Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases

The outlook on the COVID-19 coronavirus is changing every day. As of this moment, the United States has just declared a national emergency —It's difficult to contextualize rapidly evolving circumstances, but it's also equally necessary to help ourselves and others. This is why a list comparing prevalent diseases of today with the 2019 coronavirus follows.

Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases

We look at some common, and recent, infectious diseases in order to put the COVID-19 coronavirus in perspective.

COVID-19

The COVID-19 pandemic has spread to every corner of the world. The landscape is murky, and while Chinese sources claim the outbreak is slowing down in its eastern origin, some global experts are claiming we should prepare for months of disruptions before the virus is controlled.

As of writing, there are 125,048 cases of coronavirus infections in over 114 countries, and the death toll is now over 5,000 and continuing to rise.

After days and weeks of constant developments, it might feel like the COVID-19 coronavirus is the only thing we hear about. But the very novelty of coronavirus — first diagnosed in November 2019 according to Chinese officials — is why we know relatively little about it, compared to other diseases, and why it's important to follow the latest updates and the advice of local authorities.

After days and weeks of constant developments, it might feel like the COVID-19 coronavirus is the only thing we hear about. But the very novelty of coronavirus — first diagnosed in November 2019 according to Chinese officials — is why we know relatively little about it, compared to other diseases, and why it's important to follow the latest updates and the advice of local authorities.

Then there's the death rate. COVID-19 has been shown to be fatal in roughly 3.5% of confirmed cases, as ScienceAlert reports. While we don't have enough data to know the exact mortality rate — many milder cases may have gone undiagnosed — the seasonal flu typically kills only 0.1% of those infected.

Then there's the fact that we don't have a vaccine, as well as the fact that the coronavirus pandemic has the potential to overwhelm health systems worldwide, leading to deaths for people with other ailments that would have otherwise been treated.

Yearly cases: approx. 3 to 5 million

Yearly death toll: approx. 290,000 to 650,000

(Statistics from WHO)

2. SARS

As the other most prominent coronavirus in recent times, SARS is also often compared to the COVID-19 coronavirus.

SARS, also known as severe acute respiratory syndrome, was first identified in November 2002 in the Guangdong province of southern China. The SARS coronavirus, which also caused a viral respiratory illness, was eventually contained in July 2003. Before it did so, it spread to 26 countries in North America, South America, Europe, and Asia.

Though the global health community has taken on many of the lessons of SARS in the containment and treatment of COVID-19, this year's coronavirus has far outdone the damage caused by SARS. During the outbreak, there were 8,098 reported cases of SARS and 774 deaths. As per the Centers for Disease Control and Prevention, there have been no known new cases of SARS since 2004.

Though SARS killed 10% of patients, making it deadlier to sufferers than COVID-19, it infected a fraction of the people over a longer period of time.

Total reported cases: 8,098

Death toll: 774

Source: CDC

3. MERS

Another recent coronavirus, MERS, or Middle East Respiratory Syndrome, was first reported in Saudi Arabia as recently as 2012. It spread to 27 countries in Europe, Africa, Asia, and North America.

Much in the same way that COVID-19 likely originated in bats, and was subsequently passed on to humans by an as yet unknown bridge animal. MERS is thought to have been jumped to humans via camels that originally got the disease from bats.

Since it was first identified, there have been 2,494 reported cases of MERS, and 858 deaths. Infections occurred mainly due to close face-to-face contact between humans.

Though MERS's fatality rate is a very high 34% (much higher than COVID-19), the low transmission when compared to the coronavirus that originated in Wuhan means that the death toll has stayed relatively low.

Total reported cases: 2,494 

Death toll: 858

Source: WHO

4. HIV/AIDS

Did you know that before the COVID-19 coronavirus isn't the only ongoing pandemic in the world? The HIV/AIDS pandemic began in 1960 and continues to this day. However, as World Atlas points out, the peak of the hysteria surrounding the disease came in the 1980s when the world became widely informed about its existence.

From 1960 to 2020, the virus has caused over 39 million deaths. Treatment first became available for people with HIV/AIDS in 1987 and just last week the second person ever to be cured of HIV was announced.

