COVID-19: Why we need an open and distributed health system

3D printing and the merits of a decentralized economy

One of the most reassuring and impressive aspects of our current pandemic is the rapid mobilization and coordination of scientific research and initiatives. While this is primarily medical research and collaboration, it also includes non-medical scientists, engineers, and inventors, who want to contribute however they can.

This is crucial, as it provides an example of why decentralized responses are far more effective then those that require centralized control or coordination. Especially given our recent research around potentially increased pervasive health surveillance and it’s use by a predictive AI panopticon.

There will be incredible pressure, from governments and institutions, to centralize our economy and society as we move further into this crisis, and yet there is growing evidence we should do the opposite. That distributed systems are the natural response to our current predicament.

A great example of the power and efficiency of distributed systems, are the people who have proficiency with 3D printing and open source design, coming forward with their own ideas on how to expand the capacity of health care systems. Finding cheap and resourceful ways of expanding the supply of assistive and medical devices.

At the top of the list, are ventilators. Essential equipment in the fight against COVID-19, and yet in short supply. Can a distributed innovation system address this shortage better than a centralized supply chain?

Project Open Air is one of many projects that are emerging to address the shortage of ventilators. It reflects a desire to be involved, to not feel helpless, and to find a way to contribute meaningfully.

However what we see in these initiatives are seeds of a distributed innovation process that facilitates invention, and also distributed manufacturing. In using open source designs and manufacturing techniques, there’s reason to believe that this phenomena can quickly spread to areas around the world that need it.

She explained that the hospital in Brescia (near one of the hardest-hit regions for coronavirus infections) urgently needed valves (in the photo) for an intensive care device and that the supplier could not provide them in a short time. Running out of the valves would have been dramatic and some people might have lost their lives. So she asked if it would be possible to 3D print them.

After several phone calls to fablabs and companies in Milan and Brescia and then, fortunately, a company in the area, Isinnova, responded to this call for help through its Founder & CEO Cristian Fracassi, who brought a 3D printer directly to the hospital and, in just a few hours, redesigned and then produced the missing piece.

This particular success story inspired makers around the world to start organizing, coordinating, and creating a distributed supply chain in concert with health care organizations making necessary tools and devices more available.

Although as is often the case with impromptu or open source initiatives, conflicts started to emerge with the existing proprietary world of medical equipment.

Even worse, this activity attracted the attention of zealous lawyers:

Business Insider Italia explains that even though the original manufacturer was unable to supply the part, it refused to share the relevant 3D file with Fracassi to help him print the valve. It even went so far as to threaten him for patent infringement if he tried to do so on his own. Since lives were at stake, he went ahead anyway, creating the 3D file from scratch. According to the Metro article, he produced an initial batch of ten, and then 100 more, all for free. Fracassi admits that his 3D-printed versions might not be very durable or re-usable. But when it's possible to make replacements so cheaply -- each 3D-printed part costs just one euro, or roughly a dollar -- that isn't a problem. At least it wouldn't be, except for that threat of legal action, which is also why Fracassi doesn't dare share his 3D file with other hospitals, despite their desperate need for these valves.

And if you're wondering why the original manufacturer would risk what is bound to be awful publicity for its actions, over something that only costs one euro to make, a detail in the Business Insider Italia article provides an explanation: the official list price for a single valve is 10,000 euros -- about $11,000. This is a perfect example of how granting an intellectual monopoly in the form of a patent allows almost arbitrarily high prices to be charged, and quite legally. That would be bad enough in any situation, but when lives are at stake, and Italian hospitals struggle to buy even basic equipment like face masks, demanding such a sum is even worse. And when a pandemic is raging out of control, for a company to threaten those selflessly trying to save lives in this way is completely beyond the pale.

While this is indeed beyond the pale, I’m not sure such trolling will be effective in our current climate. Rather if there was ever a time to violate copyright or patents to save lives the time is now. The moral imperative is such that we should not worry about proprietary technology but instead pirate what we must and open source the rest.

This is where I’m happy to report that this is happening, in many forms, all over the world. For example, check out this arduino based open source ventilator:

Pete Florence@peteflorence
Do you want to help? Open-source project for low-cost, Arduino-based, partially-3D-printed ventilator:
github.com/jcl5m1/ventila… This is to address the potential case of COVID-19 hospitalizations depleting all FDA approved ventilators. Started by Johnny Lee. Plenty help needed.

In the event that COVID-19 hospitalizations exhaust the availability of FDA approved ventilators. This project documents the process of converting a low-cost CPAP (Continuous Positive Airway Pressure) blower into a rudimentary ventilator that could help with breathing during an acute respiratory attack.

I know that a few of my subscribers are people who have CPAP machines. This might be a way to create your own at home ventilator?!

If we get to a point that our health care systems are so overloaded, where imperfect applications like this become our only option, not only is it better than nothing, but the ability to produce these in a distributed manner is incredibly important.

Part of the reason we’re in the precarious situation we are, is because we do not have a distributed health care system, and instead have a brittle system that has key points of failure, and limited resources.

What we’re seeing a glimpse of, as a result of distributed manufacturing and network based innovation, is the potential of a decentralized health care system, that could have significantly greater capacity and resources.

The arduino based system above is meant to be as cheap and easy as possible, however there are more advanced initiatives underway that are moving quickly to develop open source solutions that are more robust:

This is what I love about open source, there’s no need for exclusivity. People can simultaneously organize and design their own open source ventilators. The more the merrier, and the more distributed, the faster these designs can emerge and be employed in health facilities all over.

Although it’s not just about ventilators, what about the shortage of face masks?

This low cost mask, soon to be trialed at the University of Leicester in the UK, was originally developed for the swift diagnoses of tuberculosis (TB). Researchers say the device has the potential to save millions of lives across the world every year through early detection of a range of serious respiratory infections and diseases.

It uses a simple duck-billed face mask adapted using 3D printed strips that can trap exhaled microbes while the mask is worn for 30 minutes. Using the mask to screen for Coronavirus could allow very large groups to be checked at once, potentially helping to curb the spread of the virus and preventing long stays in quarantine. Current diagnosis involves taking swabs from the throat and nose, and deeper respiratory samples. The samples are sent to secure labs for testing, which can take up to 72 hours.

Mike Barer, Professor of clinical microbiology at the University of Leicester, said:

“Coronavirus is spread from the mouth, throat and respiration system of infected individuals. This new approach is exciting because it could help us determine whether a person is infectious or not, even before symptoms of the virus have appeared.”

There are so many initiatives underway, that it’s hard to keep track of them all. Luminary Labs is nonetheless trying to track what’s going on, or at least doing their best:

While their priority is around new approaches to testing for COVID-19 there is a long and growing list of initiatives that does offer reason for hope as well as evidence that distributed systems are far more efficient and responsive than centralized ones.

Similarly all of us who recognize that open source is the best way of enabling and distributing technical knowledge are mobilizing to organize a new process of producing necessary medical equipment:

For the most part, I’m fairly bearish when it comes to how this current pandemic will play out, and how long it will take to be resolved. In a recent Canadaland episode I argued we should be prepared for months of isolation rather than weeks.

However open source initiatives like the ones described in this issue give me hope. If this kind of open collaboration continues, we could be looking at 4-6 months rather than 12-16. That’s a big difference.

I think this difference will come down to centralized or distributed. If as a society we fetishize centralized control, then this crisis will last far longer than if we learn the lessons of decentralization as found on the Internet.

Open source FTW!