Canadian ingenuity may save lives in Africa
If we have learned anything from this COVID- 19 pandemic, it’s that things that happen elsewhere in the world have the potential to affect us all. The global path of decimation wrought by COVID-19 has shown that there is no “them” and “us”; there is only the shared human experience of sickness and health, fear and loss. This is important to remember as the coronavirus makes its way to Africa, because Canadians are uniquely positioned to help out.
One particularly nasty aspect of COVID-19 is that it can interfere with the infected person’s ability to breathe. Since there is no cure, we are left with placing patients on ventilators to help them breathe.
As the number of people with COVID- 19 increased around the world, the fear of running out of ventilators rose sharply. Panicked, the United States and other countries enlisted non-medical companies to design and build tens of thousands of ventilators, while suspending the usual regulatory processes. Yet they ignored a basic truth: ventilators are not standalone devices. Each requires extensive infrastructure that includes high- pressure oxygen and air outlets, patient monitors, lots of electrical outlets, specialized drugs, intravenous pumps, around- the- clock nursing, respiratory therapists, doctors and other health professionals.
Intensive care units ( ICUS) are a collection of rooms that house this infrastructure. Using ventilators in other hospital settings is problematic. A recent article in the New England Journal of Medicine about the experience in New York hospitals bemoaned that, “The capacity of pressurized medical gas lines ( i. e., oxygen and air) and power supplies were limiting factors. In one perioperative area, for example, the power infrastructure was not sufficient to reliably run all the necessary critical care equipment.” And this was a perioperative area, where patients are cared for before or after surgery. One can imagine the unsuitability of an ordinary hospital room, especially in countries that lack medical infrastructure.
The realization that both ventilators and the infrastructure needed to run them might not be available is old hat to the military. In 2004, Tommy Eagles, a medic in the United States Marine Corps, asked Thornhill Medical Inc., an Ontario- based company (which one of us helped found) that was spunoff from Toronto’s University Health Network ( UHN), to try to combine the ventilator and the infrastructure needed to sustain it in one rugged, portable package. After six years, the result was a small, 17-kilogram life-support system that runs on batteries and concentrates oxygen from the air, rather than having it flow from a tank. During the current pandemic, the Canadian and Ontario governments quickly recognized the limitation of standalone ventilators and ordered more than 1,060 of these devices for use in our health-care system.
Even with our current stock of ventilators, Canadian hospitals will not be able to cope with more than a moderate surge in patients requiring life support. But that, too, is changing with the development of a pre-assembled mobile fleet of fully stocked critical care pods built into shipping containers, which are intended to absorb the spillover of infectious disease patients. These ICU pods were designed by the IDP Group, a multi-faceted group of companies in Ontario, and will be tested in the near future. If successful, they will be provided at cost to Third World countries. And it is clear that one of the places where they will be most needed is Africa.
That continent is home to 1.2 billion people, but has very few ventilators, or the infrastructure they require. For example, Kenya has 50 million people and 200 supported ventilators. Nigeria has 350 ventilators for 200 million people. For comparison, in the United States, there are 340 fully equipped ICU beds for every million people, with at least 50 per cent more ventilators in reserve. Despite the great need for ventilators, sending them without the infrastructure they require would be like sending bicycle frames without wheels.
Yet if we distributed two additional life- support systems to every existing ICU- enabled bed in Africa, it would immediately triple the continent’s high-end ICU capacity. The percentage of people saved will be small — even 1,000 ventilators divided among 1.2 billion people is a drop in the ocean — but the absolute number of lives saved could be large. Best of all, the newly installed critical care infrastructure would continue to save lives well after COVID-19 passes.
National Post Joseph A. Fisher, Laura Hawryluck and Ian Mcgilvray are staff physicians with the University Health Network in Toronto. Fisher is a founder of Thornhill Medical Inc., and Hawryluck and Mcgilvray are unpaid consultants for the portable ICU pods project.