 

Source: gevende/iStock

Today, there are approximately 37 million people living with HIV, and cases have been reduced by 40% since its peak in 1997, as access to antiretroviral medicines has a greatly extended life expectancy. Today, approximately 68% of global HIV/AIDS cases are found in Sub-Saharan Africa. This is due largely to poor economic conditions and a lack of sex education.

People living with HIV (end of 2018): 32.7 million–44.0 million

Death toll (2019): 570 000–1.1 million

Source: UNAIDS

5. Ebola

Unlike the COVID-19 coronavirus, Ebola, also known as EVD, is not an airborne disease; infection occurs solely when someone comes into direct contact with bodily fluids of some who is infected.

Recent outbreaks of the viral infection, which was first detected during an outbreak in 1976 near the Ebola River in what is now known as the Democratic Republic of Congo, have led to alarming spikes in deaths from the virus. 

Ebola is another virus that is thought to have originated in bats — in this case, specifically, fruit bats, which are a local delicacy where the outbreak started. Ebola caused the deaths of approximately 11,325 people between 2014 and 2016 and the fatality rate sits at an average of 50%, according to the World Health Organization.

Cases (Aug 2018- Nov 2019): 3,296

Deaths (Aug 2018- Nov 2019): 2,196

Source: CDC

6. Meningitis

Meningitis is caused by inflammation of the meninges. These are membranes that cover the brain and spinal cord. The infectious disease is often caused by fungi, viruses, and bacteria, though it is also possible to get it after suffering a head injury, having brain surgery or having specific types of cancer.

According to the World Health Organization, small outbreaks of meningitis occur sporadically worldwide, except in the African Meningitis Belt where large outbreaks are common and account for most deaths.

The disease can cause flu-like symptoms, as well as vomiting, nausea increased sensitivity to light and a confused mental state.

Yearly cases: approx. 1.5 million

Yearly death toll: approx. 170,000

Sources: CDC/COMO Meningitis

7. Malaria

Malaria is caused by a parasite that is carried by mosquitoes. The initial symptoms include fever, chills and flu-like symptoms, which can quickly progress into more serious complications.

The disease was eliminated from the U.S. in 1951 thanks to the pesticide DDT. Campaigns are ongoing to distribute mosquito nets to help prevent the disease in poorer countries.

As the WHO says, "Africa carries a disproportionately high share of the global malaria burden." In 2018, Africa saw 93% of malaria cases and 94% of malaria deaths.

Cases (2018): 228 million

Deaths (2018): 405, 000

Source: WHO

The 10 Worst Epidemics In History                         

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Black Plague Mask worn by Doctors

Comparing the COVID-19 Coronavirus to 7 Other Infectious Diseases: We look at some common, and recent, infectious diseases in order to put the COVID-19 coronavirus in perspective.

Telehealth is going to change Everything | LinkedIn

The Covid19 pandemic is responsible for the tragic loss of life and a shattered world economy. Will there be any positive outcomes?

Healthcare will change immeasurably. The most obvious and immediate benefit is the massive acceptance and adoption of telehealth. During the preceding five years,  when technology was developed and readily available there was only a tepid acceptance and usage of telehealth. Social distancing and a lockdown of almost the entire United States and overwhelming demand for health services motivated insurance companies and Medicare/Medicaid to authorize reimbursement for telehealth services.

After one week of telehealth, I can see that the medical world is not going to be the same. Going to the doctor is a pain in the butt. As a board-certified pain specialist, I'm well qualified to say that.

For years patients would ask why I could not just "call-in" their medications. For routine medications, I'd tell them the truth, that I needed to assess them every so often for medication efficacy and side effects. For opiates and controlled substances, I'd add that due to DEA guidelines I could not "call" them in any way. Now that the regulations have been relaxed to encourage social distancing I can legally assess patients via video chat, even when they live just around the corner from my office. Add in electronic prescribing of controlled substances (EPCS) and now I can send in that prescription.

