Plan C from Maker Space is our chronicle of the Maker Movement’s grassroots efforts to respond to critical shortages of medical equipment. This is the second article in the series.
C Is for Civic
I now know what the “C” in Plan C should stand for — Civic. If Plan A is the government and Plan B is industry, then Plan C is for civic action.
In How Civic Technology Can Help Stop a Pandemic, Jaron Lanier and E. Glen Weyl (Foreign Affairs) highlight the success of bottom-up efforts in Taiwan to control the spread of the coronavirus in that country. “The guiding principle was not top-down control but mutual respect and cooperation,” they write. Taiwan’s efforts were “a fusion of technology, activism, and civic participation” compared to the slow-moving, top-down approach of China and the United States. The article also compared the United States’s response today to the pandemic to what happened after Pearl Harbor, which was remarkable for “a range of government and citizen-driven industrial and technological innovations.”
The key, for both the United States then and Taiwan now, was catalyzing the widespread desire among citizens to be useful producers, and not just consumers, of the tools needed for victory over an enemy — whether a foreign military or a lethal virus. Societies that fail to do so in a time of crisis are wasting their most critical resource.
Look beyond the US Government. There’s reason for hope in both the quantity and the quality of participation in Plan C group efforts. For instance, the Open Source COVID-19 Medical Supplies (OSCMS) group on Facebook has grown to 55,000 people, the group’s leader Gui Cavalcanti told me, adding that there are nearly 400 volunteers helping to run it. Cavalcanti estimates that members of the group have produced 20,000 face shields and 500,000 masks. Remember, this Facebook Group was started just two weeks ago.
Who’s in that group? “It’s former executives from Fortune 500 companies,” said Gui. “It’s like, 40-some-odd doctors. 120 documentarians of various kinds, including librarians, including medical transcriptionists.” People introduce themselves briefly with a line or two about their background and interests. There are no LinkedIn links to resumes, no job titles. Those things just get in the way.
Brad Halsey of Building Momentum has formed, he says, a “well-rounded” team to innovate coronavirus solutions. It consists of “everything from PhD electrical engineers, to mechanical engineers, to people that didn’t complete college, that had no degree, and theater majors.”
When Plan A and B decide to do something, they create a task force. For Plan C, the real force is self-organizing groups of volunteer contributors. Many are working in parallel, perhaps unaware of how many work beside them, but each one is determined that this work is both urgent and vital. The vast majority are out of work or working independently of their employer — this isn’t work that anybody is getting paid to do. They do it because — well, you probably understand why, and why now.
Tuning Out the Loudest Voice in the Room
Makers and doers, by any name, know that the loudest person in the room usually has nothing to say. This Wizard of Oz character with a booming voice claims to be pulling the levers of government and industry but we don’t know the reality behind the curtain.
Those who have their heads down, the doers and makers of things, know that their actions do the talking and they gravitate to others who are also willing to do hard work. This is the self-selection process behind the people who are stepping up. It’s also why you don’t hear much about them. They are busy. They are making connections online across state, national, and corporate borders. They find each other and they find a way to work together, like a civic resistance movement.
Meanwhile, the talkers of Plan A and Plan B are having trouble working together. On Thursday the White House broke off an agreement with GM to manufacture ventilators and then downplayed the need for more ventilators. On Friday the White House, after castigating GM, demanded under the Defense Production Act that GM produce ventilators. Add to that the remark that State governors need to be more “appreciative” of federal efforts. Not much mutual respect and cooperation there.
CNN anchor Brianna Keilar had her mesmerizing Howard Beale moment this week, shouting out:
There was something cathartic hearing Keilar shout that question. Thank you.
In a separate interview, Keilar told a dithering administration official, Peter Navarro:
This week, Navarro was named the National Defense Act Policy Coordinator in charge of the government’s response to the shortage of medical equipment.
Time is everything. The crisis is upon us.
