Thread by @pmdfoster

So where have we got to on the great 'Ventilator Challenge'?

This week govt dropped support four more of the challengers; five more are 'under review'.

As things stand, none of the “innovative” designs has so far been cleared. /1Thread

ft.com/content/a60d3f…

The list of who's up and who's out is here.

You can see that Oxvent is now dropped, having been 'paused' when Bluesky was dropped back on April 11.

Must be very disappointing for them, having been at one stage told they were key to programme /2
oxvent.org

But things move on - there are less ventilators needed and, it turns out, the Challenge has had more success speeding up production of existing designs, like those from Penlon and Smiths. Some 260 Penlons so far delivered, 15,000 on order. /3

This isn't perhaps, major surprise. Indeed on March 16 Craig Thompson, head of products at Penlon warned that it was "unrealistic" to ramp up new designs because medical devices are "highly regulated" and can "take 2-3 years to develop and launch."/4

bbc.co.uk/news/business-…

Still, as the Govt points out, it had a three-pronged approach: ramp up existing production, source imports (856 imported so far, per Govt figures) and...try and make some new designs. /5

In the fullness of time there will, one suspects, be a public inquiry into the handling of the Covid-19 crisis which will look at everything from PPE, to testing and ventilators - and whether the UK performed worse than countries like Germany or France and what we might learn /6

The NHS has access to 10,900 invasive mechanical ventilators, that's 2,400+ since the start of the pandemic, though still below the government’s target of 18,000. /7

As it turned out, no-one in this 'wave' has gone short of a ventilator.

Not 100% clear why, but a combination of social distancing flattening the peak harder/faster than expected; more use of non-invasive 'CPAP' and maybe more deaths in community /8

So the NHS wasn't 'overwhelmed' but the new numbers incorporating carehome and community deaths do create some uncomfortably poor comparisons with EU countries. The inquiry will need to ask how avoidable these were if UK had moved faster on testing, PPE procurement etc. /9

On Ventilators the question will remain whether the UK Govt invested wisely it's time, money, energy and goodwill on trying to re-invent basic ventilators that - as it turned out - had questionable utility to the medical profession treating #COVID__19 /10

They will need to ask why the original specification circulated by the MHRA - the regulator - aimed so low. A machine that, at a minimum could last for "a few hours" and "in extremis" a day.

See this from MHRA's tech checklist sent to teams March 27 /11

It is true, as the Government says, that this was the 'minimum' spec - but less clear why the bar was aimed that low.

The government says the 'spec' reflected the opinion of intensive care medical professionals and the regulator. /12

We only know one doctor who was part of a teleconference on March 17 having inputs to the specification - @AlisonPittard of Faculty of Intensive care medicine - and she is clear that ventilators that lasted "a few hours" would be "no use whatsoever". /13

ft.com/content/365529…

@AlisonPittard So while it is true some were aiming higher, it is not clear why any at all were aiming so low - per that March 27 'spec' where the 'intended purpose' of the vents was to last for a few hours. The govt says it wanted transport vents - which is what Smiths device is /14

@AlisonPittard The govt also points to the fact that the original vent spec was for a “100 per cent duty cycle for up to 14 days” - but neglects to say that is a *mechanical* spec, not how long it supports a patient. No the 'intended purpose' was as stated. /15

@AlisonPittard The inquiry might ask how MHRA reconciled the specification that it promulgated on March 18 with what @AlisonPittard says she and her colleagues asked for, which is a vent that could support a patient through most of their stay in a Covid ward. Their statement is below. /16

@AlisonPittard The inquiry might ask why between March 18 and April 10, the specification was amended to prioritise higher-end functions? And why experts pushed for changes.

The government says it is "absurd" to say the MHRA put out a spec it doesn't agree with. /17

@AlisonPittard Why did the spec change? The government says the 'science' changed and understanding of #COVID__19 did also.

This is true, but back in March 17, @AlisonPittard is clear the science/medics didnt ask for that super-basic vent spec. Those positions are not yet reconciled. /18

@AlisonPittard The inquiry will also need to ask how much money spent on these innovative projects, some of which had manufacturers pre-investing in parts and production capacity. Probably a drop in bucket in the grand scheme. Govt is promising figures at some point in the future. /19

@AlisonPittard The government has already spent 3,000 words explaining its side of the story - you can read it here in full. How many questions it really answers, the inquiry, when it comes, will have to decide. ENDS

gov.uk/government/new…