My patients, providers, and staff are still working out the mechanics of a telehealth visit. It's been amazing though. We implemented work from home for most of the staff and telehealth for 90% of office visits in 1 week. Providers are figuring out what you can learn by just looking at a patient. Who knew that a knee effusion would be obvious on an iPad or that you can count respirations? Then the patient can demonstrate functionality, press on their own leg to test for edema, even perform a rudimentary neurologic and musculoskeletal exam. I want more data, like vital signs, but in this crisis, a telehealth visit is worlds better than nothing. A telehealth system that integrated with my EMR would be better yet. The best option would be a system that offered telehealth, EMR, and remote patient monitoring in a single platform.

For now, we are settling into a new normal, but what happens this summer (or fall) when we go back to seeing patients in the office? I highly doubt that Medicare is going to force the nearly 60 Million beneficiaries to go back to in-person visits for all non-rural care. On the other hand, I fully expect that HIPPA requirements will return. Whether the DEA allows EPCS with only Telehealth documentation is my main uncertainty. Here again, I'd bet that politics will lean towards patient satisfaction. Perhaps C-III and C-II prescriptions will get different guidelines. We will need (and get) new regulations on this. Plus, what defines supervision for my physician assistant when she works from home "seeing" a patient who is also in their home?

It's an open question as to how best to adapt to a telehealth world. I don't like doing new patient consults via video, but routine follow-ups have been fine. A business may be better. Patients may opt for more visits if they're easier. We'll be able to expand our catchment area since patients don't have to drive in to see us as often. But we'll also have more competition from outside providers who are able to see patients in "our" local region. I envision a less structured clinical day. Currently, I segregate surgicenter days from office days because the other providers are using those resources when I'm elsewhere. In the future, I could see telehealth visits from my device anywhere. We may need fewer support staff with fewer in-office visits. It'll be a whole new world and if we adapt we'll do well and if not we will lose out to those who do.

Published by

Brian Block, MD, PhD

Pain Specialist, Physician, Interventionalist









Telehealth is going to change Everything | LinkedIn

Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study | Gong | Journal of Medical Internet Research

How are other countries using the internet to prevent and control the COVID19 pandemic?

During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public.

Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public’s ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19.

A new approach to outpatient service delivery has been developed in China. Patients go to a medical consultation facility near their home and meet through the internet with a doctor who is based in a top-level hospital in a big city. The doctor asks the patient about his or her state of health via a webcam, through an instant chatting platform designed for the internet hospital. The patient answers questions and shows or sends images of his or her medical checks to the doctor through the internet. Meanwhile, data for the patient's body temperature, blood pressure, and blood glucose concentrations can be obtained by machine-operated devices on-site and uploaded to the diagnostic system. The doctor then makes a diagnosis and prescribes for the patient online. A few minutes later, the prescription is printed out and can be used to buy drugs at the consulting facility or another drug store. This outpatient service is in use in Guangdong province, 

As a teaching hospital of higher medical schools in Guangdong Province, a research base for postdoctoral mobile stations of Sun Yat-sen University, a non-directly affiliated hospital of Southern Medical University, and the first Wu Jieping Fund minimally invasive surgery training center in the country, there are 9 doctoral tutors and master tutors in our hospital There are 75 members, including 30 chairman and deputy directors of the National and Provincial Societies, and more than 200 doctoral and master students are enrolled in Southern Medical University. More than 300 full professors and associate professors have passed on to the medical profession; more than 2,000 white-dressed angels, Mu Chunfeng and Fangfei.

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References
1.The Second People's Hospital of Guangdong Province
Internet hospital of Guangdong province: making quality resources from top-level hospitals available widely. April 8, 2015 (in Chinese).

http://www.gd2h.com/news/yydt/a_101582.html








JMIR - Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study | Gong | Journal of Medical Internet Research:

Implementing Telehealth in Your Practice: COVID-19 Emergency : CMA

Telehealth continues to deliver value in fighting the COVID-19 pandemic by allowing physicians to see patients safely and limit the spread of the virus. Additionally, federal and state waivers, guidance and directives now enable physicians to get reimbursed fairly for telehealth visits, practices.    