Crisis Mode Is Now
The CDC has a clear definition of what happens in crisis mode — there’s Conventional Capacity Mode, Contingency Capacity Mode, and then there’s Crisis Capacity Mode. A California doctor told me that the hospital he works at is in Contingency Mode and would soon go to Crisis Mode. “You’re on your own in Crisis Mode,” he said. Indeed. If you look at a shortage of facemasks, the CDC says that its Crisis Capacity strategies include reusing face masks. Further, if face masks are not available, the CDC guidelines say:
HCP [health care providers] might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort.
“You start looking at things differently when you are in Crisis Mode,” the California doctor said. “I’m not going to see any patients wearing a bandana.”
The CDC says that Crisis Mode for N95 respirators allows “alternate strategies that are not commensurate with contemporary U.S. standards of care.” It is scary but true. This is where we are, however. This is the new reality, which Gui Cavalcanti of the OSCMS group, told me: “The news cycle has not caught up to the reality.”
3D Printing Is the Hammer
A number of makers I’ve talked to found themselves arguing against 3D printed solutions. It seems that for many 3D printing is the solution to every problem, like the adage about “if all you have is a hammer…” 3D printing’s biggest problem is that it is slow. Too slow to make many of anything. 3D printing is great for prototyping, which is making one of something. It can be used to make molds and fill other roles in the design process. But there are other tools in the makerspace and there are often faster, more scalable manufacturing processes available in industry. Still, if you have a lab full of 3D printers and you want to put them to work, you may choose the wrong tool for the job.
Bill Hemphill, an associate engineering professor at East Tennessee State University (ETSU) found a 3D design for a face shield on opensourceventilator.ie and then modified the 3D design for the face shield’s harness to produce it on a laser cutter rather than a 3D printer. “I’ve been using 3D printing since 2003,” said Hemphill, who teaches a CNC class at ETSU. “3D printers are great, they’re sexy, but they’re slow,” he remarked. His thought was: “We can bang this stuff out on a laser and cut it out at the speed of light and get a little bit more throughput.”
In Arlington, Virginia, Brad Halsey said that he was invited to a call organized by the Governor’s office of New York with a consortium of manufacturers up in New York. “The call a week ago today was about how to 3D print masks en masse,” Brad told me last Friday. He got on the call and said: “Let’s not 3D print them.” He encouraged them to consider more scalable methods.
“I went home that night and vacuum-formed a couple of masks around some plaster molds I had made and I 3D printed a couple of molds on faces,” he said. The next day, he told the consortium that the process he came up with was the best way to do it. He shared the designs and processes with the manufacturing groups. “Everything was shared,” he said, “all the intellectual property, all the CAD models, everything was shared such that at the end of this, this gets promulgated to everybody.”
Brad thinks by early next week he will be producing 5,000 masks a week with a thermoforming process, and either laser cutting or die cutting the filters: “We’ve done both, I have to see, you know, what has the best rep rate on it.” A company in New York is projecting that using their vacuum forming process, they can produce 10,000 a day. “That gives you close to a hundred thousand a week,” he said. However, New York has asked for 100 million by June.
“It means we’ve got to keep ramping up,” he said, adding that it also means that the problem isn’t solved yet.
3D printing ended up playing an important role in the solution — printing molds for the masks and producing 3D printed models of human faces for testing the masks. “The 3D printing team was exceptional,” Brad said.
UV Sanitizing Units
Brad has set up mobile training labs for soldiers in the US and Middle East, empowering them to use the tools of the maker movement and to become makers. He has been involved in hurricane disaster relief in the Caribbean and written about it for Make: magazine. He’s former military and a scientist, both of which make him an excellent problem solver who operates on the edges. I knew that he and his Building Momentum team would be up to something at The Garden makerspace in Arlington.
The first challenge he decided upon was how to safely sanitize objects with something other than a chemical cleaner. “I challenged the team to a one-week robot sprint where they had to develop a robot that could use ultraviolet (UV) light and sanitize vertical and horizontal surfaces.”
