as the inflammation-fighting drug tocilizumab, can also reduce the need for ventilators. After the U.S. government told companies like General Motors to start making ventilators last spring, America ended up with more than it needed. But the devices are still necessary to manage severe cases when patients can’t breathe on their own, and with the number of people becoming sick in India, there are many severe cases.
Help India Breathe is turning in part to projects that started in other countries earlier in the pandemic as governments realized that they might suddenly need tens of thousands of ventilators and other technology to help patients fight the disease. One team, from University College London and Mercedes-AMG High Performance Powertrains, began reverse-engineering an existing CPAP device with an expired patent in March 2020. Within 100 hours, they had a prototype; after only a week of testing, they had regulatory approval to make the devices in the U.K. As it was used in hospitals, the device helped some patients avoid the need for a ventilator, a riskier tool that can cause additional infections when its breathing tube is inserted down someone’s throat.
The money Saharan and her partners raise will be used to buy some of the machines at cost so they can be sent to India. “They’re ready to be shipped,” she says. “All we need is funding.” As many as 10,000 devices may be available, though the volunteers are initially aiming to buy and ship 50. Every device will help. Still, it’s a tiny number in the face of the surge in infections, and it raises questions about preparation: When this device and others were ready a year ago, why weren’t plans made to put more of them in place before a surge?
University College London offered to share the design freely with manufacturers and healthcare providers, and says that it received more than 1,800 requests from 105 countries, though it’s not clear how many were produced. Similarly, a low-cost ventilator quickly developed at NASA’s Jet Propulsion Laboratory last year is available through a free license from the California Institute of Technology; a spokesperson from JPL said that some companies in India had licensed the technology, but they don’t know if any of the ventilators have actually been manufactured.
A team from the Massachusetts Institute of Technology shared an open-source design for a low-cost, basic ventilator and quickly had interest from multiple large manufacturers in India, among other countries. “They ran harder and faster than we could towards productization,” says Nevan Clancy Hanumara, a research scientist at MIT who worked on the effort. The companies were ready to produce the devices at a large scale. But the Indian government didn’t choose to place orders, instead moving forward with the production of different ventilators. Many of those ventilators now sit in storage. When demand lagged earlier in the pandemic, the Indian government didn’t ultimately buy all of the ventilators it had initially ordered, and some are still in warehouses. The country is also dealing with a shortage of oxygen and a shortage of healthcare workers trained in using those devices. Even if those problems are addressed, Saharan says, hospitals also have concerns about the quality of the batch of devices in storage, so more shipments are needed.
The U.S., U.K., and other governments are sending extra medical supplies, including ventilators, to India (along with materials to make vaccines, and some vaccines themselves). Early efforts to make lower-cost ventilators and CPAP machines arguably could have gotten more support to be ready for surges like the one happening now. It’s one more reminder of the critical role of government in a pandemic: While pro bono engineering projects can design critical tech, it isn’t useful if it isn’t managed well—and that leaves volunteers and nonprofits scrambling now to try to step in after the situation is already out of control.
Saharan’s group hopes to order ventilators from the Ventilator Project, a nonprofit that launched at the start of the pandemic and recently got approval from the Food and Drug Administration for a ventilator that’s much lower in cost than others used in ICUs. (It’s similar to the cost of transport ventilators that are usually used for short time periods.) The group is working with Janvikas, an Indian nonprofit that is tracking the current need for supplies. “They are able to aggregate the demand on the grassroots level across India, to actually understand where the demand is, and to be able to mobilize these devices where they’re most needed,” Saharan says. Critically, the nonprofit also helps with training so healthcare workers can use the equipment.
To be prepared for the next pandemic, it’s not just about having the right number of medical supplies, says Tyler Mantel, the entrepreneur who founded the Ventilator Project. Training is important, along with support from manufacturers, something that often doesn’t happen when one country is getting an emergency donation of supplies from another country. “In reality, a plan that looks ahead to the next pandemic wouldn’t say, ‘Hey, I need 10,000 ventilators in stockpile,’ ” he says. “It would say, ‘I need 10,000 ventilators and the distribution and support model that helps at the point that the pandemic starts.'”