TELEHEALTH was struggling to become a routine feature of medical care only a month ago. Flash forward to today.  The state of telehealth has changed immeasurably. How did that occur?  In the past telehealth struggled to survive due to reimbursement issues with payers and medicare.

COVID 19 pandemic happened in early January in the United States.  Medical facilities, emergency rooms, and hospitals quickly became overrun, along with shortages in PPE and sanitizers.  In several days stores were depleted of paper goods, sanitizers, and other disinfectants. Even today 3 months later store shelves lack many paper goods and sanitizers.

Long waits occur for ordering masks (N 95) online with delivery dates given as mid-May 2020. The situation changes from day to day and even hourly. The President declared a national emergency in order to source masks from suppliers, distributors, and a national stockpile. Promises have been given and promises were broken. Despite denials, politics have played a role.  Conflicting opinions from supposedly reliable sources add to the confusion.

Governors and the President ordered a national lockdown and shelter in the home to prevent further spread of the Covid infection.

Fortunately, despite telehealth's barriers, the infrastructure was already in place with many resources readily available. This is one of the rare occasions when technology was ahead of the need.

Many medical practices have no or little experience in telehealth.  The California Medical Association developed a protocol and training module for physicians in California.

CMA Physician Services has also updated its telehealth implementation webpage with additional guidance.  

Telehealth Implementation

Covid 19 Telehealth Toolkit

Covid 19 Resources

COVID-19: Frequently Asked Questions








Implementing Telehealth in Your Practice: COVID-19 Emergency: CMA

Stock up on these 9 healthy foods to boost your immune system during coronavirus

When will it end?  By now we have been couped up (isolation) for many weeks as we wait for the Covid 19 curve to flatten out.  You are most likely tired of the routine diet you have been eating.  And because you are unemployed (unless you are an essential worker) your budget has been destroyed. For those of you who are working, exposure to Covid 19 means your immune system needs to be maximized.  Exercise and nutrition are key components to dealing with stress.

As cases of coronavirus continue to rise, taking daily precautions such as washing your hands, social distancing, exercising and getting enough sleep is key to lowering the risk of infection.

But maintaining a healthy diet to help boost your immune system may also give you an edge. It’s important to note that no research has been done on foods that help fight against COVID-19 specifically.

However, previous studies have found that eating certain foods can improve your health and strengthen your body’s ability to fight other invasive viruses.

Here are some recommendations. 

Here are nine expert-approved foods to stock up on during your next grocery store trip, along with creative ideas on how to add them to your diet:

1. Red bell peppers
Red bell peppers reign supreme when it comes to fruits and vegetables high in vitamin C. According to the U.S. Department of Agriculture, one cup of chopped red bell peppers contains about 211% of your daily value of vitamin C. That’s about twice more than an orange (106%).

A 2017 study published in the National Institutes of Health found that vitamin C contributes to immune defense by supporting a variety of cell functions and can lower the risk of respiratory infections. It can also help the growth and repair of tissues in your body.

“Daily intake of vitamin C is essential for good health because our bodies don’t produce it naturally,” Dr. Seema Sarin, an internal medicine physician at EHE Health, tells CNBC Make It.

She suggests slicing one up and eating it raw with hummus as a crunchy snack or mixing some into your salad. If you prefer them cooked, throw a handful in a pan for a quick stir-fry.

2. Broccoli
Broccoli is also rich in vitamin C. Just half a cup contains 43% of your daily value of vitamin C, according to the NIH.

“Broccoli is packed with phytochemicals and antioxidants that support our immune system,” says Sarin. It also contains vitamin E, an antioxidant that can help fight off bacteria and viruses.

According to the Dietary Guidelines for Americans, vitamin C is one nutrient Americans aren’t getting enough of in their diet, so finding simple ways to add it in is crucial.

“To get the most out of this powerhouse vegetable, eat it raw or just slightly cooked,” says Sarin. “I love sauteing broccoli with garlic and Parmesan, or stir-frying with bell peppers, ginger, garlic and mushrooms.”