Why do we need UV sanitizers? “If all kinds of things start coming en masse into hospitals from the community,” asked Brad, “how do you know people don’t have the virus when they’re making these things?” He wanted to get ahead of that problem and “find a better way to sanitize all these things.”
Why do we need a robot to do this? “UV light suffers from something called the inverse square rule,” Brad told me. “That means the further you get away from an object with that light, the effectiveness of sanitation falls off exponentially. So a robot actually ensures that you’ll get the right distance and the right sort of power density that you need.” UV-C light, the type that’s used for sanitizing, is also more damaging than the UV-A and UV-B that give us sunburn, so it’s not something a human operator wants to be exposed to. The team started on Monday and by Friday, they had a robot moving around able to disinfect things. In week two, they improved the robot so it could move on carpet.
They had problems getting components but some supplies were salvaged from previous projects, including tank treads. Getting UV-C bulbs was a challenge but they got them. “So now this thing will really, truly, ionize and kill everything in a room,” said Brad. The UV-C sanitizing robot is not just for medical uses. It can be used for sanitizing any place, and Brad has had calls from community centers and airports.
The next project was a UV-C sanitizing grill, which looks like a cross between a BBQ and a tanning bed. “It’s based on the same science,” Brad explained. “If you can keep the bulbs a fixed distance from what you want to sanitize — as long as you know the fixed distance and the wattage you’re working with, you can use a mesh grill. With this setup, you close the lid and turn it on and it kills everything inside of the grill.” The grill took them about three hours and they put this video on their YouTube channel.
Brad said that they have two tracks for these projects, one is DIY and the other is more refined as a product. “The idea was to spark the interest of the DIY community and to learn something ourselves,” said Brad. But they also responded to commercial opportunities, such as a construction company that wanted to sanitize masks on a construction site.
Brad’s team has responded but they are also reeling from the financial impact of COVID-19 on their business. “All of our trainings were canceled, all of our corporate events were canceled, all of our events in The Garden (makerspace) were canceled.” But they keep working fast.
He’s also wondering how organizations in the government and military could accelerate the efforts of Plan C.
So it’s like coupling to the space station, right? There’s like a lot of stress in how you finally coupled the space shuttle to the space station. But once you do it at all, everything starts going well. That coupling between us and them, it’s what we have to go through and then doing the same thing together would be a lot better.
He’s also thinking about how to change the policy to fit what the technology can do rather than making the tech fit the standard policy. “We need policy makers to quickly look and tailor policy to the tech that is available to us at hand,” he said.
Supply Chains Are Broken
If you don’t have parts, you can’t make anything. That’s true of the largest manufacturer as well as the smallest. State governors complain that they are competing against each other for ventilators. The deeper you go, the ventilator manufacturers are also competing against each other for component parts. When you add a GM as a ventilator manufacturer, that’s one big player trying to source the same parts as everybody else. As a source told me, “You’ll just have a lot of unfinished ventilators, all missing the same couple of parts.”
OSCMS’s Cavalcanti, whose regular job is CEO of a robotics company, said that he noticed that the supply chain was broken five or six weeks ago. “I stopped being able to make robots,” he told me, “The reason why is because robots are collections of a thousand parts from a thousand different places all around the world.”
When suppliers are offline, he said, making something is not just “a hard problem anymore, it’s an impossible problem because most places can’t make specialized things.”
He realized that with medical supplies being already in low supply across the US, plus the supply chain being broken, there was a big problem. He gave this example.
“Let’s say, we have an N95 mask that is manufactured in the US. They might get one of their pieces of plastic from China. They might get another source of plastics from India. They might get elastic bands from somewhere else. If there are problems with any of those parts, then everything breaks. You stop being able to make the thing.
“What I was foreseeing was this issue where all the centralized manufacturers that are used to making millions of things because they have rock-solid supply chains that arrived just in time, all of that would break down. If you’re waiting for anything from India, the entire country just went into lockdown. You can’t get anything out right. It is going to cascade around the world.
