By Sue Halpern
Alittle more than a week ago, Isaac Budmen heard that a coronavirus testing site was going to be set up in Syracuse, New York, not far from where he lives with his partner, Stephanie Keefe. The couple, who are both artists, own a company that makes 3-D printers. They knew that medical workers had a shortage of face shields, one kind of personal protective equipment (P.P.E.), and they wondered if they could help. On a recent Saturday evening, after a few hours of research, Budmen and Keefe designed and printed a face-shield prototype. It wasn’t very good, Budmen told me. They modified the design, adding sizes for different face shapes, making sure there would not be a space between the shield and the wearer’s forehead, where microbes might be able to reach the eyes, nose, or mouth. With their printers running all night, they figured they could make a total of fifty shields. The office of the Onondaga County executive asked them to make three hundred.
According to a survey released by the U.S. Conference of Mayors on Friday, about ninety-two per cent of the group’s members (two hundred and thirteen mayors, from forty-one states and Puerto Rico, representing forty-two million Americans) do not have enough testing kits or face masks for first responders and health-care workers; eighty-five per cent said that their hospitals do not have enough ventilators. The U.C.S.F. Health hospital system, in San Francisco, is running out of nasal swabs for testing, and a health-care system in Texas that serves a million people is in danger of shutting down testing sites because of a shortage of protective gear. In New York, where people are now waiting in long lines outside of emergency rooms and refrigerated trucks have been deployed as temporary morgues, Governor Andrew Cuomo asked the federal government to help the state get thirty thousand ventilators. But that help doesn’t appear to be coming anytime soon. In a recent interview on Fox News, Donald Trump said, “I don’t believe you need forty thousand or thirty thousand ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order thirty thousand
Across the United States, an ad-hoc corps of health-care workers, designers, engineers, and fabricators like Budmen and Keefe have stepped into the breach. Dr. Paul Biddinger, the chair of emergency preparedness at Massachusetts General Hospital, recently said, at a virtual town hall for the newly formed Massachusetts General Brigham Center for covid Innovation, that the situation requires “an Apollo 11 moonshot.” Dr. Gary Tearney, a pathologist and the co-director of the Center, said that the initiative was set up to marshal “the enormous outpouring of support” following the hospital’s recent public plea to anyone with 3-D printing and other prototyping capabilities, to make personal protective equipment for health-care workers. “We’re looking at designs and coördinating a way to print the most promising,” Tearney told me. “We have to make sure they are safe for providers and patients” while bypassing the standard, protracted, ways of vetting new equipment, he said. On a separate call, Dr. Reza Farivar, a neuroscientist at McGill University, likened the effort to the Apollo 13 mission, “you know, when they had to build a filtration system out of tubes, and so on.”
The New England Journal of Medicine recently predicted that the United States may need as many as a million ventilators, and estimates put the country’s current stock at no more than a hundred and sixty thousand. Some of these are non-functional, as Californians found out last week, when Los Angeles received a hundred and seventy broken ventilators from the federal emergency reserve. Farivar has put his brain research on hold to organize the Code Life Ventilator Challenge, a two-week competition to design a coronavirus-specific ventilator so simple that it can be built and deployed anywhere on the planet. The challenge comes with a hundred-and-forty-thousand-dollar prize from the Montreal General Hospital Foundation, and nearly seven hundred teams from all over the world have signed up to participate. “This is an all-hands-on-deck situation,” Farivar said. “All of us are anxious, but the antidote to anxiety is creativity.”
A similar competition, the CoVent challenge, created by a group of fourth-year anesthesiology residents at Massachusetts General Hospital, is just getting under way. “The ventilators that are used in the I.C.U. cost twenty to thirty thousand dollars and have millions of parts,” Dr. Richard Boyer, the founder and director of the challenge, told me. “We’re looking for something less sophisticated, that can keep someone alive.” These efforts join a number of global crowdsourced initiatives, like #ProjectOpenAir, in Portugal, Open Source Ventilator, in Ireland, and M.I.T.’s E-Vent project, in which participants are trying to create an emergency ventilator by mechanizing a manual resuscitation bag. For Boyer, who is just coming off a fourteen-day quarantine after being exposed to the coronavirus, the challenge is personal: he and the other anesthesiology residents are responsible for intubating patients and controlling their mechanical ventilators.
