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THE GIST of Editorial for UPSC Exams : 29 April 2020 (Breathing easy on ventilator quality (Financial Express))

Breathing easy on ventilator quality (Financial Express)

Mains Paper 2:Health
Prelims level: Ventilator
Mains level: Process to increase the production of good ventilators to increase the survival rate of COVID 19 patients

Context:

If one were to name the one hallmark feature of the 21st century, we would venture to say it is innovation.
Our modernity enables us, more than ever, to make, for instance, better predictions.
That because of the fundamental reason is technological advancement, which has now enabled us not only to generate humongous volumes of data but also to collate this and make sense of it.

What are we to do?

The first step towards solving a problem is identifying it. The critical challenge, obviously, is developing a vaccine against the disease.
With researchers and scientists already engaged in this, success is not a matter of possibility, but merely one of time.
However, until then, we are faced with more immediate challenges, which it is imperative we resolve as soon as possible. Let us take a look at one such critical problem.

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The crisis:

When Covid-19 broke out of China, it caught the world off-guard.
Its impact has sent nations into lockdown, while hospitals and medical centres teem with overwhelming activity.
As front line healthcare professionals, supporting staff and public servants work tirelessly to tend to infected masses, the world was woken up to a realisation.
Most of us were not prepared to deal with a health crisis of such catastrophic levels.
This realisation was triggered by shortage of an equipment that is an essential tool in our collective battle against the deadly virus—the ventilator.

Need to increase the supply of ventilators:

Boosting the supply of ventilators across the country and the globe is essential to setting the world on the path to resuscitation.
Covid-19 poses the most risk to individuals with respiratory challenges since the virus targets the lungs.
In the worst-case scenario, the virus can lead an individual to develop acute respiratory distress syndrome (ARDS).
Most ARDS patients need the help of a machine to breathe—this is where ventilators come into the picture.
A mechanical ventilator pushes air into the lungs and forces some of the fluid out of the air sacs.
Another key step in caring for ARDS patients is supplying them with supplemental oxygen. Thus, doctors also leverage ventilators to optimise patients’ blood oxygen levels.

Finding the perfect ventilator:

A ventilator, at its most basic, is any instrument penetrating via the mouth (endotracheal tube), nose, or skin (tracheostomy tube through a stoma, a surgically-created hole in the windpipe) to serve as an artificial airway.
In the absence of such machines, doctors may have to use a manual resuscitator called a bag valve mask, or an Ambu bag, which forces air into the lungs of patients who are either not breathing or not breathing adequately.
This cannot be used to help critical Covid-19 patients as it is not suitable for continuous use and needs a highly-trained operator to make use of it.
A good ventilator design must keep the health of caregivers as a primary consideration.

The best bet:

In the wake of the pandemic, most countries have stopped exports of medical equipment, and all global ventilators have been snapped up. Even components for ventilators are in short supply.
In India, the cottage industry has inevitably been stirred into action, with every other player claiming to have a ventilator that can meet present needs.
In their understandable desperation, driven by the grief of the human tragedy underway, local authorities, government bodies, and corporations are pumping capital into procuring sub-standard products.
This, instead of advancing our struggle, is forcing us to take a step back.

How, then, do we hit the mark amidst all this noise?

We need to move cautiously and home in on the answer by a calculated process of elimination.
Although we are engaged in a race against time, jumping the gun is not an option.
We need to make an informed decision by considering valid factors so that we can identify and pick a solution that represents the best of not only the modern industry, but also the modern age.
We cannot afford to treat our ‘suitable ventilator’ as a mere electronic item—it will be a high-precision product of the combination of top-class engineering efforts, optimum manufacturing capability, and robust financial backing.
Hence, while scrutinising a ventilator, we need to ask: Who has designed it? Who has manufactured it? Will the product stand the test of time? Can the company maintain the product over the next 3-5 years—not only until our battle with Covid-19 is won but also beyond, for future emergencies?

Ideal strategy to improve survival in Covid-19 patients:

The ideal strategy to improve survival in Covid-19 patients while preventing lung injury is invasive mechanical ventilation with low tidal volumes and high levels of positive end-expiratory pressure.
• This primarily aims to provide oxygen, remove carbon dioxide, decrease the work of breathing, and reverse life-threatening conditions such as hypoxemia, or insufficient oxygenation of arterial blood.
• As much as low ventilator inventory is a grave concern due to its shortage being directly proportional to the mortality rate, the absence of a suitable ventilator design is equally worthy of consideration.
• And, we can generate a fair idea of what an ideal ventilator looks like, and of what it can do.

Conclusion:

• A good ventilator must be a high-precision product, a combination of top-class engineering efforts, optimum manufacturing capability, and robust financial backing.
• Hence, considering the lineage of the company creating the new-age ventilator is crucial.
• The good news is that India, the third-largest startup ecosystem, is well-equipped to breed such innovators.

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Prelims Questions:

Q.1)With reference to the food security in India, consider the following statements:
1. Under the National Food Security Act (NFSA), the PDS covers 100% of the population in rural areas and 80% of the population in urban areas.
2. Over 10 crore people have been excluded from the Public Distribution System (PDS) because outdated 2011 census data is being used to calculate State-wise National Food Security Act (NFSA) coverage, according to economists Jean Dreze and Reetika Khera.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2