“I was quickly seeing that the only way to supply people right now might be to make it ourselves. It might be for the makerspace down the block from the hospital to actually go ahead and make face shields for the hospital because the hospital has no face shields left.”
We Need Designs, Specifications, Standards, Documentation
Just jumping in and building something is kind of a stupid thing to do but a lot of makers do exactly that; in part, it’s just how they’re wired. That’s from Gui himself. “I’m an engineer. That’s what I want to do but it wasn’t the right thing.” Like 3D printers, it’s a good way to make one of something rather slowly.
To tap into the collective knowledge, you need to have documents — design drawings, specifications, requirements, industry standards. In any industry, these are widely available inside companies but not always shared in the open. Proprietary specifications protect industry IP but hinder open-source civic efforts.
FreeRead.org — The Fight for Open Standards
A group called FreeRead.org launched a petition on Change.org asking that international standards organizations “give engineers the Standards needed to build ventilators in fight against COVID-2019.” The petition reads in part:
The technical details that ensure the quality, safety, and efficiency of ventilators sit behind paywalls. Volunteer teams must pay tens of thousands of dollars for the needed Standards. In February, FreeRead.org petitioned academic publishers to remove paywalls for all Coronavirus science. Today, that science is free to read for everyone in the world. We asked loudly, and we were heard. Let’s ask again.
We ask the International Organization for Standardization (ISO) and The European Committee for Standardization (CEN) to give engineers the Standards needed to build ventilators (ISO 11.040.10 and all other needed codes).
We beg ISO and CEN to join ASTM, who released their Standards for Masks, Medical Gowns, Gloves, Hand Sanitizers, and Respirators in support of the fight to help medical personnel and save lives.
When standards are beyond the reach and the budget of civic innovators, it is as though they don’t exist and have to be re-created.
An Open Source Guide to Medical Supplies
“The goal of OSCMS has been to create a repository of vetted content,” said Gui. The group saw the need to create accurate content covering the description of a disease, how it’s treated and what supplies are used to treat it. For those supplies, they wanted to see open source alternatives. “A rural hospital, in the middle of nowhere, is not going to have the buying power of a regional system that can buy every single N95 mask that China ever makes,” said Gui. “They’re going to need options.” The effort led to the Open Source Medical Supplies guide (v1.1). It’s now well over 80 or 90 pages long.
The goal was also to support review of existing open source designs by getting them in front of medical and engineering professionals. “So if you go to our guide, and click on surgical masks,” said Gui, “you will find all sorts of mask patterns from all sorts of different people. You will find information on what a surgical mask does. You will find standards that apply to surgical masks.”
“It’s about enabling you to make your own solutions. The key issue for us is not just giving people the one answer that relies on the one supply because that’s quickly not going to be available in your area. Equip people with the knowledge of what they need to design in order to do this thing.”
A victory for OSCMS group this week was that the National Institute of Standards and Technology (NIST) distributed the open source medical supplies guide to their network of Manufacturing Centers.
Many Roles Available, Most of Them Local
One reaction I’ve heard is that for a new person visiting any of the groups, it is overwhelming. There are a lot of people and a lot is going on. It might be helpful to think of the many efforts as having several phases:
- Design and prototyping
- Deployment of solutions to places of need
Most projects right now are in the design and prototyping phase. Some have moved on to production. In each phase, there are potentially different roles and different people involved. There is no expectation that everyone is or should be a designer or engineer. As Gui mentioned, they have many different people with a wide range of skills. All can be useful and valuable. Relatively speaking, there are fewer people needed during phase 1 because that can be coordinated on a global scale. More people will be needed once there are designs ready for production and product solutions are ready for deployment, both of which must happen in every community. It will take many hands.
To support local organizing efforts, OSCMS has published a registry and guide for creating “well-coordinated local response teams.” Ja’dan Johnson, the OSCMS group’s communications lead, said that individual makers and others approaching hospitals themselves are likely to cause confusion and meet with some resistance. A “well-coordinated” approach establishes an intermediary group to work with hospitals and local officials. This group can develop a process for distributing vetted devices in the right places throughout a local community.