One of the people on the Center for covid Innovation call was Dan Baker, in Nashville. Baker is the global supply chain officer at Smile Direct Club, a company that makes “invisible” aligners. It turns out that a printed nylon his company uses can be employed to fabricate face shields. On Friday, Smile Direct Club shipped its first thousand face shields to a hospital in Boise, Idaho. Baker and his crew are also figuring out how to make N95-like filtration masks that snap together like Legos. “Our R. & D. and engineering team was in the lab all weekend,” Baker told me, “working like mad scientists, pulling designs off the Internet, making different things. We’re at the final stages of designing and testing to prove the efficacy of the design to enable multiple use, that they can be sterilized and used safely.” The mask is a Class II medical device which requires approval from the F.D.A. Once they get the go-ahead, he estimates that Smile Direct Club can crank out three thousand masks a day, repurposing thirty to sixty of the company’s industrial 3-D printers to do so.
Last week, shortly before the White House was set to announce a collaboration between General Motors and Ventec Life Systems to retool a car-parts factory to produce ventilators, Trump balked at its billion-dollar price tag. (He later invoked the Defense Production Act and ordered G.M. to make ventilators, though a G.M. spokesperson said that this directive did not change its production plans.) Retooling a 3-D printer, by contrast, is a matter of changing its software to design and model the item being produced. Industrial 3-D printers are now so sophisticated that they are used to make prosthetics, airplane parts, and hip replacements. “With 3-D printing, we can go from design to production within an hour,” Ramon Pastor, the acting president of 3-D printing and manufacturing at HP Inc., told me. “But in traditional manufacturing you have to work from a mold, and the mold has to be made first.”
Pastor, who lives and works in Barcelona, watched the virus rip through his country and ravage the medical community. HP has turned its research-and-development centers in Spain and the United States into factories for face masks, face shields, mask adjusters, nasal swabs, hands-free door openers, and respirator parts. And HP has mobilized a network of its customers, including Smile Direct Club, to do the same, sending out designs that they can print locally, at scale. “We’ve realized that in moments of crisis, having digital factories and a distributed supply chain is a good thing,” Pastor said. HP is also collaborating with researchers to make splitters so that existing ventilators can be shared, and participating in the global effort to design and manufacture field ventilators. Pastor had just received word that the F.D.A. had approved an exemption for 3-D-printed nasal-testing swabs, and expected that H.P. would soon be shipping a million of them a week.
Formlabs, a 3-D-printing company whose printers are used by hospitals to make pre-operative models, are ramping up the production of nasal swabs to fast-track tests. Gaurav Manchanda, Formlabs’ Director of Healthcare, estimates that, between the company’s two hundred in-house 3-D printers and those of its customers, they will be able to produce up to a hundred thousand swabs a day at peak capacity. They will begin to be shipped to testing centers in New York and Florida this week. “It’s taken about two weeks to go from an idea to something we can offer patients,” Manchanda said.
As for Keefe and Budmen, after they produced the three hundred face shields for Onondaga County, they published their design on the Internet, and devoted their Web site to connecting those in need of P.P.E.—health-care workers, first responders, prison medical personnel—with those who can print them. A local film company is running the logistics. The couple’s fourteen industrial 3-D printers, each of which is able to produce one face shield an hour, are running day and night. So, it seems, are Budmen and Keefe. (The first time I spoke with Budmen, it was nearly midnight.) “It’s been a little overwhelming,” he said. “When we talk to people on the front lines, it’s hard not to take their urgency as our urgency, and their panic as our panic. At the same time, it’s amazing to see how many people are willing to give everything they have to help.”
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