Local ventilators need of the hour to prepare for COVID-19

As the number of coronavirus cases rises in India, the focus has shifted to the country’s weak health system and the massive shortage of ventilators it is likely to face if infection rates continue to increase.

According to estimates put out by Johns Hopkins University, Center for Disease Dynamics, Economics and Policy, and Princeton University, the demand for ventilators in India is expected to surge to 1 million by July 2020, while the availability is between 30,000 and 50,000. Going by the current rates, more than 400 million Indians are likely to be infected by July. At the peak, 700,000 to 1,200,000 people are likely to need ICU care.

“We are not yet ready with the number of ventilators required to tackle a pandemic,” said Dr H Sudarshan Ballal, chairman of Manipal Health Enterprises Private Ltd. “It is important for us to contain the virus and break the transmission chain in the next two weeks so that we do not reach a situation where ventilators are needed in large numbers.”

Dealing with COVID-19 starts with prevention. “We not only need to prevent infection but also delay and decrease the number of infected patients going into intensive care. That’s a challenge often overlooked. Ventilator care comes at the end of the spectrum,” said Dr Dhruva Chaudhry, President of Mumbai-based Indian Society of Critical Care Medicine and COVID-19 State Nodal Officer for Haryana.

He pointed that 80 of 100 COVID-19 patients will recover and be able to take care of themselves. “Of the remaining 20 patients, 50% may need ventilator and 50% may need simple oxygen therapy, which implies that out of 100 patients only 10 may need ventilator support. The entire exercise at present is not get into this last phase,” he said.

Stating that India is fully dependent on import of ventilators, Dr BS Ajaikumar, Chairman & CEO of Healthcare Global Enterprises, said: “While a patient needs ventilator only in the last stage, those with underlying lung conditions and smokers who get infected with coronavirus may require it early. Going by the experience of Italy and the US, we must be prepared for any eventuality.”

Most ventilators in India are either imported or assembled using imported components. To reduce the number of patients who will need intensive care and ventilators, those severely infected must not be treated alongside people with symptoms in the preliminary stages, he explained.

Renowned cardiac surgeon and Narayana Health chairman Dr. Devi Prasad Shetty said: “It is vital for the government to direct local manufacturers to mass produce ventilators so that we do not face a situation like Italy where people died for want of treatment.”

Ventilator manufacturers across the country indicate their inability to ramp up production in such a short time with export restrictions on medical devices in major supplier countries. The possible solution is to produce basic ventilators using indigenous design and components.

Mysuru-based ventilator manufacturer Skanray Technologies has ramped up its capacities and plans to manufacture 100,000 ventilators in two months. The company’s founder Vishwaprasad Alva says he plans to share his design and certain critical components with other companies, which can manufacture ventilators quickly. The company is working with Niti Aayog, DRDO and the Karnataka government on design and supply of locally-sourced components. Skanray has production facilities in Karnataka, and in Italy, China and Brazil.

“I have upgraded my production line. I am certain we can deliver 100,000 ventilators in a few months with the help of Mahindra Technologies and Bharath Electronics, which will take up production of ventilators employing my specifications and material,” Alva said.

The main challenge for most manufacturers, however, is that components have to be imported from Europe and China, where the pandemic has restricted production. Ashok Patel, CEO and director of Vadodara-based Max Ventilators, said, “Ventilators are an amalgamation of a host of technologies and components sourced from various countries. Our ventilators have eight kinds of sensors, mostly produced in the US, Europe and Japan. Supplies have been hit in the past two months. India does not make even small components like resistors, capacitors and diodes, which we have to import.” His company has scaled up to 150-170 ventilators a month from around 70-80 a month. They now plan to produce 350 units a month, provided import channels open up.

“Big automobile companies have been urged to help us with funds or a proposal for a vendor development department. The government has assured us of faster customs clearances,” Patel said. “One of our ventilator models is made mostly of local components and its production can be ramped up to 500 units a month if doctors are keen to use it,” he added.

Agreeing that localisation of components and sharing of design can enhance production capacity, Vinit Acharya, MD of Ahmedabad-based ventilator manufacturer Life Line Biz, said, “This is a situation nobody could foresee. Around 40,000 ventilators are available in the market and 1,500 have been supplied by all vendors in the past fortnight. These are good numbers. But, if we reach a situation like Italy or China, we will need 10 times more.” His company makes 30-40 ventilators a month, and can ramp up to 300 a month if local components were available, he said.

At a press briefing in New Delhi on Friday, Lav Agarwal, Joint Secretary, Ministry of Health and Family Welfare, said that the government had asked one of its PSUs to supply 10,000 ventilators and has also asked Bharat Electronics Limited (BEL) to supply 30,000 ventilators in a month or two.

(M Raghuram contributed to this story from Mysuru)