Urgent moves to build ventilators here
New Zealand doesn’t have enough life-saving medical ventilators to cater for a Covid-19 emergency, and we are low priority when it comes to securing scarce overseas stocks. So Government and business leaders are getting together to see if we can make them ourselves.
It’s as simple as this: when it comes to saving the most seriously ill Covid-19 patients, ventilators are what you need. Not the sort that move air around a building, but the medical sort that push air into and out of someone’s lungs, mechanically delivering breaths to a patient who is physically unable to breathe on their own.
In a Covid-19 environment, medical ventilators are essential for the 12 percent or so of patients in ICU where the virus has attacked their lung tissue and stops them being able to breathe. The machines keep them alive while their body - and their doctors - fight the virus. Hopefully they recover from the virus and their lungs start working again. Then they can come off the ventilator and go home.
But New Zealand doesn’t have nearly enough of these magic machines - and most of the ones we have are already in use for non-Covid-19 patients.
How many do we have?
It’s hard to find out exactly how many medical ventilators are in New Zealand, though the Health Ministry is working on getting the numbers. But a study quoted by the John Hopkins Centre for Health Security in 2018 suggested the US has more than 20 intensive care beds with medical ventilation capability per 100,000 people, Canada has about nine, but New Zealand and Australia have only 5.4 of this bed/ventilator combination per 100,000 in the population.
Don’t imagine these ventilators are sitting around in corridors waiting for Covid-19 patients. They are in high demand, particularly in the winter. Doctors might hold a tiny percentage back for an emergency, but basically they are all being used.
And that’s a problem.
Countries all around the world are scrambling to get ventilators, so you can’t just phone up a big manufacturer like GE or Dräger and order one. Like thermometers and hand sanitiser in your local pharmacy, they are all sold out.
Italian hospitals are so short of ventilators that doctors are having to make heartbreaking choices
Other countries are scrambling to work out what to do. Italy, the new epicentre of the pandemic, has called in the army to help the country’s only ventilator manufacturer quadruple monthly production.
Tragically, Italian hospitals are so short of the machines that doctors are having to make heartbreaking choices about who gets to go on a ventilator, reserving them for people who are likely to recover. Too old? Too sick? Sorry, we can’t spare one for you.
The UK hasn’t reached that stage yet, but Prime Minister Boris Johnson this week called on engineering firms, including car companies Ford and Honda, digger maker JCB and even aero-engine producer Rolls Royce, to see if they could switch some production to ventilators.
And now the race is on in New Zealand. Over the last 48 hours, coronavirus experts have teamed up with business leaders, and with government ministers and officials, to find a solution to the ventilator shortage. Even the Prime Minister is involved.
A bed and a ventilator
Wendy McGuinness knows as much about pandemic preparedness as almost anyone in New Zealand and she is hugely relieved there's action at last. McGuinness heads Wellington-based think tank the McGuinness Institute, which focuses on New Zealand’s preparedness for future risks like pandemics or climate change.
McGuinness quickly grasped that the Covid-19 pandemic was different from other potential pandemics, particularly a flu pandemic.
A key difference was the need for ventilators.
“There was a moment when I realised how this was going to play out. I looked at pictures of the Wuhan hospitals and each patient had a bed and a ventilator.”
Of course it's not as simple as that. McGuinness puts me in touch with Dr Kate Baddock, a GP and chair of the New Zealand Medical Association. Baddock explains that patients on mechanical ventilators need to be unconscious, they need IV fluids, sedation, and someone to monitor every function in their body 24/7.
Still, without the ventilator, the rest is pointless.
It's not that governments don't think about these things. In 2007, following the Ebola outbreak, our government commissioned Whanganui company Quality Safety International to make 20 million masks for a national stockpile. Masks were again seen as crucial when, in 2015, the McGuinness Institute did a report on New Zealand's supply chain resilience following the West African Ebola outbreak.
Meanwhile, New Zealand's Influenza Pandemic Plan (2017) shows the Ministry of Health holds stockpiles of various essential medical-related products in DHB and bulk stores around the country. There are masks, gowns and gloves, there are intravenous fluids and the equipment needed to give them to patients, and there are needles and syringes.
But no ventilators.
As February progressed and McGuinness heard nothing about ventilator stocks, McGuinness got really worried.
She wrote to Health Minister David Clark on March 2 pointing to overseas ventilator shortages and asking about the situation in New Zealand.
“How many ICU beds does New Zealand currently have with medical ventilators and how many are currently being used?” she asked. “How many other respiratory devices do we have and do medical professionals consider they are useful (eg are they able to be repurposed into medical ventilators?).
“Has the Ministry of Health been in contact with suppliers or other organisations based in New Zealand that might be capable of manufacturing medical ventilators in preparation for possible outbreaks?”
She didn’t get a response.
From zero to high alert
In fact it appears it wasn’t until this week, two weeks after McGuinness’ letter to Clark, that things started to happen at an official level.
Then everything moved quickly.
McGuinness ramped up her campaign, along with fellow pandemic specialist Roger Dennis and some business leaders and investors.
And the Government started to talk about the issue.
Health Minister David Clark said yesterday that stocktakes were under way to determine the number of ventilators available around the country.
Some decommissioned hospitals had old equipment which could be repurposed, he said, while there were “varying levels of ventilator” that could be deployed by health professionals if needed.
Clark is right. Ventilators like the ones pictured in Wuhan, or used in intensive care units and operating theatres in New Zealand, are complex.
But they don’t have to be. Ambulance crews use hand-held, manual ventilators in emergency situations, and there are many types of ventilators in between.
Health Minister David Clark said conversations were under way with medical equipment manufacturers in New Zealand to ensure the country had the capacity it needed.
But what does that mean?
Fisher & Paykel is New Zealand’s best-known medical equipment manufacturer, and sells respiratory products - but not ventilators.
“We do not manufacture ventilators and don’t have expertise in this specific product area,” spokesperson Karen Knott told Newsroom yesterday. “Right now the company is currently focused on responding to increased demand for respiratory humidification products and we think that is the best thing we can be doing in these challenging times.”
So are there other options? Yes, say manufacturers like Guy Stewart, chief executive of Christchurch-based refrigeration company Skope.
“Manufacturers are good at manufacturing,” Stewart says. “We have sophisticated equipment and clever people.”
Stewart isn’t saying Skope could switch from building fridges to making ventilators, but he says Skope and others could be part of a solution - making sub-frames, for example.
“I don’t need to design it. As long as I’ve got good instructions, my guys could make it.”
Stewart says in a crisis, traditional supply chains have to adapt.
“After the earthquake, Fonterra shipped water to Christchurch in milk trucks. Supply chains have to adapt to fix a problem, and here the problem is a shortage of ventilators.
“They might not be the sexiest ventilators you’ve ever seen, but in theory Skope could put bits together, or make components.”
And in conjunction with other local manufacturers, with perhaps a few key components coming from overseas, that could work.
Saving businesses too
As Ardern and her Finance Minister Grant Robertson look at ways of keeping struggling manufacturers going during the crisis, this could kill two birds with one stone.
There is a whole lot of unused production capacity in Christchurch at the moment, Stewart says, and people worrying about their mortgages.
“The demand must come from the Government saying ‘make it happen because we’ll pay the bill’.
“If you motivate a whole lot of businesses, everyone gets what they want - ventilators to save lives and work for businesses needing to survive.”
Will that happen? It's still very much a movable feast as Government and the private sector explore options. Asked if some of the $32 million earmarked in yesterday's emergency health package for expanded ICU capacity would be used to purchase more ventilators, David Clark was succinct.
"Yes," he said.
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