Covid19 and Ventilator
At the night of April 5, the number of Covid-19 cases in the world was 1.25 million while the number of deaths was around 68,000. Thus, the fatality rate worldwide worked out to around 5%. This number is aggregate of 181 countries but if we consider the Covid19 infection and deaths country wise, the scenario is varying across countries, in some cases, there is huge variation. If we consider Italy, the number of Covid19 cases in the country was 124,632, with 15,362 deaths. Thus, fatality rate for the country works out to12.32%. On the other end is Germany; it had 96,092 cases and 1,444 deaths, thus, fatality rate works out to 1.5%. Though it is quite low in comparison to Italy, even in Germany it has almost doubled in comparison to last week’s ratio of around 0.8%. India, as on Sunday, April 5, had 4,198 cases and 114 deaths. This works out to an approximate death rate of 2.7%. Experts say that the low death percentage in Germany may be because of much wider testing that increases the denominator as well as the higher availability of ventilators whereas in India it may be because of the hot and humid weather. While aggressive screening (especially at entry points), large-scale testing, the use of masks, social distancing, and early lockdowns may have slowed the spread of the pandemic, ventilators are necessary for the treatment of Covid19 patients as the coronavirus attacks patient’s lungs; in most cases it compromises their ability to breathe.
In India, instead of slowing down, the number of patients has increased at higher rate during the last few days, mainly because of Covid19 infected people from Tabligi Jamat moving countrywide. It is expected that the present rate of infection will come down in the ensuing days but the absolute number will continue to increase, thus, the requirement of ventilators will continue to increase. Ventilators are mechanical breathing devices. They deliver air to the lungs through a tube placed in the windpipe; this air delivery is crucial to keep Covid19 patients alive. The closed-loop ventilators are capable of delivering the required amount of air to the patient while controlling the pressure and the flow rate of the air. Be that as it may, in addition to supporting the Covid 19 patients, ventilators are also required for supporting other respiratory patients who do not have coronavirus ailments. Under the circumstances, countries, one after another, are ordering ventilators in huge quantities to face the challenge of the spread of Covid 19 whereas there are only a few manufacturers worldwide.
As of now, India has an estimated 40,000 working ventilators. A number of experts say that these will be totally inadequate in case there is a surge in Covid-19 infections. If approximately 5% of the cases with infection having acute breathing problems are needed to be sent to intensive care units (ICU), the requirement of ventilators will be huge; no one, as of now, knows the number of ventilators that will be needed over a time till Covid19 is controlled. This requirement cannot be met even by imports as a single ventilator requires over 1000 parts which are manufactured in different regions and countries. Europe, USA and China are the main manufacturers of ventilators and their parts. Ventilator pars move across the world to support manufacturers.
The Central government has already placed orders for 10,000 ventilators on China. Further, she has placed orders for domestic production of 40,000 ventilators to support the hospitals for treatment of Covid-19 patients. The Noida-based Agva Healthcare has been able to develop suitable ventilators and an order of 10,000 ventilators has been placed with them. The company is expected to begin delivery by second week of April. Additionally, Bharat Electronics Limited, a public sector unit, has been ordered to manufacture 30,000 ventilators. Bharat Electronics Limited, as of now, does not have the technology, thus, they will have to collaborate with some domestic manufacturer(s). Meanwhile, Maruti (now Suzuki, India) has jumped into the fray on the request of the government. It will manufacture ventilators in collaboration with local manufacturers; it aims to jointly produce 10,000 ventilators per month. Lately, a good news about ventilator has come from IIT, Roorkee. It has developed a low-cost portable ventilator in collaboration with AIIMS-Rishikesh. As per them, it can be manufactured for at a cost of ₹25,000. The ventilator was demonstrated to many manufacturing companies. Quite a few of them have expressed their interest in manufacturing the ventilator, which has been named ‘Prana-Vayu’ by IIT-Roorkee. The ventilator has already been tested and demonstrated. It is a closed-loop ventilator that is capable of delivering the required amount of air to the patients while controlling the pressure and flow rates through an automated process. It gets an automatic feedback that enables the system to control tidal volume as well as the number of breaths per minute. In addition, the ventilator developed does not require compressed air for functioning, thus, it can be useful in cases where hospital general wards or open areas are converted into ICUs. IIT-Roorkee has claimed that the ventilator will be useful for a wide degree of congestions in the respiratory tract. The ventilator is applicable for serving all age group of patients, especially the elderly. Both under normal and patient-specific breathing conditions, the prototype has been tested successfully. The need of the hour, however, is to establish assembly line manufacturing systems and deliver ventilators in the volumes required to meet not only national but global need.
Prof. Arunaditya Sahay
Professor and Dean (Research), BIMTECH