The Race To Make Ventilators Is Not Like World War II

The Race To Make Ventilators Is Not Like World War II

Elon made it sound like a breeze. It started on March 18th with a casual tweet to a fan promising that Tesla would make ventilators “if there is a shortage,” setting off an avalanche of replies educating him that there was, already, a shortage. Within hours, Bill de Blasio tweeted “New York is buying!”; within a week, Musk’s dim Twitter-sourced awareness had manifested into a full-fledged promise to open a Buffalo solar cell factory for ventilator production “as soon as humanly possible.”

In the interim, GM and Ford announced partnerships with ventilator manufacturers, and Trump invoked wartime powers to order GM to make ventilators (blaming GM for dragging its heels, oddly). Many optimistic forecasters likened the industry-spanning coalition to America’s victorious World War II weapons manufacturing spree. Surely people who make rockets and cars can make air-pumping boxes. A widget is a widget. How hard could it be?

To some manufacturing experts, expecting Tesla to make ventilators makes about as much sense as assigning the job to a kitchen appliance factory.

“The president ordering GM to make ventilators at Lordstown, where GM made Chevy Cruzes, reflects a complete lack of understanding what manufacturing is all about,” Willy Shih, Professor of Management Practice in Business Administration at Harvard Business School, told Gizmodo. Shih cautioned early—mid-March, as the notion of GM and Tesla making ventilators was nearing the horizon—that auto manufacturers would need to jump through several flaming hoops. Among them, licensing a design, obtaining hundreds of unique components, crafting specialised tools to make each part, and obtaining FDA certification to put life-supporting Class II medical devices on the market.

Manufacturers have pulled together to solve several of those problems. Medtronic has posted its ventilator design for makers to download. GM and Ford have lent their supply chain muscle and infrastructure to medtech companies so that they can scale up their existing operations. Tesla has unveiled an in-house ventilator design using car parts (although some lately noted that Tesla has sent Bilevel Positive Airway Pressure (BiPAP) machines used to treat sleep apnea, rather than sophisticated ICU ventilators, to New York, so take its claims with a grain of salt).

GE Aviation workers have since called on their company to follow suit, convert plants in order to make ventilators and save jobs while they’re at it. “If GE trusts us to build, maintain, and test engines which go on a variety of aircraft where millions of lives are at stake,” GE Aviation union leader Jake Aguanaga asked on a press call, “why wouldn’t they trust us to build ventilators?” (GE Healthcare has partnered with Ford Motors instead.)

But there is no “converting” a factory, in the way we think of maybe moving the laser cutter over here and the conveyor belt there and firing up the 3D printer. To “convert” a factory these days is to move entirely new equipment into a building with four walls and retrain the existing workforce. GE Aviation workers have made the case that GE Aviation has both, pointing to empty and mostly-empty warehouses in Texas, Virginia, Kansas, Kentucky, and Massachusetts and tens of thousands who’ve been laid off over the past several years, with 2,600 more layoffs announced in late March due to the coronavirus slowdown.

But why aviation? Why Tesla and GM and Ford, companies that don’t produce anything that looks anything like ventilators?

“Automakers’ capabilities are in making engines, internal combustion-powered devices, sheet metal bending,” Shih said. “An automaker could probably make emergency generators because they know how to make small engines. They do fabricate HVAC systems for cars, but a ventilator isn’t like I’m going to stick my car air conditioner up to a tube to a patient. I think you have to think about what capabilities do I have, and how do I apply them?”

Shih pointed to a more 1:1 “conversion,” in which the Broad Institute of MIT and Harvard turned its genome and exome sequencing lab into a covid-19 test processing facility within days. They constructed walls to create isolation rooms, bought protective equipment, and implemented new cleaning practices. They were already familiar with the regulatory landscape of testing facilities and were able to speed RNA testing using robotic liquid-handling machines, rather than the time-consuming manual tests. Similarly, Ford has found overlaps with simpler PPE technology, reportedly repurposing car fans for use in respirator masks.

Unlike respirators, ICU ventilators are made up of hundreds of parts that the slightest slip-up could render useless; under normal circumstances, they need to pass rigorous safety tests to ensure, among other things, that the delicate monitoring system will work in order to prevent deadly hyperinflation. (Hospitals across the country are creating makeshift ventilators out of things like anesthesia machines as a last resort, to doctors’ dismay.) They require the expertise of a niche industry that’s perfected the technology for a limited market.