3. Chickpeas
Chickpeas contain a lot of protein, an essential nutrient made of amino acids that help grow and repair the body’s tissues. It’s also involved in synthesizing and maintaining enzymes to keep our systems functioning properly, according to the Academy of Nutrition and Dietetics.

“Chickpeas are also packed with zinc, which helps the immune system control and regulate immune responses,” Emily Wunder, a dietitian and founder of the nutritious recipes site Healthier Taste, tells CNBC Make It.

Roasted chickpeas are great as a quick great snack or salad topper. Make sure they’re completely dry before roasting. Then add a few tablespoons of oil (vegetable, canola or grapeseed oil all work well) and bake at 400 degrees Fahrenheit, stirring halfway through until they’re crispy.

For a nice kick, Wunder suggests adding some salt and paprika. If you’re using canned chickpeas, she says you’ll want to rinse them thoroughly to cut down on sodium content.

4. Strawberries
Wunder enjoys half a cup of strawberries to get 50% of her vitamin C needs for the day.

“Vitamin C is great for strengthening your immune system,” she says because it can help protect cells from damage caused by free radicals that we’re often exposed to in the environment.

Wunder recommends adding chopped strawberries to yogurt, oatmeal or on top of whole-wheat toast with peanut butter. “Of course, they go well with smoothies, too,” she says.

5. Garlic
“Not only is garlic full of flavor, but it’s packed with health benefits such as lowering blood pressure and reducing the risk of heart disease,” according to Sarin. “Garlic’s immunity-boosting abilities come from its heavy concentration of sulfur-containing compounds, which can help fight off some infections.”

Garlic has been shown in the past to help ward off the common cold. In a 2001 study published in Advances in Therapy, participants who took garlic supplements were less likely to catch a cold. And those who did get infected recovered faster than participants in the placebo group.

It’s an easy vegetable to work into your diet, says Sarin. You can add to it anything — from pasta sauce and salad dressings to soups and stir-fry dishes. She suggests aiming to consume two to three cloves per day.

6. Mushrooms
“While sun exposure is the best source of vitamin D, it can also be provided by some foods, including mushrooms,” says Wunder.

A 2018 review of mushrooms as a vitamin D source found that the “sunshine vitamin” can help enhance the absorption of calcium, which is good for bone health and may also protect against some cancers and respiratory diseases.

Mushrooms are great as a side dish or appetizer. Wunder recommends roasting them at about 350 degrees Fahrenheit, using one to two tablespoons of oil, minced garlic and a dash of salt and pepper. For something more flavorful, bake button mushrooms stuffed with cheese, onion and artichoke hearts.

7. Spinach
“Spinach is rich in vitamin C and full of antioxidants that help shield our immune cells from environmental damage,” says Sarin. “Plus, it has beta carotene, which is the main dietary source of vitamin A — an essential component of proper immune function.”

Like broccoli, it’s best to consume spinach raw or slightly cooked. To incorporate more spinach into your diet, Sarin suggests blending it in a smoothie, cooking it with your morning eggs or, as an easy side dish, lightly sauteing with garlic.

8. Yogurt
“Yogurt is a great source of probiotics, which are good bacteria that can help promote a healthy gut and immune system,” says Sarin. Recent studies have also found probiotics to be effective for fighting the common cold and influenza-like respiratory infections.

Sarin recommends choosing plain yogurt — rather than anything too flavored or sweetened — and topping it with fruit and honey. “Or, you can add it to your favorite post-workout smoothie,” she says.

Those on a dairy-free diet can still benefit from almond-milk and coconut-milk yogurt options.

9. Sunflower seeds
“Sunflower seeds are high in vitamin E, which works as an antioxidant and helps boosts the immune system,” says Wunder.

Small but mighty, just one ounce of dry-roasted sunflower seeds can give you 49% of your daily value of vitamin E, according to the NIH.

Line a baking pan with parchment paper and roast unshelled sunflower seeds at 300 degrees Fahrenheit until they’re lightly browned. Then add the seeds to your salad or toss them with roasted vegetables. You can also use raw seeds in place of pine nuts for some homemade pesto.

