Radio Cade

Everything You Need to Know About the Ventilator Shortage and COVID-19 (Part 2 of 2)

April 08, 2020 Radio Cade Season 1 Episode 74
Radio Cade
Everything You Need to Know About the Ventilator Shortage and COVID-19 (Part 2 of 2)
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Radio Cade
Everything You Need to Know About the Ventilator Shortage and COVID-19 (Part 2 of 2)
Apr 08, 2020 Season 1 Episode 74
Radio Cade

Moving COVID-19 patients from one ICU to another is possible thanks to transportation ventilators.  In the second of two episodes on ventilators, James Di Virgilio talks to Dr. Richard Melker, Professor Emeritus of Anesthesiology at the University of Florida College of Medicine. He holds over 25 issued U.S. patents including several for emergency medical devices in use throughout the world,  and by the US Special Forces. 

Show Notes Transcript

Moving COVID-19 patients from one ICU to another is possible thanks to transportation ventilators.  In the second of two episodes on ventilators, James Di Virgilio talks to Dr. Richard Melker, Professor Emeritus of Anesthesiology at the University of Florida College of Medicine. He holds over 25 issued U.S. patents including several for emergency medical devices in use throughout the world,  and by the US Special Forces. 

Intro:

Welcome to a special two-part edition of Radio Cade . We'll be discussing COVID-19 and ventilators. In part one, we visit with Dr. Sem Lampotang. And in part two, we visit with Dr. Richard Melker. We hope you enjoy the program. Inventors and their inventions. Welcome to Radio Cade a podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade , who invented Gatorade in 1965. My name is Richard Miles. We'll introduce you to inventors and the things that motivate them, we'll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

James Di Virgilio:

Welcome to a special episode of Radio Cade. I'm your host, James Di Virgilio. Today we're going to be covering mechanical ventilation and its effect on the COVID-19 crisis. Mechanical ventilation is a life-saving therapy that is used extensively and modern intensive care units. The origins of modern mechanical ventilation can be traced back five centuries ago to the seminal work of Andreas Vasilis really the founder of modern human anatomy. Joining the program now is Dr. Richard Melker. We just had him on the show very recently. He is the professor emeritus at the Department of Anesthesiology at the UF College of Medicine. We touched on ventilators last time you were with us Dr. Melker, COVID-19 had not taken off yet like it is now. We want to talk with you about ventilators. I know you have a story about how you got interested in them. Welcome to the show. And tell us a little bit about that story.

Dr. Richard Melker:

Well, thank you. Yeah, I think using a chronological order will allow people to understand how we got to the sophisticated ventilators we have today, and also as to why we don't have enough of them. So I went to medical school and graduated in 1974 and did my residency in pediatrics at a hospital in Los Angeles called Harbor General Hospital. It's now called Harbor UCLA Medical Center, but most people would never recognize the name of the hospital, but the hospital had another name called Rampart General. And Rampart General was a hospital used in a TV show called The Emergency. And back in the days, when I was doing my residency at Harvard General Hospital, they were filming this show and using my hospital as where the patients were taken by ambulance. And I was doing my residency and realize that when the paramedics came in, they really had no understanding about children. So I went to the chairman of my department and I said, you know, Los Angeles County has one of the best EMS systems in the United States. It was one of 12 systems that was a paramedic system at the time. And I said, if I can spend some time with them, I would like to write some material that they could use for training paramedics on how to care for children. And my chairman was all for it. So every Friday at 12 o'clock, I would leave the hospital and I would go to ride with the paramedics for the rest of the day. And the fire station that they were using on television was actually the fire station that I worked out of with the paramedics. And by the time I completed my residency and was ready to move to Florida, I had written a textbook some information on how paramedics should care for children. And so I had filled a gap that one wouldn't think needed to be filled, but it was very clear that it was because this information was shared around the United States. So I came to the University of Florida in 1977, and I did a fellowship. And during that fellowship, which means I was already a licensed physician and I spent two additional years doing pediatric cardiology and critical care medicine. And I was fortunate enough at the University of Florida to work in the critical care division with some of the most brilliant faculty who were developers of some of the original ventilators that were used, both for adults and for children. And when I completed that fellowship, obviously I knew a lot more about ventilators. And when I started and I became the medical director of the Alachua County EMS system, and I started riding on the ambulance with the crews, or I would carry a radio and I would meet them at the scene of an accident or whatever the medical issue was. And what I realized was that on the way to the hospital, they were ventilating patients. And I'll describe ventilation in a moment. I'll define it for you. They were ventilating in patients with what was called the demand valve. And basically many of your listeners would be familiar with a lot of demand valves like scuba gear. When you want to take a breath, you breathe in and the valve gives you as much air compressed air as you need. And when you're filling your lungs with air, then you exhale. And the valve closes so that it's not wasting gas. And you're only using the gas when you need it. Another example of a demand valve is a fireman where these face masks, which have a demand valve built into them so that they can go into a fire and their faces are covered and they're breathing air from a cylinder. And so they're not breathing in all the toxic fumes and everything. So anyway, the demand valve that was used for all these other applications had been modified so that you could use it to ventilate a patient. So what are you trying to do when you have a patient who's not breathing on their own or breathing inadequately? What you're trying to do is to push gas into their lungs. And in order to do that, you have to use a pressure higher than the ambient pressure. So you push the button on the demand valve and it forces oxygen into their lungs. And when they exhale outcomes the carbon dioxide, that's building up in their blood. So when you ventilate somebody, you give them oxygen under pressure. And then they usually passively the lung recoils and outcomes, the carbon dioxide. So that's what a ventilator does. And a ventilator is different than a respirator. And the terminology right now is getting very confused. Respirators are devices that the user is breathing normally, and either it filters the air or serve some other purpose, but it's driven by the normal breathing pattern of the patient who's using it. So when you and I are breathing like, while we're talking, now I take a breath in and the pressure inside my chest is lower than the sea level pressure that we're at. And therefore a gas goes into my lungs and that requires muscles, the respiratory muscles for that gas to get into my lungs. The gas comes out when you stop breathing in because the chest wall and the muscles recoil and the gas comes out. So a respirator is a device where the user is breathing in and out. Now a ventilator is a device that does exactly the opposite if using positive pressure forces gas into the lungs of the patient, and then they exhale. So some people say you inhale and you exhale. And other people use the older terminology where you're really then is inspiration. But unfortunately when you breathe out, it's expiration. So you're expiring. And with what's going on now, and other terms we went to inhalation and exhalation because of the poor connotation of the word expired . So I'm now at the University of Florida. And I I'm looking at these devices that the paramedics are using. And I was fortunate to have many colleagues, like I said earlier, who had a lot of background in the development of ventilators. As a matter of fact, some of our faculty helped develop the baby bird, which in early 1960s was the first ventilator designed specifically for neonates and these people at the time were in the military. And they developed the baby bird with a scientist and aviator by the name of Forest Bird. So anyway, one of my colleagues, a respiratory physiologist , and I went into the laboratory and studied how this demand valve that they were using on the ambulances works . And what we found is that when you push the button, it would drive gas into the stomach because the resistance to the gas was lower into the stomach than it wasn't to the lungs. And another problem with it is that it had a peak pressure because everybody was afraid of over pressurizing the lungs. So as you push the button and the pressure went up, the flow of gas would go down. And so it became very apparent that what was needed in what's called the prehospital arena or the military theater was a ventilator that worked just like the ventilators that we were using in the hospitals. And so with a number of colleagues and I, we developed and actually produce a number of portable ventilators, which is generically called transport ventilators. And so we spent the next couple of years writing papers and doing the research and looking at different transport ventilators. And we liked to believe that we helped advance the development of more and more sophisticated transport ventilators.

James Di Virgilio:

So with regards to transport ventilators, we can look at this like other ventilators your innovation story from start to finish, you said was several years, correct?

Dr. Richard Melker:

Correct.

James Di Virgilio:

Okay. Where we are now with regards to ventilation, let's bridge these stories, and we just talked with Dr. Lampotang and he was saying that the FDA of course, is relaxing some restrictions that exist, that I'm sure you were facing fully when creating your transport ventilator to allow for these new designs to come into play. So in the arena of ventilation, the question everyone is asking is why don't we have enough ventilators. They're academic studies that are from the early two thousands that suggest that in a surge situation, we won't have enough of them. Hospitals could not possibly afford to have all the $50,000 ventilators, but they could have cheaper solutions on hand in the event that this happens. So why do think we haven't done that? And should we have even done that in the first place? Maybe we should have waited until we had an event. What are the answers, I guess, to these medical innovation questions when it comes to crisis predictable crisis maybe? Not really sure.