“Some people say, GM, Ford, you have all these resources, you oughta be able to marshal all of your resources just like we did in World War II,” Shih said. “I wasn’t alive then, but the products were a lot simpler. They had fewer parts. A lot of them were made by bending and machining metal, where you have kind of the same basic type of manufacturing technology. But to make things like ventilators, you need oxygen sensors, you need valves and monitoring equipment.”

A supply line can be as important as a factory

A car manufacturer whipping up ventilators didn’t make sense to ventilator manufacturer Ventec, either, at first. As Ventec CEO Chris Kiple told Planet Money in late March, “If you had asked me [before the covid-19 outbreak] if it was possible for a medical device company to work with an auto manufacturer, I would’ve said, no.” But they quickly realised that GM could bring supply chain resources and space to ramp up their own production, rather than reinventing the wheel at their own plants.

Ventec CSO Chris Brooks told Gizmodo that his industry typically makes only tens of thousands of ventilators a year globally, and each of Ventec’s machines has nearly 700 parts. Even at full tilt, the company would never have been able to meet the demand of tens of thousands of respirators per state; meanwhile, GM makes millions of cars per year—sheer scale isn’t nothing.

“Pivoting to GM opened up a whole wide world of new suppliers that we otherwise wouldn’t have access to,” he said, referring to a “Rolodex” of suppliers GM was able to muster on a dime. “Just identifying new suppliers is a very long process. There are a lot of people who work with moulded plastics, but you need to have an understanding of who can do the moulded plastics with the materials that we need, with the specifications that, and who could do so quickly. The automotive industry has its own pool of metals and plastics and other suppliers, and they were able to identify suppliers that could either reopen their factories or could work around the clock to retool and provide the supplies that we need.”

Brooks added that GM’s production team could look for redundancies that more hands can smooth out. “They took all of our existing work instructions to say, ok. This is one process that currently has one person working on it for a total of twelve minutes. How can we break that down into two process pieces with two people, each working for five minutes? That’s something that the GM team does really well.”

GM also had an advanced electronics facility in Kokomo, Indiana with a workforce whose skills dovetail with Ventec’s needs. “It was slightly different from what you typically envision as large robots slinging big pieces of steel around to assemble a car,” Brooks added.

Brooks said they’ve accelerated from “zero to sixty” in just a few weeks. The Department of Health and Human Services announced on Wednesday that it expects GM to produce 30,000 ventilators to add to the Strategic National Stockpile by August—but Governor Andrew Cuomo, who has predicted a need of 30,000 to 40,000 ventilators for New York State alone, warned last week that New York would run short of its supply… on Wednesday.

Supply lines are only as strong as shipping lines

While Brooks says that 80 per cent of materials for its ventilators are sourced from the U.S., Shih still predicts issues beyond the control of U.S. manufacturing might. “People tend to look at the supplier companies, the companies that make the parts and source the raw materials. But if you look at what’s happened to container shipping on the one hand, and air cargo on the other hand, I think we are headed for a lot of disruption.”

Shih explained that a shipping container typically takes about a month to get from Shenzhen, China to Europe, and then longer to get to the U.S. He predicts that with the supply shock in China, followed by the demand shock in the U.S., cargo shipping is headed for a typhoon.

“It was only about two weeks ago that ports along the southeastern seaboard and the Gulf Coast got their last shipment from China from before the Lunar New Year break,” he said. “So when the ships don’t come in, it causes a huge mess, because all the empty containers are in the wrong place.” There are only so many empty shipping containers to go around. And over the past few months, a lag in sailings from China left the rest of the world short not only of electronics parts but also containers, which the U.S. and other countries need to move essentials like food. Now western importers worry that they won’t be able to handle the surge in backlog shipments.

“If you think about what’s happening—now retailers like Macy’s are closed, and Amazon is not taking non-critical merchandise, so a wave of imports like shoes and furniture are coming into the East Coast of the U.S., and they have nowhere to put them because the distribution centre for these stores are closed, or they’re backed up, and they can’t take any more merchandise,” Shih elaborated. “So then people will run out of truck trailers to move the containers around. What do you do with all these full containers nobody can accept? So you wonder why it’s hard to move PPE when you need it.

