Canada’s race to procure ventilators for COVID-19 patients in the early days of the pandemic had researchers, scientists, industry and a notable astrophysicist working “night and day” to design machines that could be quickly manufactured domestically.
Various efforts included a Montreal-based competition that drew global competitors and a group of scientists and engineers involving Queen’s University professor emeritus Art McDonald, co-winner of the 2015 Nobel Prize in physics.
McDonald said Cristiano Galbiati, a colleague and physics professor at Princeton University and an institute in Italy, contacted him from Milan during lockdowns in early 2020 to say the technology they had developed to detect dark matter could be adapted to produce a low-cost ventilator.
At the time, some countries were scrambling to get more ventilators, which pump oxygen through a tube in the windpipe and into the lungs of patients to help them breathe.
There were also fears about doctors having to decide which patients would be prioritized for scarce ventilators.
But months into the pandemic, they were learning ventilators were not always the best option, especially for elderly patients with chronic conditions. A dramatic drop in use of the machines occurred when vaccines became available, starting in mid-December 2020.
Still, by fall 2020 thousands of ventilators were set to be manufactured in response to multiple contracts that were awarded by the federal government in the spring. And while procurement is an essential part of emergency preparedness, some wonder if more effort instead should have been spent addressing what they consider a weakness in our health-care system _ that of staffing and space.
Public Services and Procurement Canada said the total cost of more than 27,000 ventilators Canada stockpiled was over $807 million, including $82.5 million for the Mechanical Ventilator Milano (MVM), designed by McDonald’s group.
Dr. Srinivas Murthy, a critical care and infectious diseases specialist in Vancouver, said that while Canada pushed to procure ventilators at a time when no one knew how COVID-19 would proceed, it takes people _ including doctors, nurses and respiratory therapists _ to staff intensive care units where the machines are used.
“We bought a lot of stuff, meaning the ventilators specifically, because that’s one of the things we thought we actually needed. But I think we acknowledged that it was mostly space and staff that were the main limitations with the health system, rather than the stuff,” he said.
“Without a doubt, I think (procurement) is part of any sort of readiness or preparedness infrastructure but without adequate staff it’s not really useful and we need to emphasize that human resources component more and more,” said Murthy, who is a also a clinical associate professor at the University of British Columbia.
From McDonald’s point of view, the surplus may still be a valuable asset. Although thousands of ventilators remain unused, the rush to manufacture the machines is an example of global collaboration during a time of need. Plus, even as the use of ventilators declined, the health community worried about the potential of a highly transmissible variant that also caused severe illness.
If that happens in the next pandemic, the surplus supply may be a valuable asset, McDonald suggested.
“We’re lucky things weren’t worse,” he said.
Shift from dark matter to ventilator
McDonald was working with a global group of scientists doing a large physics experiment involving a liquefied form of argon when they decided to harness their skills to design a cheap, easy-to-operate ventilator that uses a different type of gas – oxygen.
He said about half the group of about 450 scientists took on the ventilator design challenge proposed by his Italian colleague.
“We switched gears completely using our technical experience to produce something that was needed, and needed cheaply, with a small number of parts because parts were very difficult to get. We had a prototype running on the bench in 10 days,” McDonald said of developments in Italy.
It required fewer mechanical parts and valves than its traditional counterparts but could be used with intubated adults in an ICU, he said.
To join the effort to design, prototype and test the ventilator, McDonald tabbed scientists and engineers from Canadian Nuclear Laboratories, at Chalk River, Ont., the Sudbury Neutrino Observatory, or SNOLAB, the deep underground lab that focuses on the study of dark matter, TRIUMF, a physics lab at the University of British Columbia and the McDonald Institute, named after him, at Queen’s University.
A proposal for a further developed, made-in-Canada ventilator by McDonald’s team, along with proposals from others, had already been selected days before a March 2020 news conference in which Prime Minister Justin Trudeau spoke about procuring medical equipment.
Trudeau called for ventilators to be built domestically, “as many as possible, and as quickly as possible.”
The Italian government did not award a contract for the MVM, even though it was certified for use in Europe, McDonald said, adding the only large-scale production of the machine occurred in Canada.
A design McDonald’s’ group forwarded to Health Canada in June 2020 received emergency approval in September that year. The ventilator was being manufactured about a month later in Markham, Ont., and about 7,000 of the machines were shipped to the National Emergency Strategic Stockpile by February 2021, he said.
In the end, the vast majority of ventilators were not requested by provinces and territories because they were not needed.
Thousands of ventilators for the future
The Public Health Agency of Canada said about 24,500 of over 27,000 ventilators currently in the national stockpile were produced in Canada by five major manufacturers and most of them could be used for patients requiring ventilation for long periods.
Before the pandemic, the stockpile held about 500 ventilators, it said in a written statement.
“Based on the lessons learned through the COVID-19 pandemic, PHAC continues to work closely with provinces and territories and other partners to define needs and inform ongoing efforts to prepare for future public health emergencies.”
As part of its efforts to divest of surplus supplies, the government donated 539 ventilators to India, Pakistan and Nepal, the agency said, adding it worked with manufacturers to facilitate the training of local health-care clinicians and technicians as part of the support that was requested.
For McDonald, the quick actions of scientists, engineers and manufacturers wanting to make a difference will always stand out, as will the Zoom calls of 100 or more people who were “working night andday” to design and test prototypes.
“That capability exists. And we’re continually on the lookout for ways in which we can apply it for society’s benefit.”
All-out effort drew students to competition
Tanya Bennet, a PhD student in biomedical engineering at the University of British Columbia, remembers the sleep deprivation she and seven other students gladly endured as they joined a ventilator design competition launched by the Montreal General Hospital Foundation and the McGill University Health Centre.
“There were many nights when we were taking shifts in terms of sleeping and working,” said Bennet, a respiratory researcher whose team sprinted from one deadline to another for various facets of their design and consulted clinicians.
Supply challenges meant some parts, including valves, which control the amount of air and pressure in a ventilator, were not available.
“We were very lucky that one of the individuals in our group fancied himself a bit of a tinkerer,” Bennet said. “He had some machinery that would typically be found in a machine shop, just in his garage, so we were able to manufacture some things that definitely wouldn’t have been manufacturable in the classic household.”
Over three months, the UBC group created a design that was ultimately shelved because there was no need for more ventilators.
However, the experience prompted Bennet to switch from respiratory research to another field.
“I will be in medical device development, solving those clinical problems as they arise.”