British manufacturing giants such as Dyson and JCB face months of arduous preparation before they can turn their hands to building ventilators.
Experts warn the appeal of British Prime Minister Boris Johnson for businesses to turn their factory production lines into ventilator conveyor belts may not be realistic.
The firms may need to overhaul their entire supply chain and have to hastily train their staff to make and check the critical life-support devices.
Today’s ventilators include a computer-electronic control system with valves, regulators, filters, oxygen and exhalation sensors, flow meters.
Reports suggest that British companies may soon be ordered rather than asked to manufacture ventilators much like firms 80 years ago during the Second World War.
Robert Harrison, a professor of engineering at Warwick Manufacturing Group, thinks that firms like JCB and Rolls Royce could, in theory, manufacture ventilators.
Mr Harrison says sourcing the parts required would be difficult, while training staff to build and test the life-saving apparatus is also fraught with difficulties.
‘They have relevant skills and capabilities, but given that all the design and manufacturing related information could be supplied to them, getting the parts and the tooling to manufacture such a thing will be a significant task, perhaps taking many months,’ he said.
‘Today’s ventilators are quite complex products – there is a computer-electronic control system with valves, regulators, filters, oxygen and exhalation sensors, flow meters.
‘Because something is needed very quickly, I think it would not be a case of utilising any new technologies but taking a tried and tested design and trying to reproduce this in volume and at the required level of quality.
‘As this is a life-critical piece of equipment, achieving this is a significant challenge given that, amongst other things, it requires an existing manufacturer of such equipment to provide their design and manufacturing-related know-how as an enabler.’
Professor David Delpy, a Fellow of the Royal Academy of Engineering, also raised concerns about how quickly production of ventilators that are up to regulatory standards can be increased to meet demand.
‘This proposal assumes that the NHS wants more of the latest spec ventilators with all the usual manufacturers’ guarantees and liability cover,’ said Professor Delpy, who is also of the Defence Scientific Advisory Council.
‘Since modern ventilators are usually electronically controlled with a variety of built-in sensors, there may be supply chain limitations on how rapidly one can ramp up production.
‘The previous generation of mechanical ventilators were relatively simpler, and components could be manufactured by many engineering companies with fairly standard machine tools.
‘These are certainly adequate for all but the most complex ventilation support cases, but I suspect there are currently no UK manufacturers of these since there is no NHS market for them.’
The government’s wants to ramp up production of medical ventilators, which help circulate oxygen to a patient, during the ‘unprecedented’ circumstances caused by COVID-19
WHAT ARE VENTILATORS AND HOW DO THEY WORK?
A ventilator is a machine that supports breathing by getting oxygen into the lungs and removing carbon dioxide from the body.
The amount of oxygen the patient receives can be controlled through a monitor connected to the ventilator.
The ventilator is connected to the patient through a tube that is placed into the mouth or nose and down the windpipe.
The amount of oxygen the patient receives can be controlled through a monitor connected to the ventilator.
Modern ventilators are electronically controlled by a small embedded computer processor that allows pressure and air flow to be adjusted to an individual patient’s needs.
Anyone on a ventilator in an intensive care unit will be hooked up to a monitor that measures heart rate, respiratory rate, blood pressure and oxygen saturation.
A ventilator also may be used during treatment for a serious lung disease or other condition that affects normal breathing.
They are classified as life-critical systems and precautions must be taken to ensure that they are reliable.
Dyson, Rolls Royce, JCB, Honda, Philips and Unipart are among those who have either been confirmed to be involved with the request or have registered their interest.
In response to how Dyson would build ventilators, a spokesperson told MailOnline: ‘Using our expertise and resources we are working with other companies to see if we can provide a rapid solution.’
Rolls Royce, meanwhile, told MailOnline: ‘We understand that the government is exploring ways in which businesses can help deal with the outbreak of COVID-19.
‘As they shape their plans, we are keen to do whatever we can to help the government and the country at this time and will look to provide any practical help we can.’
A spokesperson from logistics company Unipart also confirmed to MailOnline that it had been approached by the government.
‘We’re pleased to be involved in such an important project and doing everything we can to help,’ they said.
Asked whether there was concern that the NHS is entering the crisis stage of the pandemic without enough ventilators, the PM’s official spokesperson said: ‘We are facing what is an unprecedented situation.
‘That’s going to require an unprecedented response and that’s why the Prime Minister is urging industry to work with government.
‘The response has been a positive one.’
Ventilators work as an artificial set of lungs that bring in oxygen and remove carbon dioxide from the body.
They are commonly used for treating people with respiratory illnesses as well as breathing difficulties, as experienced by COVID-19 patients.
But the NHS only has 5,000 of the machines and will need ‘many times more than that’ in the weeks and months ahead, according to Health Secretary Matt Hancock.
‘If you produce a ventilator then we will buy it – no number is too high,’ he said this weekend.
‘We’re working with companies – we’ve been working with them for some time – both to buy ventilators that are available but also to switch over production so ventilators and other critical equipment.’
Concerns have also been raised as to how quickly production of ventilators can be ramped up to face an illness that is yet to peak in the UK.
There are now more than 1,500 confirmed coronavirus cases in the country, with 55 deaths.
It is unknown whether James Dyson’s company would use its specialist knowledge in vacuum and motor technology would be required to make the ventilators
There are also doubts as to how mass producers of hand dryers and tractors can turn their workforce to mass-producing ventilators at scale with the known-how required.
Companies would also have to equip production lines and train workers to assemble and test the product, while sourcing the parts quickly, such as electronics, valves and air-turbines, could be difficult.
This could be made made more manageable for the big firms if subassemblies were made by an existing ventilator manufacturer.
Hancock admitted that ventilators are ‘relatively complicated pieces of kit’ and that he ‘couldn’t make one’ himself.
‘But they’re not so complicated that the advanced manufacturing that this country is so good at now can’t be able to turn its production lines over to,’ he said this weekend.
Participants with knowledge of the call said the government wants to have the ventilator push ‘on stream’ within the next fortnight.
It was claimed by one person who reportedly participated in the call that Mr Johnson had ‘joked’ the coordinated effort to build the machines could be known as ‘Operation Last Gasp’.
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.