Coronavirus could decimate Africa, except for CPAPs; FDA approves application; US hospitals increasingly using
WASHINGTON, D.C. (April 20, 2020) - The coronavirus could easily decimate the populations of many African countries - making what happened in the U.S. look mild by comparison - because of the lack of the most important tool for preventing death - ventilators.
The Lack Of Ventilators
Most countries in Africa have very few ventilators - WHO says fewer than 2000 ventilators among 41 countries, Somalia has none - and even fewer people trained to operate them, so many experts are predicting a catastrophic situation, far exceeding that experienced in the U.S. and other countries, once cases of COVID-19 begin to exponentially balloon on that continent.
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As of Friday, there were only about 19,000 confirmed cases of coronavirus, and 10,000 deaths, across the entire continent, but both numbers are expected to explode since there are few if any governmental restrictions to slow its spread, and very limited resources to treat its 1.3 billion inhabitants (almost 17% of the total world population), or to perform the contact tracing necessary to slow its spread.
Thus the UN Economic Commission for Africa has reported that Africa might see 3.3 million deaths and 1.2 billion infections, and, even under a best-case scenario, a total of 300,000 deaths from the coronavirus can be expected this year alone.
But a novel proven strategy now growing in use could make it possible to provide enough respiratory assistance to save hundreds of thousands of African lives, even for people who live in remove villages without access to reliable electricity, much less ventilators and those trained to operate them, says professor John Banzhaf, who was one of the first to suggest and aggressively promote this new procedure.
Poor Man's Ventilators
Ventilators are very expensive ($25K-$50K) and complex pieces of equipment which require trained operators, and are often already scarce during the current pandemic, even in rich western countries.
But CPAP, BiPAP, and similar breathing machines - sometimes called "poor man's ventilators," and used to treat snoring and other sleep apnea problems - have now been approved for use in treating COVID-19 patients, and have been shown to be effective in many cases.
Banzhaf, an MIT-educated engineer and inventor, was one of the first to suggest and widely promote the concept of using these comparatively simple and much less expensive devices in many situations in which a COVID-19 patient required respiratory assistance to remain alive, but did not necessarily need the full power and sophistication of a modern hospital ventilator.
His suggestion received a major boost when the U.S. Food and Drug Administration [FDA] not only recommended the procedure, but made it legal by a ruling dated March 22.
Treating COVID-19 Patients
In a guidance document for treating COVID-19 patients issued on that date, the agency said: "Continuous Positive Airway Pressure (CPAP), auto-CPAP, and bilevel positive airway pressure (BiPAP or BPAP) machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition."
The Australian counterpart of the FDA - its TGA- issued a similar ruling shortly thereafter, and doctors treating COVID-19 begin using the devices where it seemed appropriate, occasionally adding oxygen and/or making modifications.
This dramatic expansion to the arsenal of weapons against the deadly virus is very important, says Banzhaf, because:
- ventilators are in short supply while there are millions of existing CPAP machines, in homes and in medical warehouses, with some no longer even needed by former users;
- hospitals are able to afford many more CPAPs (at about $850) than ventilators ($25K-50K), especially since there is little use for the latter once the COVID-19 peak demand ceases;
- people are readily donating CPAP machines which are no longer needed, something Banzhaf originally suggested in a TV interview;
- many CPAP machines can be powered by 12-volt electricity, so they can be used wherever there is a car or truck, even if electric power in the region is spotty, intermittent, or even unavailable.
New York State has already acquired thousands of CPAP and BiPAP devices to deal with its anticipated ventilator shortage.
Indeed, the New York Times has just reported that "doctors at North Shore University Hospital on Long Island have been using machines designed for people with sleep apnea to keep scores of coronavirus patients breathing," and that such innovations "may have helped stave off the dire ventilator shortages and rationing that some had feared but have not come to pass."
The Times report also points out that "many hospitals are using them to increase oxygen levels without resorting to intubation" - since intubation is a procedure with major risks because most COVID-19 patients who are intubated die, and others suffer long-lasting problems.
The Times also says that "the devices, doctors say, have been especially helpful for coronavirus patients with moderately impaired lung function."
CPAPs May Save Coronavirus Patient's Life In Africa
In a modern hospital setting, oxygen is usually readily available, and doctors have found that it can be used to increase the effectiveness of CPAP, BiPAP, and similar breathing devices. But any oxygen at all, much less a ready and reliable supply, is frequently not available in many locations in African countries.
But like many CPAP machines, oxygen concentrators - small devices which extract oxygen directly from the air - are not only designed to operate from a 12 volt source; they often have built-in batteries to make them completely portable. Indeed, many elderly Americans who need additional oxygen can actually carry their concentrators with them as they go about their daily activities.
Thus, suggests electrical engineer Banzhaf, both a CPAP device to help ventilate lungs, and an oxygen concentrator to help provide more oxygen for the lungs, can be used to keep a coronavirus patient alive anywhere in Africa where there is a car or truck which can be operated occasionally to keep the battery fully charged.
Coronavirus in Africa and beyond: Tools For Fighting The Deadly Virus
Indeed, in many cases an older used battery from a car or truck - one no longer able to provide sufficient power to turn over an electrical starter on a car or truck - can still store far more electrical energy than is necessary to operate both a CPAP breathing device and an oxygen concentrator to keep a COVID-19 patient in respiratory distress alive, even if there is no ventilator and a trained ventilator operator.
And even if one or both of these devices does require 117-volt AC power to operate, an inverter - a device about the size of a pack of cigarettes which converts 12-volt DC power from an automobile or truck battery to 117-volt AC power - can be used to keep the patient alive or breathing even in the most remote parts of the continent.
Of all the tools for fighting the deadly coronavirus which have come out of universities, this may be one of the most useful, and one with great potential for saving many lives in Africa.
It is also rather clearly one of the most unusual, since Banzhaf isn't a medical person, nor even a scientist and practicing engineer.
Rather, he is an interdisciplinary academic figure who has made his mark in fields as varied as public health ("The Man Behind The Ban On Cigarette Commercials"); computer science, game theory, and political science (the "Banzhaf Index"); and public interest litigation ("a Driving Force Behind the Lawsuits That Have Cost Tobacco Companies Billions of Dollars").
For more information, please see http://banzhaf.net/by/COVID.html