The International Medical Education Trust 2000 (IMET2000) has joined forces with key healthcare stakeholders in the UK and overseas to help fight COVID-19. For the time being, we must assume that the virus will defy any vaccine immunity generation and that too many people are non-compliant to give hope that prevention can follow a test and trace campaign.
We are therefore developing a management, care and treatment programme for infected patients, regardless of age, which treats the virus and avoids having to put seriously ill patients on invasive ventilators. In the UK, we have worked closely with senior colleagues at University College London (UCL), who have developed the UCL-Ventura CPAP respirator. It is the premier choice of the UK’s National Health Service and has already proved itself in more than 120 hospitals. It has also had widespread international uptake.
The UCL-Ventura CPAP received approvals from the UK medical devices regulator under the emergency scenario of COVID-19. Since March 2020, IMET2000 has raised funds for:
- WHO-standard PPE
- purchase of UCL-Ventura CPAP respirators for the Middle East, Uganda, Bengal, Ghana and India
- purchase of more than 500 disposable breathing circuits for delivery of oxygen to patients
- training by our dedicated staff of many additional (over 600) healthcare workers in basic life support and critical care of COVID-19 patients using our respirators and mannequins
- purchase and delivery of essential toiletries and sanitary products for patients infected by COVID-19.
We support not only hospitals and centres dedicated to the treatment of COVID-19, but also other outlying hospitals and small clinics in rural areas that are often ill-equipped to cope safely with infected patients. Based on experience and UK recorded data pulled together by the UCL Intensive Care Teams, combined with IMET2000’s experience overseas, we have created an advanced model of critical care for COVID-19 patients. We will pioneer it in a few selected hospitals in the UK, then launch it globally for low-resource countries in the Middle East, Africa and Asia.
Few hospitals in low-resource countries have Intensive Care Units (ICUs) with ventilators, or staff trained to international standards to run them efficiently. Existing staff are dedicated to other urgent and life-threatening conditions, and few are available to cope with a surge in COVID-19 cases.
Furthermore, even in well-funded health systems, survival rates after invasive intubation for oxygen delivery to ventilators are low (in the UK, it is running at 50%). In poorer health systems, it is likely to be worse. Experience in the UK and other advanced medical systems has clearly demonstrated that ventilators should be the very last resort for this particular coronavirus. Instead, early access to high concentrations of oxygen is essential, either delivered by nasal cannulae or by constant positive airway pressure (CPAP) respirators. These are non-invasive and deliver pressurised oxygen via a tight-fitting plastic mask to inflate the lungs. In the UK, the use of the UCL-Ventura CPAP respirator has been shown to reduce the number of seriously ill patients progressing to mechanical ventilation by 50-60%. This is consistent with COVID-19 data from China and Italy.
Building on Success
IMET2000’s experience in the Middle East over the last six months has shown that low-cost solutions are needed to reduce the fatality rate still further. The UCL-Ventura respirator itself is low cost (less than 10% of the price of a mid-range ventilator), durable and simple to use. It is supplied with a portfolio of testing and training materials, requires minimal maintenance and will continue to play an important role for certain categories of patient long after the pandemic is over.
So the issue is clear: How do we make more UCL-Ventura respirators available in all hospitals, large and small? There are three main problems for low-resource countries and outlying hospitals: The cost of the disposable breathing circuits, which can only be used for one patient; the cost of oxygen; the availability of oxygen.
Our project sets out to tackle all three problems using a system-level, integrated approach. It includes inexpensive medications to improve survival rates still further and avoids potential long-term sequelae of severe infection and long periods spent on ventilators.
To address the issues outlined above, we have collectively agreed on a project that we believe could be a game-changer in our response to the coronavirus pandemic. The project comprises:
- The urgent purchase of 50 UCL-Ventura respirators to be evaluated in several challenged health systems. At greatly discounted cost to IMET2000, together with disposable breathing circuits and an oxygen rate controller for each respirator (£2,000; on a non-profit basis, covers materials and manufacture costs), we are budgeting £100,000.
- Development of re-usable breathing circuits. Currently, these circuits must be disposed of after just one use. They comprise tight-fitting plastic masks that are placed over the patient’s face, connected via easily inserted and frequently changed filters to plastic tubing to the source of the oxygen. Each single-use circuit costs about £68, so treating hundreds of patients soon becomes costly, to say nothing of supply-chain constraints. Professor Shipley in her UCL laboratory, together with our colleagues at Cardiff University and Northwick Park Institute for Medical Research, are therefore working on ways of using chemical sterilisation to make the circuits safely re-usable. We are hiring experts in this field and will need at least three months of work to be sure we have cracked the problem. If successful, the savings for small hospitals already struggling financially will be substantial.
- Improving oxygen delivery. In low-resource settings, a plentiful supply of oxygen for COVID-19 patients is likely to become a growing problem. Cylinders are expensive, as is refilling them at frequent intervals. Oxygen concentrators, which take in air and remove pollutants and nitrogen to leave only oxygen, are more reasonably priced, but are not able to supply high enough flow rates to CPAP respirators, so we need to design, engineer and produce a new model at low cost. Professor Shipley of UCL has taken this on board as a major IMET2000-funded project. If successful, it will be enormously important globally, not just for this COVID-19 pandemic, but for likely future events too.
- An advanced training programme. Based on the experience of UCL’s Department of Intensive Care, of Dr Zaben at University Hospital in Cardiff and the IMET2000 team that he leads in many countries, we have put together an advanced training programme for face-to-face and online training. It includes all that has been learned about COVID-19 over the last nine months, including low-cost medications such as dexamethasone and critical care nursing.
By building a model to manage patients suffering and dying from the coronavirus and trialling it in the UK and low-resource countries overseas, IMET2000 can bring value to all countries facing military conflict, severe economic deprivation or (as in this case) natural disasters. In this pandemic, we are all afflicted at great cost. Since March 2020, IMET2000 has spent more than £200,000 on COVID-19 related projects and child mental health projects indirectly impacted by the pandemic. We have been in emergency mode, either treating COVID-19 patients in the Middle East (Palestine, Jordan, Syria and Lebanon) or simply trying to head off predicted waves of infection in Africa and Asia. Now we intend to harness all that accumulated expertise, together with that of experts at UCL and elsewhere in the UK, to pioneer a model of management that will offer immediate benefits to the health sectors in both the UK and in poorer countries where IMET2000 is active.