The last time anesthesiologist James Nilson went backpacking, he probably didn’t expect to be using a camping technique later in the operating room.
“I've been living in the woods, backpacking and hiking my entire life. So, you know, there's a lot of adaptations that you make when you're out in the woods that call upon your ability to just be a little bit creative. And that seems to be holding pretty true in a career as an anesthesiologist as well,” he said.
Nilson belongs to a group at Tufts Medical Center nicknamed the "Apollo 13 Team" because it has been tasked to come up with innovations to fill gaps in medical supplies and personal protective equipment. One of the group's innovations is a splash guard — modified from a piece of camping equipment — to protect staff when a patient needs to be put on an oxygen delivery system.
Tufts is just one hospital where doctors are channeling their inventive side to battle the pandemic. In Boston, Mass General Hospital announced the launch of its COVID Innovation Center in April. At Beth Israel Deaconess Hospital, a pathologist started an open-source project to come up with a better, cheaper nasal swab for coronavirus testing.
A short supply of tests, protective gear and equipment has led medical professionals around the world to come up with creative ideas to fill the medical supply chain gap. And the global nature of the pandemic, experts say, is driving a shared sense of purpose, leading to collaborative efforts that not long ago would have been hard to imagine.
“This notion of both the necessity and call to action coming together to drive breakthrough is precisely what we're seeing today," said Karim Lakhani, a Harvard Business School professor and co-director of the Laboratory for Innovation Science.
The protective shield that Nilson helped develop at Tufts contrasts with the traditional technique used with patients on oxygen. While other hospitals are using a plexiglass box placed over a patient’s head, the Apollo 13 Team thought this method isn’t ideal because patients must lie flat, and the boxes aren’t flexible.
“Typically you want to have them with the head of the bed elevated 30 degrees or greater to help improve their ability to oxygenate. So those boxes didn't really make a lot of sense to me," Nilson said. "We started exploring alternatives. And that's when we started talking about this idea that's been used in the backpacking industry for quite some time.”
The idea came from the bivy sack — a lightweight alternative to a tent that serious backpackers shelter under when sleeping out in the elements. Nilson and his equally outdoorsy colleague, Dr. Pavan Sekhar, took some PVC tubing and a large plastic bag typically used to cover ventilators and jury-rigged it into what they now call a "splash bivy."
The tubing arches the bag about a foot and a half above the patient’s face. The sides of the bag are tucked under the mattress. The entry point for the physician or nurse is at the top of the patient’s head.
“It creates kind of a big open hood over the patient. And then at the end of the bag that now sits over the patient's chest, that can just kind of be tucked under the patient's blanket. And that’s it. It’s as simple as that. It’s just one step better than throwing a plastic bag over a person's head,” Nilson said.
It's cheap and could protect hospital staff and the room from contamination. Nilson says the splash bivy has been used for various procedures and surgeries, including an open tracheotomy on a COVID-19 patient.
At Beth Israel Deaconess Hospital, Dr. Ramy Arnaout, a pathologist, noticed in March that the hospital was dangerously close to running out of testing swabs. He immediately started coordinating an open-source project on GitHub, mainly a software development platform owned by Microsoft, to design a new nasopharyngeal swab for coronavirus testing.
“This is a work of, I don't know how many, probably a couple hundred people now, including very many people at the BI and elsewhere. And we've only gotten this far and as fast as we have by people sharing credit and not taking it,” Arnaout said.
This nationwide team, all working remotely via the GitHub repository, came up with more than 150 novel swab designs made of 45 different materials. They whittled the list down to four prototypes. Nasal swabs don’t require FDA approval.
This collaborative effort included Beth Israel’s next door neighbor, the Wyss Institute for Biologically Inspired Engineering. In a little over a month, they went from ideation to 3-D printed prototypes to scaled production. The end result: a nasopharyngeal swab that’s cheaper and faster to make than traditional swabs because the entire device is made of the same material. The swabs are now being used in short human trials at hospitals in New York and Arizona. The Wyss Institute said the trials are expected wrap up by the end of this week and the data will be used to inform larger trials with COVID-19 patients.
Richard Novak, a senior staff engineer at Wyss, said the open collaboration is why they were able design and manufacture the swab so rapidly.
“There were CEOs of companies talking to technicians, talking to faculty and everybody in between," Novak said. "The open aspect was really important.”
Meanwhile, IPB Inc., a California-based medical device manufacturer, has been working around the clock to ramp up production of the new swabs to reach 200,000 per day by May 15.
Novak said the company was willing to take on the risk of manufacturing an open design without possessing a license to produce it.
“IPB basically said, ‘Okay, we'll just do it. Here's our schedule, and this is what we think we can make. And so, they really just took it on, and it was great,” Novak said.
IPB, Inc. told WGBH News that the new swabs, including sterilization and packaging, run about 60 to 70 cents apiece. An online search shows traditional testing swabs start at approximately $1 each — if any are in stock.
Lakhani said he isn't surprised by the cheaper price.
“Innovations from the crowd tend to be cheaper, faster and better than their traditional competitors. And it's this mixture of new creativity, new ideas, rapid prototyping, rapid testing and the integration of the user in the process which yields these outcomes,” Lakhani said.
The term “open source” dates back to the 1990s, when software developers freely shared their designs with each other, contributing to the infrastructure of the internet.
“The software industry has forever changed because of this. But now in the physical space, in the space of instruments for physicians, for PPE and so forth, we've seen the same dynamic come through. And I think that should tell us that there is a wellspring of innovation and creativity that exists amongst frontline workers,” Lakhani said.
At Brigham and Women’s Hospital, dermatologist Sherry Yu helped modify an open source design for a piece of PPE.
“We had a community member reach out to us from BoroBot, who noticed the open source design from Prusa out of the Czech Republic and wondered if he could help us produce some 3-D printed face shields,” Yu said.
The makerspace community in Middleboro 3-D printed some prototypes for the hospital. The clinical and infection control teams at Brigham and Women's made some modifications, and thanks to several local partnerships, they now have several hundred reusable protective face shields. Yu says scaled production is now in the works, and the hospital has also made their new design freely available so that others can use it.
There is no time for trade secrets in a health crisis, especially when everyone is a stakeholder.