Brittany Anas is a health and nutrition reporter. She has written for HealthDay, Women’s Health and The Denver Post. Follow her on Twitter @BrittanyAnas.




Stock up on these 9 healthy foods to boost your immune system during coronavirus

The COVID-19 vaccine development landscape-The Perfect Storm

Covid Viral Particles

Discover the world’s best science and medicine

COVID 19 provided the fertile ground for a singularity of events and technology.  Covid19 will have a long-lasting effect on the world. Considering it is one of the simplest forms of life it's impact is as great as a world war, and it will require a worldwide "Marshall Plan"

The effects of the pandemic have resulted in less pollution, due to decreased carbon emissions from motor vehicles. Airplane travel has decreased by over 90%, non-essential businesses have closed. Unemployment has soared suddenly within a two week period.  

This is the first pandemic of a global nature, far exceeding that of SARS, MERS, and H1N1 during the last two decades.  It comes at a time where the internet and health information technology has matured.  Telehealth has increased accessibility and allowed social distancing to occur, removing another infectious route in the clinic and/or hospitals.

There is no industry untouched by this pandemic.  It has catalyzed the use of modern technology, modeling, and algorithms, to follow and predict outbreaks.  The world has never been so connected, allowing an almost synchronous exchange of information around the world. An epidemic of infectious disease at far distant points on Earth are instantaneously announced, not only by official sources such as the World Health Organization and Social media platforms such as Facebook, Twitter, and Instagram. We have discovered public health organizations have become outmoded during the last decade.  The learning curve is steep and necessity is the mother of invention.

We see how important supply logistics and communication are essential ingredients for dealing with shortages of critical medical equipment such as facial masks, gowns, gloves, ventilators, sanitizers, and ordinary hospital supplies.

Makeshift Ventilator for Shortages of Ventilators

1. 
   

The COVID-19 vaccine development landscape:

Free AI software helps find COVID-19 in chest X-rays

Dutch companies are using a free AI tool to help hospitals generate heatmaps of COVID-19 seen in X-rays. (Delft Imaging)

Two Dutch companies are providing artificial intelligence (AI) software free of charge to hospitals to help triage COVID-19 cases by highlighting affected lung tissue in chest X-ray images.

The companies see the tool as especially helpful in places where healthcare resources are limited and where X-rays are available, but CT scans are not.

The software tool, called CAD4COVID, builds on an existing tool certified by the Dutch Ministry of Health called CAD4TB that has been used in more than 40 countries with 6 million people to screen for tuberculosis, according to the joint companies involved, Thirona and Delft Imaging.

Normally, COVID-19 has been detected with a CT scan and an RT-PCR test, but since resources are limited in many areas, X-rays can be a useful tool to provide first-line triage before further testing, the companies said.

Hospitals can register on a Delft-sponsored website to learn more about CAD4COVID and gain access to the tool. The website includes a liability clause and notes that CAD4COVID is not yet certified but has been submitted to the Dutch Ministry of Health. CAD4COVID has been developed to support the COVID-19 crisis and is not intended as a commercial product, according to a company FAQ.

The companies noted that CAD4COVID will be continuously improved and optimized.

CAD4COVID works by generating a score of between 1 to 100 to indicate the extent of COVID-19-related abnormalities found in an X-ray and then displaying the abnormalities through a heatmap and quantifying the percentage of the lung that is affected. 

The FAQ says that the tool processes chest X-ray images both from CR and DR X-ray in DICOM format.

In the first phase, CAD4COVID is available as a cloud-based solution and users will receive a unique account for their facility which provides access to a CAD4COVID viewer. The companies said that they will not use a hospital’s data for product development purposes without further permission.

Guido Geerts, the CEO of both Delft Imaging and Thirona, said that CAD4COVID will be especially useful in areas where the virus is active and care resources are low. “Our breadth of experience in such settings has made us very concerned about the implications that COVID-19 can have on countries where the healthcare infrastructure is already under pressure,” he said in a statement. “Many of the measures implemented across Europe and the U.S. will be difficult to replicate in Africa.”  CAD4COVID is available for free “to have a big impact, quickly,” he added.