“We need to create resilient local groups,” said Gui. “It can’t be dependent on one person because that person is likely to get sick.”
“It doesn’t matter if you’re building things, if hospitals aren’t willing to accept them,” said Gui. “You need to have people who are talking to hospitals and making them comfortable with what you’re doing before they’re willing to accept them. And you have to have people who are finding out who in your community needs these things other than hospitals.”
The broader point for all Plan C efforts is that coordinated global efforts must connect with many, many coordinated local efforts for this work to have the intended impact.
Bill Hemphill and the ETSU Emergency Face Shield
One of the first things Bill Hemphill from an engineering department at East Tennessee State University told me about his face shield project was that simply getting the news out that there was a local solution has relieved “a lot of anxiety” in the community. I asked him why. He said hospitals, particularly in rural areas, were worried about running out of medical supplies like face shields and being behind everyone else in line. When they learned that a local university was capable of making face shields, they were relieved. One day, he said, a remote hospital in the mountains was panicking, tracking down supplies just in case they might run out; the next day, Hemphill said, after learning about his emergency face shield project, they were calmer. “They realized they were on the way,” he said “and they could get them.” He said it’s anecdotal but it’s the kind of impact he’s seeing.
A week ago, on a Saturday evening, Bill got a call from his boss, Dr. Keith Johnson, who asked him about making a 3D harness to attach face shields to a person’s head. The State of Tennessee had put out a call for 1500 MM headband units for face shields, which were needed in Nashville. Because Bill lives close to campus, he went in right away and started working. Three hours later, he had found a design, modified it and produced a prototype. He found “this flat-stock mask” design for the harness on his social media feed; it had standup pieces and used a tab-and-slot system to put the pieces together. “But it was cut from a single sheet,” said Bill. “And that’s when I said, ‘Oh wow, we can do this on a laser’ and knew we had plenty of stock.” Three hours later, he had modified the original design for use with standard hardware and produced a prototype.
Turns out, Bill had his own salvaged supply of plastic sheets. The product name is Tritan Copolyester, made by Eastman Chemical, an East Tennessee company. “Several years ago, they called up and said, ‘Hey, we’re getting ready to landfill a bunch of sheets,’” Bill recalled. “I said, ‘Bring ‘em over here. We’ll find a place.’ So we had 3,000 pounds of stock that I figured was a lifetime supply, and we’ve been churning through it.” A unique local supply chain made it easy and cheap for him.
He changed the slots into holes to use long screws that are standard hardware. Bill wanted a design that was simple enough to be made from supplies available at a Walmart or hardware store. “The strapping comes from a fabric supply store, and other than that, everything else comes from Lowe’s.”
Bill teaches CAD and CNC programming. “Since this is college, and I have adult learners,” he told me. “I’ll be honest with you, I have the best job in the world.” His lab has a water jet. He gives students a small project, designing bottle openers and cutting them out on the water jet. “Part of that design process is that students need to give me a layout of nested shapes on standard stock size.” Now students had a real-world project, a design that they could work on from home.
Bill made some demonstration units and showed them to the university’s director of emergency management, Andrew Worley, who told him that ETSU could start making them for the State of Tennessee. On Saturday, just under a week later, “We spent all day and banged out 500 shields in ten hours.” He got some assistance from another faculty member in another program who volunteered to come in because he “was going absolutely stark crazy in wanting to do something.” Bill taught him how to operate the controls on the laser cutter in five minutes.
Worley got together with the director of facilities to plan on-campus production. “[ETSU personnel] can make these face shields because the facilities folks are on standby and have free time,’” he told Bill.
