'The project hasn’t gone as quickly as we'd have hoped': Ventilator deadline pushed out again

The deadline to produce 20,000 noninvasive ventilators has been pushed back for a third time, with the National Ventilator Project (NVP) running a month behind schedule.

Medical experts, both independent and within the health department’s ministerial advisory committee (MAC), said that every day lost could see people’s lives hanging in the balance.

The machines — pivotal for treating those seriously affected by the virus — will be built by as many as six companies or consortiums that responded to a call for proposals ahead of the national lockdown.

The first 1,000 units are due to be delivered to hospitals by the end of July or early August.

Not only are the ventilators needed to treat those in severe respiratory distress, but they use less oxygen — an increasingly scarce commodity as hospitals fill up.

A source on the MAC said noninvasive ventilators are of vital importance as hospitals in Gauteng, KwaZulu-Natal and the Eastern Cape are reaching capacity.

“The project hasn’t gone as quickly as we would have hoped, but that is true for many things in this pandemic,” said the source.

In May, the department of trade & industry said it expected delivery of the 20,000 ventilators in the first week of July.

Spokesperson Sidwell Medupe said delays with the initial “optimistic” timeline were to be expected.

“Within a space of four months we have gone from zero to the first units of fit-for-purpose ventilators coming off production lines at companies that had not previously manufactured such devices.

“South African engineering and clinical ingenuity has pulled off what even the most advanced countries have struggled with,” he said.

He said the first contract for 10,000 ventilators has been awarded to the Council for Scientific & Industrial Research (CSIR), with negotiations under way to finalise contracts for a further 10,000 units.

The noninvasive ventilators — easier to use than normal mechanical ventilators — use continuous positive airway pressure (CPAP) to force air into the lungs.

The Western Cape health department said the locally produced machines will come too late and are no longer needed in its hospitals.

 Spokesperson Mark van der Heever said the province has already ordered 80 machines outside of those produced by the NVP and “we do not envisage requiring any additional ventilators”.

Health department spokesperson Popo Maja insisted only 700 ventilators will be needed by the time the peak arrives. That will augment the current stock of 7,134 mechanical and invasive ventilators in the public and private sector, he said.

Barry Schoub, professor emeritus of virology at Wits University and former head of the National Institute for Communicable Diseases, said hospital capacity is greatly threatened in this “explosive phase” of the pandemic.

“Securing equipment like ventilators, oxygen and PPE [personal protective equipment] will be critical,” he said.

“Think about the field hospitals; they too will need equipment like ventilators because the current hospital capacity is close to full.”

Professor Guy Richards, head of critical care at the Wits School of Medicine, said noninvasive ventilators provide a more efficient method of treatment, which relieves pressure on oxygen stocks.

The current treatment method for Covid-19 patients struggling to breathe is placing them on high-flow nasal oxygen, and when that fails, invasive ventilators.

“The CPAP systems could be employed anywhere, as long as there is infrastructure to run them. High-flow nasal oxygen is not possible for a large number of patients because it places strain on oxygen supplies,” he said. The noninvasive systems use four times less oxygen.