Free AI software helps find COVID-19 in chest X-rays | FierceElectronics:

Covid 19 and Technology

Bare Bones Bag-Mask Ventilator

While government orders for social distancing and travel restrictions are in place to mitigate the spread of coronavirus, the development and implementation of technology to produce critical medical supplies is becoming crucial as overcrowded hospitals face shortages of ventilators and masks. In addition, technology is driving efforts to detect the presence of COVID-19 in patients and in biomarkers that could signal the presence of the disease in specific geographic regions.

But more than technology is needed. Making sure the ventilators work properly is important, and so is the presence of a strong supply chain to ensure supplies get to critical locations in a timely manner.

Because ventilators serve a critical patient need, ensuring they work properly is of utmost importance. One company playing a role is National Instruments, which makes automated testing and measurement systems to measure an array of devices. As no two ventilator models are alike, National faces the daunting challenge of testing ventilators with different shapes, features, etc. National is partnering with a number of companies in their testing efforts.

The urgency of producing ventilators has received a strong response from crowdsourced efforts and universities. Some of the current university efforts involve researchers from MIT, the University of Minnesota, and Vanderbilt University. All are based on advancing the manually bag-operated valve mask, known as a BVM or Ambu-bag.

Advanced technology, such as robots, is also being used to expedite COVID-19 testing. At the University of California at Berkeley, a pop-up diagnostic lab has been set up that uses a liquid handling robot able to process more than 1,000 patient samples daily. The lab is initially handling the UC Berkeley community but could expand its efforts to the greater East Bay area.

Artificial intelligence, not surprisingly, is also getting into the act. Two Dutch companies are providing artificial intelligence (AI) software free of charge to hospitals to help triage COVID-19 cases by highlighting affected lung tissue in chest X-ray images. The software tool, called CAD4COVID, builds on an existing tool certified by the Dutch Ministry of Health called CAD4TB that has been used in more than 40 countries with 6 million people to screen for tuberculosis, according to the joint companies involved, Thirona and Delft Imaging.

Detecting signs of coronavirus before it can spread will be the key to controlling future outbreaks. Researchers from Cranfield University in the UK are using paper-based kits to test wastewater for the presence of biomarkers in urine and feces samples, that could determine if there are carriers for COVID-19 present.

A team at the University of Minnesota is pursuing a design, called the Coventor, based on a bag-valve-mask that uses an electric motor that turns a crank that pushes a piston up and down. Two weeks ago, a prototype proved successful in a trial run.

Vanderbilt University’s design similarly involves an Ambu-bag, retrofitted with a mechanism to apply the necessary squeezing action. The first prototype consisted of nylon webbing wrapped around an Ambu-bag attached to the crank arm of a windshield wiper motor to apply the repetitive squeezing force

In all three cases, the basic engineering challenge is to take a low-cost design and figure out an economical way to eliminate the need for an operator.

But that’s not the end of the story: A low-cost ventilator will ultimately need specific performance characteristics and features—the very blueprint of any product design—to be safely used in a clinical setting. And determining what those are will require the practical, real-world experience and medical know-how of doctors.

To that end, the three teams consist of a mix of engineers and doctors, bringing together the best technical and medical expertise to bear on the issue.  

MIT Mechanical Engineering Professor Alexander Slocum, one of the authors of the MIT paper on a low-cost mechanical ventilator, stressed that no engineering team can come up with a low-cost ventilator design without specific performance requirements (other than cost) and be effective. “Which is why we work with doctors on the problem and where we post [to the website MIT E-Vent] as we learn,” he noted in an email response.

From that learning is emerging a more detailed set of specifications, which the team is sharing with others who may be seeking to manufacture a low-cost emergency ventilator.

For example, the website states that, “Any low-cost ventilator system must take great care regarding providing clinicians with the ability to closely control and monitor tidal volume, inspiratory pressure, bpm (breaths per minute), and I/E ratio, and be able to provide additional support in the form of PEEP, PIP monitoring, filtration, and adaptation to individual patient parameters. We recognize and would like to highlight for anyone seeking to manufacture a low-cost emergency ventilator, that failing to properly consider these factors can result in serious long-term injury or death.”