The University President, Dr. Brian Noland, suggested that they set up production in the football locker room, noting that the team wouldn’t be practicing any time soon. So they are set up pilot production on Friday morning and by day’s end end had produced over 150 face shield assemblies. On Monday, they’ll begin producing shields using donated hardware and supplies. Bill wrote in email:
Within a few days, ETSU personnel created a system that, given raw materials and supplies, can now easily make 100+ units/8 hr day shift using just the existing on-campus “essential employee” skeleton crew in Facilities. Given the need, with volunteer staffing for 24/7 production, this could scale up easily to ~2,800+shields/week. And we are a school; a week ago, none of this existed.
Bill summarized his week this way:
I teach manufacturing. I teach CAD, CNC. I said we can do this. There’s no reason why we can’t. Once again, I took an existing design and now we have this design variant. The idea was to make it exportable and make it available for makers so that anybody who had access could make these themselves and feel like they’re making a contribution.
I asked Bill how he tested it. “My wife is much smarter than me,” he said. “She’s a PhD nurse and I showed it to her and she said ‘Yep, that’d work.’”
TEMPORARY link to the CAD data and the preliminary photos and early draft PowerPoint document: dropbox.etsu.edu/message/kFeBqPsBFmakK4EVVar3HP
Designing and Testing a Face Mask
The shortage of masks, particularly N95 masks needed for healthcare professionals, has been a challenge met by many groups. One is called FixtheMask. I spoke with Sabrina Paseman, an ex-Apple product designer with a mechanical engineering background, and David McCalib, ex-Amazon and co-founder of Printforia with a background in advanced manufacturing and fulfillment. David is the vicinity of Portland and Sabrina is in the SF Bay Area.
Sabrina gave me a wonderfully clear explanation of the problem and her solution, which was much simpler than I expected. She did her own hands-on research, examining the N95 mask.
“I was trying to break them down into their components and understand what makes N95 masks so good.” She found out that “they are made of this fabric called ‘melt-blown’ fabric, which is apparently very difficult to produce.” During her research, she learned from an NPR article that “China has maxed out the capability of all of their melt-blow machines, and they’re rapidly trying to make more melt-blow machines.” These machines work like a cotton candy machine. As someone explained to her, the machine has a big spool of plastic.
The same way that the sugar fibers attach to a sheet or a roll, the same thing happens with melt-blown fabric. So you basically have these very thin spindly fibers of plastic that attach onto a sheet. And what that does is it creates a matrix of a very fine, thin fibers that makes it very difficult for very, very small particles to get through.
She said it works as a filter for two reasons: One, there’s a number of mechanical things that a particle can do when it hits a matrix. It can either bounce off or try to go through and get stuck. There’s an electrostatic component too. Some of N95 masks are a little bit fuzzy on the outside. With that design, some particles that are charged will stick electrostatically to the fibers instead.” She added: “N95 means that it can filter out 95% of small particles, small as defined, as I believe, 0.3 microns or smaller.”
Her research also led her to wonder why surgical masks were any different than N95 masks. There are far more surgical masks available. She determined that both N95 masks and surgical masks were made of the melt-blown fabric, so their ability to filter tiny particles (95%) was the same. The major difference was the fit of the mask. The N95 mask if worn properly fits tight against a person’s face. The surgical mask is a loose fit that tends to leave openings on the side. However, she was able to verify from additional research that both types of masks are made in the US to the same standard. She told me:
So I saw one statistic on NPR that said we make 600,000 N95 masks per day. This is a while ago, so it might be different now, but they make 200 million face masks per day. By that statistic, surgical face masks are 300 times faster to make than N95 masks. So if we could utilize surgical masks that are tested to our standard efficiently, that is actually a solution for us to bridge our shortage.
The problem then was how to make surgical masks fit snug to the face of the health care professional? The challenge was to create a tight seal. She began brainstorming with two fellow engineers, Simon Lancaster and Marguerit Siboni. Wearing a surgical mask, she demonstrated holding her hand to the mask, pressing it against the face with her fingertips. “If we could just seal like this, wouldn’t that be great?” she thought, and began trying to mock things up, each one of them doing it at home.
