The US needs to manufacture more CPAP machines - STAT

I don’t want to be intubated.

That was my main thought a few weeks ago as I lay in bed at home, having trouble breathing and watching my pulse oximeter show that my blood oxygen was under 93% when it should have been over 95%.

I had just tested positive for Covid-19 and wanted to stay out of the hospital completely, or at least for as long as I could. Being short of breath meant I could develop hypoxia — too little oxygen in my bloodstream — which would mean I’d need to go to the hospital, something I wanted to avoid because it would increase my chances of being intubated and put on a ventilator.

The thought of being put on a ventilator frightened me, since nearly 90% of Covid-19 patients in the New York City area who were put on ventilators died.

Because I had been short of breath, exhausted, and feeling a tightness in my chest before testing positive for Covid-19, my father sent me a continuous positive airway pressure machine, also known as a CPAP, to help me breathe. This device is commonly used to treat obstructive sleep apnea.

Using CPAP requires wearing a mask that covers the nose and mouth. It is connected to a blower that pushes air through a hose and into the mask. Computer logic in the blower sends puffs of air into the mask timed to the user’s breathing patterns. The extra air pressure in the mask keeps the airway open and allows the user to breathe. It’s different in that way from a ventilator, which breathes for you.

I put on the mask, turned on the machine, and watched as my blood oxygen level rose to a manageable level, and helped keep it there over the next few days. I was able to work every day with intermittent use of the CPAP machine, and within a week was back on my feet.

I’m not alone in thinking that CPAP machines can play roles in fighting Covid-19. Emergency physicians I’ve spoken with directly, and others I have seen in the news, such as Colleen Smith from Elmhurst Hospital in Queens, N.Y., say that CPAP machines can be used for some patients in place of ventilators, providing all of the breathing support that’s needed and freeing up scarce ventilators for sicker people. For others, they could act as a bridge before crossing over to a ventilator. For patients coming off ventilators, CPAP machines could initially help regulate their breathing.

One drawback to using CPAP machines or their cousins, bilevel positive airway pressure (BiPAP) machines, at home or in the hospital is the cost of these devices. ResMed, the leading manufacturer of CPAP and BiPAP machines, charges approximately $1,500 for them. While that’s less than the cost of a ventilator, it is too much for individuals, much less for medical systems in crisis.

My father, an inventor and inveterate tinkerer, predicted the value of CPAP in treating patients with Covid-19 weeks before sending me one. With some experimentation, he came up with the prototype below, which could be built for approximately $200 apiece.

But what we found when we began to procure the most basic parts needed for production was that, due to outsourcing, none of the components were currently being made in the U.S., including basic items such as hoses, masks, and blowers. Outsourcing to China had led China to outsource to Vietnam, and so on. Despite the free-trade mantra that outsourcing to lower-wage countries leads to lower-cost products, there has been a persistent creep in the availability and cost of almost everything that Americans need to manufacture our own products.

This wasn’t always the case. Growing up in Cuyahoga Falls, Ohio, my father worked for a company he started in his early 20s called Polymerics, for which he invented PolyGel, a common component in rubber compounds. Polymerics sold to U.S. companies different types of rubber and plastic that were needed to build anything ranging from windshield wipers to medical devices and engine mounts. While the company still exists and is still family-owned, the supply chain it depends on has become so much more complex that today we cannot find a single plastic made in the U.S. that we could use to build a low-cost CPAP device.

This dearth applies to the CPAP mask and blower. The mask involves run-of-the-mill injection molding with either additive manufacturing (3D printing) or craftsmanship machining. The blower is the heart of the CPAP. It inflates and deflates as the patient inhales and exhales. Its parts are similar to a computer fan, and those parts should be in the American arsenal to battle against pathogens. Yet they almost exclusively are made in China.

The upshot is that many individuals and hospitals in need of alternatives to highly invasive and potentially harmful ventilators facing a supply chain that makes it impossible to quickly produce them in this time of need.

What is at the root of this supply chain crisis? It could be our complacency, or unnecessary complexity, or a depletion of our greatest natural resource — expertise. The inability to get parts to make the products that we need in a timely fashion is felt across industries, but it is most relevant now to the medical industry.

My call to action is not to speed up shipments of the parts needed to build medical equipment like CPAP machines from China and Vietnam and beyond. It is to create businesses in the U.S. with the capabilities to quickly and easily build the parts we need to improve the health of Americans.

Matthew Putman, Ph.D., is the cofounder and CEO of Nanotronics, a science technology company that creates AI platforms and advanced inspection tools for manufacturing.

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