In a press release on Vanderbilt University’s website, Robert Webster, Professor of Mechanical Engineering, described why his colleagues added sensors and controls to the design. “This was the result of a lot of conversations with doctors where it became clear that a pressure sensor with an alarm on it for too-high or too-low pressure was essential to the design,” noted Webster. “This is something we would not have known without having many Vanderbilt physicians involved in the project.”

The teams anticipate it will be an iterative process and the concepts will evolve, as doctor’s feedback from early tests is incorporated into the designs.

Many engineers with specific areas of expertise may be interested and wondering how they can contribute to these efforts. Slocumb offered some very good advice: “Stay isolated and do not spread it. And when you see a design on-line, offer constructive peer review.“

What trade-offs to make in a low-cost ventilator design?

In the wake of a growing number of COVID-19 hospitalizations, health care facilities will be facing a critical shortage of ventilators. In response, some of the world’s most gifted, competent engineers at MIT, the University of Minnesota, and Vanderbilt University are pursuing the development of open-source, low-cost ventilators that can be brought to market quickly. The idea is to make the designs available to the public so that anyone can build them.

In essence, the concept for the designs came from a common starting point: Take a simple design—a manually-operated bag-valve-mask (known as a BVM or Ambu-bag) and figure out a way to automate it.

MIT’s team, called MIT E-Vent, is using as its reference a design detailed in a 2010 paper, presented at the Design of Medical Devices Conference, titled “Design and Prototyping of a Low-cost Portable Mechanical Ventilator.” The low-cost design is based on a conventional bag-valve-mask, employing a mechanical cam arm to eliminate the need for a manual operator.

FORD and General Motors are also converting production to building ventilators to assist patients with acute respiratory distress resulting from COVID19 infection.

Workers are beginning to produce life-saving ventilators at Michigan plants that normally make cars and trucks. This will take several weeks to design and manufacture them in volume.

While full production won’t begin until May, the many thousands of ventilators they make will be useful then and in later months should a COVID-19 resurgence occur in the fall or later in 2021 before a vaccine is ready and widely used.

 “We’re used to building big automotive products but scaling to produce a small ventilator requires different sourcing of components and capabilities,” Adrian Price, Ford’s director of global core engineering, said in an interview with CBS This Morning. 

“There’s quite a bit that goes into making a design that is currently produced at the rate of two a day and scaling that to over 7,000 a week,” he added.

GM is bringing back hundreds of workers to produce ventilators next week and will be imposing safety guidelines that include distancing between workers, the periodic taking of temperature and scrubbing down work areas between shifts, according to the CBS report.

The two companies together are enlisting up to 1,500 workers to make ventilators, while Ford wants to produce 50,000 by July 4 and GM wants to build 200,000 overall, according to The Washington Post.

Getting fully functioning machines ready for use that are tested and reliable will be part of the process.  Some ventilators are built to operate only for short periods of time, pumping air or oxygen into a patient’s lungs, while others must pump for days.  There can be an array of electronics for controlling alarms and fail-safes, as well as redundancy.  Testing of the machines will typically take a few minutes, looking at plastic and metal parts but also assessing how well a machine responds when in use, even when a patient coughs into a tube that is connected to the device, according to engineers.  The engineering feat of converting from making vehicles to ventilators is complex, not only because of the technology involved. Both cars and ventilators share electronics and metal and plastic parts that need to be assembled, but there are the added challenges of building thousands of medical devices rapidly with high accuracy and of keeping workers safe while they maintain personal distancing on an assembly line. Some ventilators are elegantly designed and will take more time to produce in large numbers, and they may not meet the peak demand. Others are simple, not complex and designed to work in a third world country where there is no electricity. 

Bag-Mask Ventilator with Enclosure and Intubation

Simple Bag-Mask Ventilator

The researchers noted that live SARS-CoV-2 can be isolated from the feces and urine of infected people, and the virus can typically survive for up to several days in an appropriate environment after exiting the human body. 

 

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