The answer, which came to Sabrina, was something a kid might think of, and make, which is taking nothing away from her and the team for thinking of it. The idea struck her as “freaking perfect.” She held up the answer in her hands, as she must have first showed the team. Rubber bands.
So I put it over my face. I was like, okay, this will be great. I just need some string to tie it around my head. After I showed that to (the team), we had a fellow contributor say, ‘Why don’t you just link your rubber bands together like this?’ And you have a rubber band chain.
She demonstrated, putting a rubber band chain over her face, then connecting other bands on the side, behind each ear. As she showed me, I exclaimed: “So we have the surgical masks, rubber bands are everywhere and you can do it yourself.” “Yes,” said Sabrina. “You can do it yourself.”
After seeing the demonstration, I paused and then I asked Sabrina: How do you know that it works?
That’s exactly what we’d like to validate. We are hoping to run our solution through the exact N95 CDC standard as soon as possible. I’ve gotten a quote from one lab that will do it for us for around $6,000. We don’t have any funding, but, we’re trying to figure out ways that we can fork over the money right now just so we can get it in the queue to start testing. They said that once we get the money to them, it’ll take 14 days. So. It’s really frustrating, honestly.
They are trying to find alternatives as well. They want to do tests to measure the amount of air that’s leaking out of the mask. Sabrina was in the lab on Friday trying to build a testing rig using shower equipment, hoses and knobs and Teflon tapes and a pressure generator. They also 3D printed a human head to fit the mask for testing.
David joined the team because he saw the work they were doing and how they worked together. David is a maker who had built a Personal Air Purifier Respirator (PAPR) out of parts from Home Depot but decided rather than push his project, he’d get involved with the Fix the Mask group. “The speed at which the remote teams have been collaborating is blowing my mind,” he said. Sabrina said that she “brought the team together maybe six days ago and then it started becoming like a real thing five days ago.” She added: “The most fantastic thing is that every single person who has reached out to me about this project after I posted it has been so aligned to the vision that there’s no ambiguity.”
The Need for Testing
David and Sabrina both emphasized the need for labs to do testing. Sabrina sent me a list of the equipment that she needs to help test the solution. “The most important thing we are looking for immediately is a Bay Area lab with a high resolution flow meter, pressure gauges, and an air compressor, where we can test our design.”
We discussed the importance of testing and the need for people with specialized knowledge and equipment to be testers. After our conversation, David wrote about the need for testing, included below.
The Good, the Bad, and the Ugly Truth — WE NEED TESTING!
The DIY movement is powerful, innovative, creative and extremely useful, and when directed towards new ideas around PPE or medical devices development; this is Good!
The Bad — The current lack of testing capabilities and difficulty of having one source of truth to turn to for guidance. There are multiple examples where people have designed potential solutions, but without quantitative methods to test efficacy it gives a false sense of hope.
The Ugly — a false sense of protection might occur and people can put themselves at risk.
We need a solution to develop methods to test these innovative design concepts and quickly publish the results in a way that can act as a source of truth. This is almost as important as the act of designing itself. This is why I believe so much in the work that Sabrina and team are working on. They are taking a product with known capabilities and improving it, doing it Open Source and quickly.
We need a call to action, we need self-organizing resources and teams to help with Product Testing, in the right places, to help innovators like Sabrina Paseman effect change at the needed scope, scale and speed to halt this unprecedented pandemic! Let’s work together, but at a distance to fight Coronavirus!
You might wonder — it’s an emergency, just skip testing, and get it out there. Sabrina said that the main goal is to get this solution adopted by doctors as soon as possible. “We showed this to a couple of doctors, but the rubber bands put them off. DIY is cute but that’s not going to save us like against all of the dangers out there.” Testing is needed to convince health care professionals to trust this solution.
Or wait until doctors realize that in Crisis Mode, the CDC’s recommended solutions do not offer them much protection at all.
