I don’t want to be intubated.

That was my main thought a few weeks ago as I lay in bed at home, having trouble breathing and watching my pulse oximeter show that my blood oxygen was under 93% when it should have been over 95%.

I had just tested positive for Covid-19 and wanted to stay out of the hospital completely, or at least for as long as I could. Being short of breath meant I could develop hypoxia — too little oxygen in my bloodstream — which would mean I’d need to go to the hospital, something I wanted to avoid because it would increase my chances of being intubated and put on a ventilator.

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The thought of being put on a ventilator frightened me, since nearly 90% of Covid-19 patients in the New York City area who were put on ventilators died.

Because I had been short of breath, exhausted, and feeling a tightness in my chest before testing positive for Covid-19, my father sent me a continuous positive airway pressure machine, also known as a CPAP, to help me breathe. This device is commonly used to treat obstructive sleep apnea.

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Using CPAP requires wearing a mask that covers the nose and mouth. It is connected to a blower that pushes air through a hose and into the mask. Computer logic in the blower sends puffs of air into the mask timed to the user’s breathing patterns. The extra air pressure in the mask keeps the airway open and allows the user to breathe. It’s different in that way from a ventilator, which breathes for you.

I put on the mask, turned on the machine, and watched as my blood oxygen level rose to a manageable level, and helped keep it there over the next few days. I was able to work every day with intermittent use of the CPAP machine, and within a week was back on my feet.

I’m not alone in thinking that CPAP machines can play roles in fighting Covid-19. Emergency physicians I’ve spoken with directly, and others I have seen in the news, such as Colleen Smith from Elmhurst Hospital in Queens, N.Y., say that CPAP machines can be used for some patients in place of ventilators, providing all of the breathing support that’s needed and freeing up scarce ventilators for sicker people. For others, they could act as a bridge before crossing over to a ventilator. For patients coming off ventilators, CPAP machines could initially help regulate their breathing.

One drawback to using CPAP machines or their cousins, bilevel positive airway pressure (BiPAP) machines, at home or in the hospital is the cost of these devices. ResMed, the leading manufacturer of CPAP and BiPAP machines, charges approximately $1,500 for them. While that’s less than the cost of a ventilator, it is too much for individuals, much less for medical systems in crisis.

My father, an inventor and inveterate tinkerer, predicted the value of CPAP in treating patients with Covid-19 weeks before sending me one. With some experimentation, he came up with the prototype below, which could be built for approximately $200 apiece.

But what we found when we began to procure the most basic parts needed for production was that, due to outsourcing, none of the components were currently being made in the U.S., including basic items such as hoses, masks, and blowers. Outsourcing to China had led China to outsource to Vietnam, and so on. Despite the free-trade mantra that outsourcing to lower-wage countries leads to lower-cost products, there has been a persistent creep in the availability and cost of almost everything that Americans need to manufacture our own products.

This wasn’t always the case. Growing up in Cuyahoga Falls, Ohio, my father worked for a company he started in his early 20s called Polymerics, for which he invented PolyGel, a common component in rubber compounds. Polymerics sold to U.S. companies different types of rubber and plastic that were needed to build anything ranging from windshield wipers to medical devices and engine mounts. While the company still exists and is still family-owned, the supply chain it depends on has become so much more complex that today we cannot find a single plastic made in the U.S. that we could use to build a low-cost CPAP device.

This dearth applies to the CPAP mask and blower. The mask involves run-of-the-mill injection molding with either additive manufacturing (3D printing) or craftsmanship machining. The blower is the heart of the CPAP. It inflates and deflates as the patient inhales and exhales. Its parts are similar to a computer fan, and those parts should be in the American arsenal to battle against pathogens. Yet they almost exclusively are made in China.

The upshot is that many individuals and hospitals in need of alternatives to highly invasive and potentially harmful ventilators facing a supply chain that makes it impossible to quickly produce them in this time of need.

What is at the root of this supply chain crisis? It could be our complacency, or unnecessary complexity, or a depletion of our greatest natural resource — expertise. The inability to get parts to make the products that we need in a timely fashion is felt across industries, but it is most relevant now to the medical industry.

My call to action is not to speed up shipments of the parts needed to build medical equipment like CPAP machines from China and Vietnam and beyond. It is to create businesses in the U.S. with the capabilities to quickly and easily build the parts we need to improve the health of Americans.

Matthew Putman, Ph.D., is the cofounder and CEO of Nanotronics, a science technology company that creates AI platforms and advanced inspection tools for manufacturing.

  • You’re right Mathew, you’re far from alone in thinking CPAP machines help patients infected with the coronavirus. Josh Farkas, a pulmonary professor from the University of Vermont, published an article detailing why CPAP can prevent patients from needing to go to the hospitals.

    https://emcrit.org/pulmcrit/cpap-covid/

    They do have one other important drawback, besides price, that was not mentioned on your article. CPAP machines will inevitably aerosolize the virus. Which is probably why the mainstream media has not talked about this at-home solution as often and as loudly as I think they should have.

    Because of this aerosolization of the virus, it’s important that people infected with the virus that do use CPAP machines the moment their oxygen levels drop, do so in a room that’s not shared with anyone else.

  • Isn’t one of the reasons for intertwining of our economies an outgrowth of two world wars, the thinking being that interdependency made wars less likely? That doesn’t necessarily contradict your point, but may be a worthy part of the cost benefit analysis as we devise solutions to the problem.

