Why lifesaving ventilators will be in short supply for the foreseeable future

It’s not as easy as just asking a bunch of factories to pump out these complicated machines.

In the last few days, you might have heard more about ventilators than you have in your entire life — specifically, a global shortage of them in the face of a pandemic that attacks the lungs. Because of this, some companies that make other products have stepped forward to possibly fill the shortage by using their factories to make ventilators. On the surface, this sounds like an easy, quick fix. It’s not.

Ventilators, simply put, are machines that help people breathe when they can’t breathe on their own. Air is delivered through a tube in the patient’s windpipe into the lungs, mimicking the way we breathe naturally.

Covid-19, the disease caused by the novel coronavirus, targets the lungs and can cause complications like pneumonia and acute respiratory distress syndrome. Severe cases will require a ventilator to be able to deliver enough oxygen from the lungs to the rest of the body. Without one, the patient could die. A ventilator shortage, then, will mean some patients are denied lifesaving care. And, as has already happened in Italy, doctors may have to choose which patients get ventilators and therefore live and which ones don’t and die.

Depending on how far and how fast coronavirus spreads in the United States, the number of cases could overwhelm the country’s supply of hospital beds, medical professionals, and ventilators. According to the New York Times, there are about 170,000 ventilators in US while the American Hospital Association estimates 960,000 people will need them over the course of the pandemic — which is why it’s best to do whatever we can to slow the spread of the virus so that not all patients all need ventilators at the same time.

“In a worst-case scenario, in which there is an exponential surge in Covid-19 cases, the need for ventilators could greatly outstrip the number available,” Dr. Tom Frieden, former head of the Centers for Disease Control and Prevention (CDC) and current CEO and president of Resolve to Save Lives, told Recode.

There are some simple reasons why we might end up with a shortage. In normal circumstances, 170,000 ventilators are more than enough for the ICU units and operating rooms that use them. In fact, some of the ventilators we do have are in storage, showing that there isn’t — at least, there wasn’t — a pressing need for them. Meanwhile, hospitals aren’t in the habit of buying extra equipment they don’t need. They typically can’t afford to do so.

To try to keep up, President Trump has now invoked the Defense Production Act, which will allow the federal government to order private companies to produce needed goods like ventilators. But that power is only useful if there are enough companies capable of making new ventilators in time. Eric Gjerde, the chief executive of a small ventilator company called Airon Corporation, told Wired that his company sells 50 ventilators “in a good month.” Now, he’s getting orders for thousands and isn’t able to fulfill them all.

“Making ventilators is not a trivial process,” Gjerde said. “It’s just too dangerous to be thrown into the hands of people who don’t know what they’re doing.”

Other companies are experiencing a similar push to increase manufacturing. GE Healthcare, which makes medical devices including ventilators, issued a statement saying it is exploring “all options to support this increased need,” including increasing production lines and adding shifts. A Swiss company told the Wall Street Journal that it is trying to double its ventilator production to 400 units a week, and an Irish company told the paper it is doubling its workforce to try to meet demand.

And then there’s Elon Musk. Never one to pass up proposing tech solutions to well-publicized problems, Musk tweeted on Thursday that his companies, namely Tesla and SpaceX, could also produce ventilators to help fill shortages, adding that they “are not difficult.”

New York City Mayor Bill de Blasio eagerly responded:

Simple, right?

No. There are several factors preventing, say, an electric car factory from instantly switching over to making ventilators. Musk’s saying they “cannot be produced instantly” is an understatement.

In America, ventilators are tightly regulated and must undergo a years-long rigorous testing and approval process for reasons that should be obvious — when you put someone’s life in the hands of a machine, you have to make sure it works. As MIT Technology Review explains, there are also supply chain issues with both the materials needed to make these machines and the people who know how to build them, neither of which Tesla or SpaceX factories likely have immediately available. Matt Callaghan, the cofounder of One Breath, which Tech Review profiled, intended to produce ventilators for countries in the developing world. He said that the soonest it could even start producing its devices for American hospitals would be nearly a year — and that was a best case scenario.

“[That] makes us a second-wave solution when you’re looking at the current outbreak,” Callaghan told Tech Review.

Ventilators aren’t cheap, either. At $25,000 to $50,000 each, according to the Washington Post, they can be less expensive than a Tesla, but they also require skilled people to run them. All expenses considered, keeping extra ventilators on hand might require an investment that many hospitals can’t afford, especially if they may never need them. In the case of a pandemic, the government would buy them instead — other countries are doing this — but it has yet to do so.

“Because these are complicated pieces of medical equipment and are built from hundreds of smaller parts produced by companies all over the world — all of which are facing an increase in demand right now — there is no simple way to rapidly increase production,” Frieden said. “Furthermore, operating ventilators requires tubing, oxygen, trained staff, and many other materials.”

That said, it’s not out of the realm of possibility that Tesla or Musk could, at some point, produce ventilators. In fact, Ford and General Motors are currently looking into the possibility of doing something along these lines. So while Musk’s ventilator offer will likely take a long time, if ever, to come through, any little bit may help.

“Anything industry can do to help us accelerate production of ventilators will be welcome,” Frieden said.

The good news is that America doesn’t have a shortage yet. While many predictions say we will run out of hospital beds and lifesaving equipment at some point, the future has yet to be written. Do your part to flatten the curve and maybe this virus will spread slowly enough that our future won’t look like Italy’s present.