“It’s a really complicated well-orchestrated ballet, and once you stop the whole thing and try to start it up again—it’s not going to be pretty.”

On top of that, around half of air freight is shipped in belly cargo in passenger flights, which, he said, is “three times more expensive” right now than the usual price and that’s if you can get a booking in the crowded marketplace. (Airlines, including American, are now sending some cargo-only flights.)

President Trump blustering into the headwinds doesn’t help. He’s effectively turned PPE into a global arms race, using the Defence Production Act to prevent 3M from selling certain medical supplies abroad, while beating up on India for not exporting anti-malaria drugs to the U.S.

“You have to be careful about what you do because it’s likely to come back and bite you,” Shih said.

I sighed. He sighed. “I know. It’s depressing,” he added.

Unemployment lines lead to a dead-end

This is not like World War II. But GE Aviation union leaders yearn for a patriotic all-hands-on-deck effort after years of plant closures and job cuts throughout the company. As the Wall Street Journal noted in February, GE reached its lowest number of employees since World War II. That was before GE Aviation announced that it would lay off ten per cent more of its U.S. workforce, or 2,600 people, in the wake of the coronavirus.

Jerry Carney, Conference Board Chairman of IUE-CWA, the union which represents GE Aviation workers, told Gizmodo that some laid-off workers are so eager to help fight the pandemic that they’re willing to come back and volunteer. He’s mystified by the fact that GE Healthcare chose to “add to the unemployment line” with its own aviation workforce and partner with Ford Motors to make ventilators instead. Besides the underutilised workforce, he said, GE has the space; Carney said that Madisonville, Kentucky has about the square footage of an Olympic-sized swimming pool sitting wide open. (GE Aviation did not return Gizmodo’s request to confirm whether that’s true.) Ford and GE Healthcare, which announced their partnership on March 24th, have promised to produce 50,000 ventilators by July 4th, at one of Ford’s plants.

That batch may not be enough to meet the demand, even if states pass along ventilators as their infection rates fall off. In late March, a study in the New England Journal of Medicine estimated that the U.S. might have one ventilator per as many as 31 patients who may need one. That was based on an estimate of 168,900 ventilators in the U.S. at the time (including basic ventilators and the small reserve in the Strategic National Stockpile, which has since distributed broken machines). GM plans to deliver another 30,000 to the federal government by the end of August, and Tesla remains unclear on how many ventilators it might deliver and by what deadline. Estimated infection rates are rapidly changing based on the effectiveness of social distancing measures, but state-wide repeats of New York’s shortage could be catastrophic, deaths are expected to peak nationally this month, and doctors are calling for states to give out triage guidelines. “I don’t need ventilators in six months,” New York Governor Andrew Cuomo said in March, then anticipating a need of 30,000 ventilators. “And I don’t need ventilators in five months, four months or three months.”

The wartime effort many have wished for might not bear fruit soon enough. It could have, had the Trump Administration looked into the crumbling national stockpile and invoked the Defence Production Act in February, which could have guaranteed companies (and their workers) that they would be compensated for overproduction. The fact is we don’t know how many ventilators we need. But we know we have workers willing to make them, and each week we get a rising accounting of how many workers have lost their jobs.

GE Healthcare has not responded to Gizmodo’s request for comment as to why GE made the decision to partner with Ford. For Carney, it’s just another example in a long string of bad business decisions that hang the company’s skilled workers out to dry. Carney said that during the last contract negotiation, union members hit their hands on the table to mark every plant that had closed since the last contract. They hit the table so many times that their hands got sore.

“They have very little lighting left, they got rid of transportation—all they have left is maybe three or four businesses now,” he said. “This is why GE is failing across the world.” GE merged its transportation division with Wabtec in 2018, sold its power division in 2018 and its biopharma and lighting divisions in 2019. Carney was a high-voltage electrician, back when GE owned GE Appliances; that division was acquired in 2016.

“I just wish that GE would become an American company again,” he said, with some spit on it, and he apologised for raising his voice. “Step up to the plate and keep workers working in this time. Let us produce what will make Americans, and people all around the world, safe right now.”