    • Thanks for pointing out Mark. I completely agree and think trade has made the world safer in most respects. I want to continue to do business with other countries, and think that it will be valuable for peaceful and productive relations. This is only a call to be able to have a distributed enough system that we can make what we need when we need it. It is not anti-trade, but rather figuring out a survival guide for building for the present. Somehow if we can figure out how to do that, we can also realize that it is possible to invent faster and more independently.

    • That’s what we all thought Mark. Francis Fukuyama in 1989 penned his famous ‘end of history’ thesis and since many have been convinced that trade and liberalization of markets would lead to never ending peace. History tells us otherwise. China has been gearing up for years and now many nations are entirely reliant upon them for trade. China only last week threatened Australia to end trade in certain sectors for their ongoing criticism of their regime. We need to become more self reliant as nation states particularly in manufacturing. Otherwise we make ourselves vulnerable to a nation that has no regard for the rule of law or human rights.

  • Any manufacturer in USA is subject to far worse than minimum wage laws: attornies hone in on every slight or injury and EPA measuring micro pollution.
    Just building a safe facility is costly and slow, thanks to zoning, EPA, insurance. Too many separate interests preying upon eachother, w/attys at heart of problem.

  • This is not accurate-> “ Computer logic in the blower sends puffs of air into the mask timed to the user’s breathing patterns.”
    In reality it’s constant air pressure, not puffs of air. Just clarifying.

  • What is the big deal here? There are tens and thousands of OSA (Obstructive Sleep Apnea) patients out there relying on CPAP and BiPAP machines to get a good night’s sleep these machines are made mostly by by Phillips and a Respironics and the two companies are also makes ventillators. Regardless of the parts sources or manu0facturing sites, there is absolutely anf simply no good reason to confine sourcing them to within the US. It makes no financial reason at all.

    Let’s don’t forget Apple has major issues with iPhone parts firm China and even shut down all sales of the final product for about 8 weeks in February and March. But they reopened the now after the parts suplirketscbecame online again.

    This author comes across to me as an alarmist for a non-existing crisis and spreading fake news!

  • I think the CPAP price quoted is far too high. I bought one online to take on vacation for about $300. It works as well as the one I regularly use, which has more bells and whistles, which cost $500 to $600. New York state has purchased 3,000 of the machines.

  • US healthcare supply chain is broken. We need about dozen wo/men with long white hair and beards to be thinking about these issues. I don’t think anyone is concerned.

  • Innovative and economic life saving alternative, CPAP, for treating life threatening breathing difficulties associated with COVID-19. This device is a trifecta with an organic opportunity for industry and job development in the US during this economic crisis. I

  • All the supply chain issues and lack of medical supplies points to only one fundamental issue–the minimum wage. Because of minimum wage requirement, all the wealth from the US was transferred to China over the past few decades. When the world needed US support and help, US could not, cannot keep up with our own supply and demand.

    • Nonsense. The minimum wage was created in 1934. From the late 1940s-early 1970s was the period of strongest American dominance in global manufacturing and the global economy.

      The kind of outsourcing discussed in this opinion piece emerged in the 1970s and early 1980s; and accelerated in the 21st century (a period in which the minimum wage declined significantly in real [inflation adjusted] terms). So in your thinking, this law is the problem, when it took about 50 years to express itself as a problem, and in that intervening span of many decades we had the best economy we’ve ever had?

      Nonsense. One has nothing to do with the other.

    • I don’t want to be rude or offend you or anyone, but thank you for pointing out about the minimum wage. It perfectly explains my theory, 50 years will do it. There is no other reason to outsource except cheap labor ( minimum wage). US could have kept all the wealth in the country, that went away to China along with outsourcing.

  • We’re not going to need to go down a manufacturing rabbit hole. My call to action is not go down the mfg rabbit hole, but to do follow the example of brave nurses like the ones we work with at MakerHealth to DIY them . The Spanish, for instance, solved this a month ago before while everyone was just yelling for ventilators. This is all solvable, we just have to look beyond our borders for examples.

    • Its not just the equipment that is available. Records at-NUMEROUS FEDERAL AGENCIES-prove that I am allergic to generic medicine and can take only Brand Name. Yet the military primary doctor and the military specialist refused to consider these records adequate and neither of them were able to determine the equivalent dosage for my three Anti Seizure medications. Then after both doctors told me to see a specialist within the network; they backdated the referral and tried to insist that I had been told to go only once-not true. Over fifteen months later Tricare Headquarters was questioning the handling of this situation-after the two involved doctors protested against me. Within less than a month I had the situation resolved by Tricare Headquarters’ these two doctors were useless-I would have been dead if I waited for them. Staff and management are guilty of-REPEATED NEGLIGENCE. Our active duty military and veterans their dependants deserve-MUCH BETTER. Linda Ennis-levcic@verizon.net

    • The Spanish had no economy to begin with, they were already a jobless, bankrupt, socialist culture. You can’t compare the US, to tiny derilick countries like that. Most Europeans are used to sitting around and collecting checks from the government. Ending self-sufficiency, such as manufacturing, leads to a broken welfare State, just what,criminals,need, to thrive. Taiwan, s Korea, Japan have strong manufacturing economies, and handled this virus, without breaking a sweat.

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