Ventilation capacities and the number of intensive care beds are increasing in Germany. But experts are unsure whether this is enough for all COVID 19 patients. Buying new ventilators is currently difficult – worldwide demand is outstripping supply. The manufacturers decide who they sell the devices to. How this should work, why it is not a good idea that automakers also want to build ventilators and why the situation can become critical for other sick people, in particular, explains Germany chief of the US medical device manufacturer Resmed, Katrin Pucknat.
Ms. Pucknat, have those responsible in the German healthcare system forgotten to buy ventilators in recent years?
Katrin Pucknat: No, I wouldn’t say that. In international comparison, in particular, Germany has a very high number of intensive care and invasive ventilation places, which is significantly higher than in other European countries. You have to watch how it develops, but Germany has not yet reached its capacity limits. We are in a much better situation than other countries in the world.
Nevertheless, Germany is also desperately looking for other ventilators. The global demand for you alone has more than quintupled. Can your factories in Australia and Singapore handle this at all?
It is not possible to meet the current global demand coming from all countries in the short term. No company in the world can do that. But everyone is in the process of ramping up production capacity. That is also the case with us. We strive to do everything we can to ensure maximum production. We are trying to satisfy as many markets as possible.
How fast can it work?
Compared to the status of a year ago, we have doubled or even tripled our production on various production lines. And we are planning further capacity increases in the next six weeks. The problem, however, is that not only one market is currently in demand, but the whole world. At the moment, the demand far exceeds the supply. However, we are confident that we can deliver within the next few weeks.
Who is currently coming to you – and which scenes are you experiencing?
The whole world contacts us: whether that’s South America, Africa, Asia or Eastern European countries. There is virtually no region that is not currently trying to purchase ventilators. The dramaturgy varies depending on how the existing capacities look in the countries. If you have seen the pictures from Italy or Spain, but also from New York, where there was and is a massive undersupply of ventilators, the despair and urgency is of course much higher than in markets that have good basic equipment and that Spread the disease well. These are, for example, Austria, Belgium and certainly also Germany. Nevertheless, inquiries from these countries are urgent, every country in the world is trying to prepare as well as possible.
You have to decide as to who you sell and how many devices. Who do you choose in the end? For the state customer? The regular customer? The highest bidder?
That’s right, it’s a very difficult ethical decision. But we agreed on guidelines in our company early on that determine how we decide. And these guidelines do not imply that the person who pays the most gets the equipment. Instead, we have developed an epidemiological model that we can use to look at where is the greatest need and need currently? Where do most people die? And they try to serve these markets preferentially, without withholding products from other markets. Of course, this is very difficult because you try to satisfy as many customers and countries as possible with a limited amount of products. In addition to COVID disease, it is currently just as important that we also care for patients who suffer from normal lung diseases. The corona pandemic did not simply make them disappear and they also need support at the moment. Therefore, in addition to the focus on corona patients, we also have to ensure that patients with normal ventilation here in Germany continue to have access to ventilation technology and do not fall behind.
And is that difficult at the moment?
Yes, very difficult. We currently have a lot of coordination, a lot of conference calls to ensure that there is no triage to the disadvantage of non-corona patients: for them, the ventilators must currently remain available, even though all devices for COVID treatment are currently being bought up and there is a delivery bottleneck for the “normal” supplies. We have very big concerns. Likewise, sufficient protective equipment must be available for my employees who look after and maintain these devices of our patients who are ventilated at home, so that we can carry out our vital care. We are currently not considered at all.
Delivery bottlenecks don’t just worry you here. You are already concerned with the supply of the components required for the ventilators. How big is the problem here?
It depends on the day. Fortunately, we are very big and have good contacts with suppliers all over the world. But restrictions like export bans from many countries are a huge problem. Many of our suppliers are again dependent on suppliers, many of whom are based in China, for example. And there are also delivery bottlenecks and difficulties. We have to reevaluate where we stand every day. We have to pull in a net and double bottom every day by having not just one partner to supply us, but two or three that will take effect if one fails. It is an amazing logistical undertaking.
Car manufacturers like Tesla and Ford want to help and start producing ventilators in their factories, where no cars are rolling off the assembly line. How do you rate that?
We are happy about everyone who tries to help in the crisis. But it would be presumptuous to think that you can just draw a ventilator on the drawing board and build it in a week. We have invested years in research and development. Ventilation is not an easy thing, because complex algorithms play a role that needs to be clinically validated. Besides, the advance of the carmaker creates another problem: If they also build ventilators, this leads to a much higher demand for components on the world market. Components that not only we, but all ventilator manufacturers depend on. When new players enter the market and tap these components, it makes it all the more difficult for us to increase our capacities. We, therefore, appeal to the car operator to check whether they can support themselves with the construction of components. An example would be Tesla, which could produce much-needed batteries and rechargeable batteries for ventilators.
Can states be satisfied with stocking up on ventilators to save lives?
No, you always need personnel who can operate these devices. In Germany, we are well equipped with intensive care physicians and ventilation specialists. However, the need for nursing care has not changed for the better thanks to Corona. One has to look closely at what might ultimately cause Germany to fail when it comes to treating COVID patients. But abroad is certainly a bigger problem. There are markets in which very little ventilation technology has been used so far. There are often not so many qualified specialists there who have the experience of how to use such a technology.