Part special Epidemic-proofFuture Perfect series on what we can upgrade to prepare for the next epidemic.
Some of the most unforgivable images of the early epidemic were the crisis in our hospital’s personal protective equipment (PPE) – a picture of doctors and nurses wearing rebuilt garbage bags, swimming goggles and snorkeling masks as the supply of PPE dwindled. Attack of Kovid-19.
These images show how unprepared we were to deal with the fast-moving epidemic. U.S. hospitals rely heavily on foreign suppliers, especially in China, for PPEs, and there are no rules that require hospitals or states to maintain certain levels of stock in the event of a crisis. Most did not; U.S. healthcare operates under severe financial pressure and timely sourcing – at normal times – is more affordable. The result was a supply crisis that hampered our response to the epidemic.
While the country waited for U.S. manufacturers to increase PPE production and stabilize the supply chain, an interesting stopgap solution emerged: 3D printing. In the face of the mask shortage, an alliance of private, government and volunteer groups came together to fill a void, focusing their efforts on the production and distribution of 3D-printed masks.
Their work, to be sure, was almost not enough to fill the gap. But as a stopgap, they undoubtedly helped, especially at the local level where such operations were focused – and all this suggests a limited but promising role for 3D printing in the fight against future epidemics.
“The Wild Waste of PPE”
The PPE crisis was so severe in the early days of the epidemic that it was difficult to exaggerate, especially for healthcare workers on the front lines of the crisis.
The shortage led to a deadly search for masks and other equipment that pitted hospitals and states against each other. John Hick, medical director for emergency preparedness at Henepin Healthcare in Minnesota, recalls the length of time his hospital needed to secure shipments from a growing insufficient stock. “We knew that the supply chain would not be able to keep up with the epidemic. And it’s not, “he told me.
Meanwhile, Chinese suppliers tried to circumvent the export sanctions imposed by the Chinese government at the beginning of the epidemic. “When we were getting samples of masks and gowns from China,” Hick told me, “a lot of the time they would come in a box wrapped in clothes, so from an export point of view it would look like they were sending them and not. PPE.”
Premier Inc., a healthcare provider, told me that orders increased 17-fold in the early days of Covid-19 and that hospitals across the country were sending representatives abroad in a desperate attempt to buy any of their remaining supplies. Sometimes they were lucky, but the workers were unfamiliar with the process and often returned with counterfeit goods without prior contact with the sellers – or sometimes nothing at all.
It was “PPE’s Wild West,” Hick recalls.
That’s where 3D printing came from.
Promise to print PPE in epidemic crisis
3D printers can create solid, three-dimensional objects from digital design. Following a digital blueprint, elements such as plastic or metallic powders are stacked one after the other, one after the other – a reason why 3D printing is also known as addition production.
Given enough raw materials to work with and a digital design, 3D printers can create physical objects like face shields and masks in minutes or hours. This is far from perfect – additive manufacturing has generally relied more on prototyping design than full-scale manufacturing – but the desperate need for PPE in the early stages of the epidemic pushed the limitations of 3D printing technology.
This is exactly what the Covid 3D Trust project tried to do once the PPE deficiency became apparent at the onset of the epidemic. The group was founded under the umbrella of the National Institutes of Health (NIH) 3D Print Exchange, a program the organization launched in 2014 to support biological research; They mainly print 3D models of molecules studied in biology research labs.
They already had the necessary infrastructure and were able to work closely with the Food and Drug Administration (FDA) and the Department of Veterans Affairs (VA). To support state-of-the-art biomedical work, printing masks and face shields for healthcare workers. In just 10 days in March 2020, they were able to deliver a platform that would host a crowded source repository of 3D-printed design for masks, facial shields and other supplies such as nasal swabs for testing – all tested by VA. Meet the FDA’s Emergency Use Approval for PPE.
Meanwhile, the Advanced Manufacturing Crisis Production Response (AMCPR) Exchange, a website platform operated by America Max (a public-private partnership to promote innovative work such as 3D printing), has provided small manufacturers with a platform to connect with buyers. According to Megan McCarthy, lead of the NIH 3D Print Exchange program, the demand was clear: traffic at the COVID 3D Trust site was booming, with 15,000 users per month before the epidemic and 30,000 users per day. In March 2020.
The success of AMCPR depends on individuals, volunteer groups, university organizations, and commercial organizations that have taken steps to contribute their local 3D printing capabilities to provide the PPE needed for the Covid-19 response effort.
Among them was the Illinois PPE Project, a volunteer-led effort that came together when the urgent need for PPE at a nearby hospital became apparent and the response from established organizations proved weak. The project was able to rely on volunteer efforts to arrange product delivery for veterans, use the loading dock space donated by the local company and call the hospital, and find out who needed it the most.
A report compiled by America Max estimates that its efforts include the manufacture and distribution of 38 million face shields and face shield parts, more than 12 million Covid-19 diagnostic nasal swabs, more than 2 million ear savers and several thousand mask components and ventilator parts. (Ear Saver is an attachment that can be used to make masks more comfortable by removing stress from the ears. It may not be important for the average person wearing a mask temporarily as they dive into a store, but it is a very relevant provider of health care for those who Often a mask is worn for a 12-hour shift.)
Nation of Makers, a nonprofit founded to support the “maker” community – a subculture that focuses on engineering new hardware and tinkering, often through 3D printing – estimates that approximately 50 million units were produced for PPE and other medical supplies in 2021. Covid-19 response by local addition manufacturing groups by January of this year. This is a staggering number – although still small in terms of aggregate demand between domestic production and the healthcare system; In March 2020, the US Department of Health and Human Services signed an agreement with the company for 600 million N95 masks to be delivered within 18 months.
A stopgap, not a solution
As those statistics suggest, 3D printing is inherently small in size. It is not a long-term solution to meet PPE demand in the healthcare system, and will never be as cost-effective as traditional mass production. Its main value is that it can be done locally, with minimal lead time, and can temporarily fill in the blanks to buy time for larger-scale production and shipping.
3D printing also has value as a means of prototyping new PPE designs. Digital designs can be quickly modified during the addition manufacturing process to try new methods. A notable success during this epidemic was the Stopgap Surgical Mask, a sterile mask with a replaceable filter that meets FDA standards and is currently undergoing CDC’s NIOSH approval process for N95 masks.
Other promising projects have made it to the prototype stage; Specifically, the Bellus3D app (which unfortunately is now discontinued) hoped to offer a service for scanning a person’s face to combine with 3D printing to create a custom-fitted reusable and sterile mask, or a customizable plastic to enhance the seal Can create frames. Of a surgical mask.
But the additive product is just that: additive. To prepare for the next epidemic, the supply chain needs to be reformed and emergency reserves for conventional PPE need to be increased.
The wish list for the upgrade is long: in the case of PPE, shipping away from shipping on time; Tax incentives or hospital regulations to encourage year-round PPE production; And, among many others, new processes to improve the supply of PPE and chains across hospitals and across the state.
But we now have the limitations of 3D printing in an emergency and how much more we can push them. It has almost certainly saved some lives at this time and may be even more effective in subsequent epidemics.