‘My Republica’ online news reads on its first page in April 8. This shortage of ventilators, not only in Nepal, but in the world has emerged as a key aspect of Coronavirus Pandemic. As seen in countries where COVID-19 death rates are growing at a tremendous rate, the crucial device that comes in handy, when a patient is in the verge or life and death, is a mechanical ventilator. Seeing the above mentioned last headline, it can be easily concluded how prepared we are for the worst. Also , as mentioned in the third headline, how much we need it.
Mechanical Ventilation is a term for ‘artificial ventilation’ where a mechanical means is used to assist spontaneous breathing of a patient. It generally includes positive pressure ventilation where air (or any other gas mix) is pushed into the lungs through the airways, and negative pressure ventilation where air is, in essence, sucked into the lungs by stimulating movement of the chest. It is mostly assisted manually by an Anesthesiologist, Respiratory Therapist (RT), registered nurse or a Paramedic. It is used in intensive care units (ICUs) in hospitals. The first use of mecha nical ventilation in 1953 against polio patients reduced the polio death rates from 87% to 25%. There are ventilators ranging from basic to highly robust ventilators which are very effective, as well as costly. The cost of effective ventilators ranges from average or $20,000 to $100,000 even in developed countries. It can seemingly be said that sometimes ventilators are responsible to bring the dead, back to life, during minor respiratory failures, who would otherwise be dead especially due to COVID-19.
Regarding ventilation service in our country, the first thing to consider is that we do not have ‘respiratory therapy’ in Nepal. Doctors are the only personnel, who can carry out the ventilator settings. Our nurses are not comfortable to use them due to lack of proper training. Ourphysicists state, if a patient is in need of ventilation. Surely, the experience and knowledge of that physicist at that time, highly affects his choices. In this case, if there was a decision support system on a machine that could easily decide whether a person needs ventilation depending upon the current status of the patient, it would be one of the wise method to utilize the limited ventilators already available in our country. It would be very useful especially in case of COVID-19 pandemic where staffs generally seek a contactless environment for operation. It would not only reduce the biases of physicist over the patient, it would also reduce the time of checkup for experts, who would otherwise be useful elsewhere. Especially, when the Nepali national news are rapidly announcing the resigning of doctors and experts, due to lack of safety in diagnosis, such a machine would be of great help. It would be more beneficial in a country like ours, where the average health status is better than most of the developed countries, which means, the potential for the recovery and productivity exists, even if treated by a very basic ventilator service.
But, especially in a developing country like ours, even though death rates due to respiratory failure in COVID-19 is a very general case, most of the patients die before the intensive care on ventilation is assigned or sometimes they are ventilated long after, when theyactually needed it.Ventilators are merely the machine that works after switching it on. They need proper and time to time adjustments, whereas an immediate checkup, if the machine starts giving off notifications that the patient’s status is getting poor. A proper knowledge on ventilators and maintenance service is also required since the machine is very vulnerable. On the overall, it is clear that the machine would be a very useful, if it is assigned to the right person at the right timeand a tiresome one, if it is wasted on someone who doesn’t need it. This ca n be solved, if another such machine exists that would easily decide whether the ventilation is required for the patient, at that current time or not. It would further be able to decide if the patient would just need basic ventilator settings or an intense ventilator settings. It would also decide the time of ventilation for the patient. It would also decide a relative answer to a question of ‘who gets the ventilator, if there are five patients in need of it , and a single ventilator exists?’ Yes, it seems ridiculous, but we must be prepared for the worst in case of a pandemic like this.
The main challenge to build such a machine is that, there are no such machines currently operating in the world as far as I am concerned. In my opinion, since there are no such machines, a way to build such machine in a country like ours could be by organizing nationwide onlinehackathon and design competitions to design and write algorithms for such machines and declare a high prize which would boost up all the innovators currently on lockdown. Also, these machines would reduce the caregiver’s care to the patient, is not an advantage for both the patients and the staffs, but in case of pandemic like this, where quarantine is preferred, it would prove just useful as well . Also, to convince funding agencies, about the benefits of mechanical ventilators and a need to utilize them, only in proper patients, especially during a scarcity like this, is a challenge to us.
Since, one ventilator existing for nearly one million patients in our country, is true. It is also true that our country is among the countries with no COVID-19 death victims. With such results, a wise use of a single ventilator by developing a decision supportive machine that decides whether the ventilation is required or not would be very crucial for saving lives of upcoming COVID-19 victims in our country. The country needs management, good governance, support from funding agencies and all the very best initiatives and new projects from the innovators and engineers all over the nation to fight against the p andemic, that way we will be able to minimize the risk slowly and slowly finally to eradicate COVID-19 out of the nation.