Health Care Professionals Are DIY’ers
While the medical establishment may be skeptical of DIY solutions, there are nurses, doctors, and other health care professionals (HCP) becoming innovators out of necessity. I credited this idea to Jose Gomez-Marquez, who really developed and documented these DIY solutions in the Little Devices Lab at MIT. The most famous, so far, is Dr. Marrone in Italy, who developed a splitter to share a respirator between two patients.
This is what we are down to. Splitting ventilators, and facing serious dilemmas like choosing who will be actually ventilated when everybody should. #TakeThisSeriously, bloody seriously.Never thought it was so bad. Thx to @PulmCrit for the inspiration and tips. pic.twitter.com/0aP7gaD9Er
— marco garrone (@drmarcogarrone) March 20, 2020
New York hospitals are preparing to use his solution, according to The New York Times, which seems to grasp the extremity of the situation, in the story: ‘The Other Option is Death’: NY Starts Sharing Ventilators.
In a Taiwan hospital, Dr. Lai Hsien-yung developed an “Aerosol Box,” a clear plastic box that fits over a patient’s head and allows physicians to safely perform endotracheal intubations. (Taiwanese doctor creates cheap protective device amid virus crisis — Focus Taiwan)
The California doctor I mentioned above, the one who said his hospital was about to go into Crisis Mode, was Dr. Randell Vallero, a gastroenterologist in Roseville. He had contacted me to share the PAPR he had built with his son. “I’m a physician and a maker,” he told me. “But I was a maker way before I became a doctor.” He and his family have gone to Maker Faire Bay Area for years, even exhibiting Halloween AV and robotic props in 2018.
He shared this Instructable for a PAPR that he and his son came up with. He explains how a PAPR works: It uses a motorized fan to pass air through a HEPA filter, which removes the contaminants and supplies purified air to a mask or hood. They made theirs out of a full face swim mask, tubing, computer fan, HEPA filter designed for a vacuum cleaner, and 3D printed parts, all powered by a 5V USB power bank.
A similar project in Italy using a scuba mask has received attention, but Randell said he and his son were thinking about how to create some kind of hood and realized they had scuba face masks, which he admitted had not been used much. “We used to think scuba masks were for people who couldn’t swim,” he said.
Randell will continue to make his protective gear if he has to, and it’s something he knows he can do. The doctors, nurses and other medical professionals are in the trenches, he told me. They are the soldiers and captains of this war, and they don’t have the supplies and equipment they need to fight it.
The Civic Response Will Continue to Grow, Exponentially
Bill Hemphill of ETSU not only knows how to make things. He knows how to respond to a crisis by taking action, like so many of the people I talked to for this article. Bill also recognizes the opportunity to get others involved and he’s talking to people who have the tools in a barn or garage to contribute to the effort. He wrote to one man who had read the local news story about the ETSU effort:
Documenting the process and getting out the word to others is key to engaging that hidden and latent community of makers (like yourself) who, given the materials and a plan, can do their individual, small parts and meaningfully contribute to ‘the greater good.’
Members of the community feel trapped and helpless/useless. Based upon phone calls, e-mails, and posts on social media, folks really WANT to be engaged and do something to help. Maybe they have a garage at home; they can fabricate one or two in-process parts feeding supplies to a centralized kitting or assembly operation (like ETSU’s). Maybe they can assemble products from kits at home on a card table in their den or on their porch. Or maybe they have the capacity to be somewhat vertically integrated and just need raw materials and a plan to turn out finished goods (like you would be with your barn/workshop).
If we are at war with a virus that spreads through a population exponentially, our population’s response has to grow exponentially. Civic participation, even from home, is “the most critical resource” (Lanier and Weyl) in this fight. The citizens of Plan C won’t be defined by the crisis but by their response to it.
In a crisis, a society can lose its humanity and spirit, but it can also renew itself by rising to the challenge. By creating leaders who act with purpose and vision, and making its people and civic institutions resilient and responsive, ready for any crisis, a better world can be salvaged from the old.
If you’d like to share your projects or ideas, write Dale at firstname.lastname@example.org.