Ventilators can be modified to help FOUR coronavirus patients breathe at the same time if the NHS is still critically short of the machines when the outbreak peaks, scientists say
- St John’s Medical Center in Detroit found success with method on fake lungs
- In theory it could work on four adults, although risk of infection may go up
- But scientists say if matter of life and death then the technique should be used
- Comes as NHS faces dire shortage of ventilators as it heads into outbreak’s peak
- Coronavirus symptoms: what are they and should you see a doctor?
Ventilators can be modified to treat multiple coronavirus patients at once if the NHS is still short of the machines when the outbreak peaks, research suggests.
A US-study used a single ventilator to help four adults breathe at the same time for 12 hours by connecting a series of plastic tubes to the device.
Scientists were able to split the flow of oxygen four ways and redirect it into lung simulators using cheap tubes that are readily available in all hospitals.
The method could be used as a last resort by frontline medics if health services are overrun by coronavirus patients whose lungs have failed, researchers say.
British experts have told MailOnline the method may carry a risk of cross infection, but in a life or death situation ‘there was no debate’ about whether to use it.
It comes as the UK hurtles towards a full-blown outbreak with the NHS still critically short of ventilators.
Dr Charlene Babcock from St John’s Hospital and Medical Center in Detroit demonstrates how to modify ventilators
She splits the flow of oxygen four ways and redirect it using cheap tubes that are readily available in all hospitals
The NHS currently has around 5,000 adult ventilators and 900 for children in critical care facilities.
It could need an additional 20,000 in a worst-case scenario, according to the Department of Health.
Prime Minister Boris Johnson has issued an appeal to vehicle manufacturers to switch their production lines and help produce the life-saving machines.
The coronavirus outbreak has so far killed more than 100 people in the UK and infected over 2,500, officially. But health chiefs are only currently testing patients in hospital.
Experts say the true number of cases is likely more than 80,000 because many are self-isolating at home and haven’t been tested.
The 2006 study, by St John’s Hospital and Medical Center in Detroit, investigated whether ventilators could be quickly modified in the event of a disaster.
A 2006 study used a single ventilator to help four adults breathe at the same time for 12 hours by connecting a series of plastic tubes to the device
What is a ventilator?
A machine that helps people breathe.
It puts oxygen directly into patients’ lungs and removes carbon dioxide from them.
Ventilators are used to help a person breathe if they have lung disease or another condition that makes breathing difficult.
They can also be used during and post-surgery.
A breathing tube connects the ventilator machine to your body.
One end of the tube is placed into the lung’s airways through your mouth or nose.
In some serious cases, the tube is connected directly to the windpipe through a small cut in the throat.
Surgery is needed to make the hole in the neck. This is called a tracheostomy.
The research team, led by Dr Charlene Babcock, used standard ventilator plastic tubing to split the flow of air four ways from the device.
They found a single ventilator could be quickly modified to treat four adults weighing roughly 70kg (11 stone) for at least 12 hours.
The study was published in the journal Academic Emergency Medicine in the wake of the 9/11 terrorist attacks.
But, as the coronavirus outbreak overwhelms hospitals around the world, Dr Babcock has uploaded a new tutorial on YouTube showing how the ventilators can be modified in this way.
In it, she shows how to connect tubes normally used for tracheotomies to modify the ventilators.
But the doctor admits the study was limited because it did not look at humans and instead used lung simulators.
Writing in the study, she says: ‘The chief limitation of this study is that it is a simulator study. Therefore, only successful physical ventilation could be demonstrated.
‘The presumption of equal ventilation to all four lung simulators presumed equal lung physiology.
‘A patient with asthma with greater resistance to ventilations may not receive equal ventilation with this system.’
Paul Hunter, an infectious diseases expert at the University of East Anglia, told MailOnline: ‘Normally I would worry about possible cross infection between the patients using the same device, but if it is a choice between certain death for half the patients and the possibility of a subsequent bacterial chest infection. I do not think there is any debate.’
Ventilators are used to help a person breathe if they have lung disease or another condition that makes breathing difficult
The NHS currently has around 5,000 adult ventilators and 900 for children in critical care facilities. It could need an additional 20,000 in a worst-case scenario, according to the Department of Health
Professor Mark Tooley FREng, a fellow of the Royal Academy of Engineering, added: ‘I have never heard of ventilators being shared between multiple patients as the process of ventilation is very personal – the controls and sensors are set to satisfy an individual patient needs and wellbeing.
‘The risk of infection would also be high if used for seriously ill patients. In theory it could be possible, but it would be a very complex procedure, fraught with issues.
‘As far I as I can tell, it has only been done as a simulation, many years ago, and never on real-life patients.’
Experts have also warned there are a number of problems with Boris Johnson’s call to arms to manufacturers to start producing ventilators.
They say there are not enough fully qualified intensive care staff to operate the ventilators, which also require a host of supplementary pieces of kit to function.
And they said that it could take weeks, if not months, to ensure the equipment is manufactured to a professional standard and safe to roll out across the country.
Nicki Credland, chair of the British Association of Critical Care Nurses, told Nursing Times: ‘That’s an absolute guarantee – we simply do not have them. We will need to look at diluting our workforce to be able to manage the situation.
‘If you’re an intensive care patient who requires ventilation, you require a lot of other things as well as ventilation.
‘There appears not to be plans about where we’re going to get all of that extra kit or expertise from either.’
Dr Rinesh Parmar, chair of the Doctor’s Association UK, added: ‘Whilst NHS hospitals make emergency plans to create ITU [intensive treatment unit] beds and the government purchases more ventilators, the elephant in the room is the lack of highly trained intensive care nurses and doctors.
‘It is pointless acquiring new ventilators without enough highly trained staff to operate them.’
Dr Parmar added that securing more capacity in private hospitals could free up more space to treat coronavirus patients needing breathing assistance. But he warned there were still too few intensive care beds within these hospitals.
He added: ‘The systematic under-resourcing of the NHS and exodus of staff that the government has presided over has ultimately left the country with a severe lack of specialist intensive care nurses and doctors.’
Helen Meese, vice chair of biomedical engineering at the Institution of Mechanical Engineers, said there were several problems with using vehicle manufacturing firms to make the ventilators.
Dr Meese told the Health Service Journal: ‘Ventilation equipment, like all medical devices, is very strictly regulated to ensure patient safety.
‘We must be clear, that while many engineering companies and individuals have come forward to support this initiative, it will take several weeks, if not months, to ensure the right processes are in place to increase production of these precision parts.’
WHAT DO WE KNOW ABOUT THE CORONAVIRUS?
What is the coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.
Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.
The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Where does the virus come from?
According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.
However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
What does the virus do to you? What are the symptoms?
Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.
However, an investigation into government surveillance in China said it had found no reason to believe this was true.
Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.
Can the virus be cured?
The COVID-19 virus cannot be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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