World Health Organisation (WHO) director-general Tedros Adhanom Ghebreyesus has a grim message for us: The Covid-19 pandemic is accelerating.
And Prime Minister Muhyiddin Yassin, during Wednesday’s live telecast, said the number of cases in Malaysia more than doubled in only a week, citing it as the reason for extending the movement control order (MCO) by an additional two weeks.
Worldwide, it took the virus 67 days to infect 100,000 people. The second 100,000 cases took only 11 days and the third 100,000, a stunningly short four days.
The global death toll has exceeded a whopping 19,000 people, which is around half the number who perished in the horrific Nagasaki atomic bombing in 1945, right at the tail-end of World War II.
The battle against the infectious disease is only going to intensify. There are many weapons we’ll need in our arsenal to mount an effective counter-offensive, and the last line of defence is the ventilator.
Ventilators are complex medical devices that aid those who can’t breathe adequately on their own; and are often the only things that stand between a person in critical condition living or dying.
According to WHO, 80% of Covid-19 infections are mild or asymptomatic, 15% are severe infections that require oxygen and 5% are critical infections that require ventilation.
And according to Harvard epidemiologist Marc Lipsitch, anywhere from 40% to 70% of the world’s population will be infected by Covid-19.
That means, conservatively, 3.12 billion people around the world will eventually be infected. Let that sink in for a bit.
If that seems way overblown, keep in mind that he’s not the only expert to think so. Ira Longini, a biostatistician and adviser to the WHO, thinks two-thirds of the world will eventually contract it and Prof Gabriel Leung, the chair of public health medicine at Hong Kong University, thinks it’ll infect 60% to 80% of the world’s population.
So how does this play into our impending ventilator crisis?
If we assume that 40% of Malaysia is infected, that puts it at 11.9 million people infected. And out of that, if 5% require ventilation, we’re looking at a staggering 594,000 people. Granted, they won’t all need it at the same time – at least let’s hope they don’t.
Assuming around 5% of that number need it at any one time, which is a conservative assumption considering the current rate of infection, we’re looking at needing at least 29,700 ventilators nationwide.
Guess how many Malaysia has now?
No, I’m not kidding. That’s all the ventilators we have and it includes the ones in private hospitals. For comparison, the US has 172,700, Germany has 25,000 and France and the UK have 5,000 each. And yet they are scrambling to drastically ratchet up production to meet skyrocketing demand.
The situation is so dire in Italy that the military is providing manpower to help a ventilator company speed up manufacturing. Hamilton Medical, the world’s largest ventilator manufacturer got a request for 4,000 ventilators from Italy. However, they could only send 400 due to production constraints.
New York state alone is expected to need 18,000. They only have around 6,000 currently. Struggling to meet demand, the US has asked automakers GM, Tesla and Ford to start making ventilators as well.
Malaysia’s ministry of health recently placed an order for 800 new ventilators and private hospitals have pledged to lend 116 of the 450 ventilators at their disposal.
The fact of the matter is, if the virus continues to spread at its present velocity, Malaysia won’t have enough ventilators. As the patients who need critical care pile up, as they undoubtedly will, we’ll start feeling the punch (no, it’s most certainly not going to be a pinch).
As it stands, we’ve already filled up 34% of hospital beds nationwide. When the number of infected people triples, which is almost certain, we’ll be forced to turn to temporary isolation and quarantine centres.
JP Morgan just came up with a report saying that it expects cases in Malaysia to peak in mid-April at around 6,300, and then eventually subside. If this happens to be the case, Malaysia will be considered a success story and it will prove that the government’s actions were effective.
However, I’d prefer to err on the side of caution. What if there is a third wave as some have posited? We thought we were spared from the worst of Covid-19 after the initial 20-plus cases but then the tabligh gathering happened – and became instrumental in kicking off a second wave that’s currently ravaging us.
We need to be prepared for the worst case scenario, or at least close to it. And for that, we need to act decisively now. Here are four ways we can:
Make a simple, low-cost ventilator
This is our best bet by far. We can design and manufacture a simple, bare-bones ventilator which is a fraction of the cost and complexity of existing ones. Ventilators currently cost upwards of RM110,000 and are complex machines, requiring expertise to handle.
MIT is currently working on publishing an open-source design that is low-cost and can be built with relative ease.
Bangladesh, with a population of 165 million people, only has 1,000 ventilators. According to Dr Mamur Hossain, an ex-Tesla robotics engineer and my co-founder at a previous startup, this has spurred innovation in the country, nudging him and his alumni network to develop and trial a ventilator that is many times cheaper.
Malaysia should mobilise its tech talent to work off these models, tweak it as it sees fit and start making it for the local market.
We can utilise the wealth of manufacturing capability at our disposal, Proton and Perodua being prime candidates. 3D printing can be used extensively as well to accelerate testing and development.
Use anaesthesia machines to supplement ventilators
Dr John Hick, director of emergency preparedness at Hennepin Healthcare in Minnesota, and Laura Forese, executive vice-president of NewYork-Presbyterian, say that anaesthesia machines can act as makeshift ventilators in times of dire need.
Some desperate US hospitals are even modifying and using oxygen devices usually used for decompression sickness or foot ulcers as makeshift ventilators.
Hook up multiple people to a single ventilator
A 2006 study by St John’s Hospital and Medical Centre in Detroit suggests that a ventilator can be used to treat four patients at once by using a tubing to split oxygen flow four ways. However, there’s a caveat – the lungs of the patients sharing a ventilator need to be of similar size.
The best part is, it’s been proven to work. After the 2017 Las Vegas shooting, there was a ventilator shortage, which spurred a physician to try this technique. It was a success, keeping victims alive for hours until additional ventilators were sent to relieve them.
Buy more ventilators
I deliberately put this at the end of the list as, surprisingly enough, it’s probably the least tenable solution. And this is because ventilator makers worldwide are currently absolutely inundated with orders.
Chris Kipple, CEO of Ventec, a ventilator manufacturer in Seattle, says: “I can tell you with a 100% confidence that every single manufacturer is facing a backlog right now”.
At any other time, this would be the best option, but the current climate is such that even if we do order more ventilators, the chances that we’ll be able to receive them in time for them to be useful is highly doubtful.
All in all, our healthcare system and the nation at large are being tested like never before. I have no doubt we will eventually emerge victorious – but only if we act faster, including in getting sufficient ventilators.
The views expressed are those of the author and do not necessarily reflect those of FMT.
CLICK HERE FOR THE LATEST DATA ON THE COVID-19 SITUATION IN MALAYSIA