Dr. Richard Melker:

So, as you've mentioned, the ventilators that are being used in the hospitals to care for these patients are extremely sophisticated. The permutations and combinations of settings on these ventilators are mind boggling. And these are extremely expensive devices because they have electronics in them. And they have a lot of other features and they're made in relatively small numbers as we have unfortunately become aware of. And so when we started working on transport ventilators, we actually had companies come to us that were contracted with the military to develop ventilators for use in the battlefield scenario. And I know of ventilators that some of those companies made for the military exclusively, which I am sure in the right patients would be more than adequate to ventilate them in the hospital. Now, one of the interesting things that we're learning and most of this information is coming from Italy because unfortunately they were severely hit by the virus and undermanned to care for the tremendous number of patients that they saw. But the lung injury that we're seeing with the COVID-19 virus is very different than the lung injuries that we normally use these highly sophisticated ventilators for, and I'm not doing clinical research anymore, but it would seem to me that because this lung injury is different and it doesn't require some of the high pressures and sophisticated techniques that are used in the intensive care units, that some of these ventilators would actually be excellent ventilators for the properly chosen patients. As a matter of fact, the doctors in Italy assumed that the lung injury was similar to what they had normally encountered during their practice. And they initially set up the ventilators so that they could treat these patients. And they found that the patients were doing very poorly. So some very good scientists who were also clinicians did some studies using CT scanning and showed that when they set up the ventilator to ventilate these patients with the normal settings that they were using, they were over inflating the lungs. And what happens when you're over inflate , the lungs, your heart can't push blood through your lungs. And so one of the major findings that the Italians found and obviously is now well known everywhere. They're treating patients with COVID-19 is that you don't have to what they call positive end expiratory pressure. In other words, you don't need a lot of pressure to keep the lung from collapsing. And as a matter of fact had deleterious effects on the patients.

James Di Virgilio:

Very interesting. I don't think I've seen even a single article yet that has talked about that in detail with regards to that, which to me immediately raises another question. In my professional life, I'm an investor. And all my years of studying have led me to believe that predicting things as humans is often a fool's errand, we think we know the solution to something we say here's variable, A and variable B, variable C will be this, which then creates something called a three body problem. For those of you listeners who enjoy things like that, where you really don't know what the third variable is going to be. So oftentimes in my life, I've found that reacting quickly tends to be the best way to handle something. What you're saying is interesting. Here's a different situation. Although we could have predicted a surge event, maybe we would have spent a lot of money building ventilators that wouldn't necessarily work , or in your case, we actually already have ventilators that you were saying solve this problem. Now the question is producing them. So with your ventilator specifically, is it difficult to get the parts to make your ventilator? Now, if you had to mass produce your ventilator, could it be done or is there not enough supply of those parts?

Dr. Richard Melker:

So there's several answers to your question. Number one, there are a couple of companies that have mass produced ventilators for the military, and I've not kept up with them. In other words, when they were developing those ventilators and wanted to know what features had to be in those ventilators for use by the military, that's where we were involved. But I've actually met with the president of the company a couple of years ago at a special forces meeting. And they were selling ventilators like crazy to the military. And I personally believe that those ventilators have features in them that would make them more than adequate to care for many of the patients with COVID-19. So I don't know how many of those ventilators the military has stockpiled, but you asked the second question, which is equally as important. So, these sophisticated ventilators, and even these less sophisticated transport ventilators or field ventilators have lots of parts of them. And we can tell every company in the United States to start making ventilators, but there are only a certain number of the key parts for those ventilators. And so right now, and I've spoken to several people. In other words, there are chat rooms and a lot of different ways that I keep up with my colleagues who are still doing research on ventilators and parts has become a real problem. So, I'll just give you one little anecdote. When I was at the University of Florida doing my fellowship, we wanted to transport patients from other facilities to our facility. And there was a brilliant respiratory therapist by the name of Paul Blanche. And he went and built a ventilator. And because it was a one off, it did not have to go through FDA certification. We'll just skip that whole story. And he built a couple of Blanchlater. And when the helicopters service came into being at the University of Florida, we would transport patients from other facilities to our facility using the Blanchlater. Now the Blanchlater's a little box, you know , size of a shoe box. The ventilators that they using in the hospitals weigh several hundred pounds and they're huge. And by now you've probably seen plenty of pictures of them. So the Blanchlater at our hospital was what we use to move patients from the operating room to the intensive care unit or from the intensive care unit. So you have an MRI done because you can't bring an MRI machine up to the ICU or from the ICU to a CT scan. So, our hospital had a Blanchlater, a couple of them for these unique transport situations. Well, it turns out that Paul's little ventilator was so good that he formed a company with a gentleman who had been involved in ventilator companies for his whole career. And they started manufacturing this ventilator and went through FDA approvals and everything. And they were selling and are selling a considerable number of these ventilators every year. But they've got an order from the government for 10 times that. So, from one day where you've got all your parts and everything to build ventilators at the rate that your company is building them to suddenly have to make 10 times or a hundred times that number of ventilators, where are the parts going to come from? Where are the components going to come from? And that has turned out to be part of the issue. So I don't personally believe telling general motors to make ventilators is going to solve our problem because they have no inventory. What we need to do is have the companies that are making the ventilators maximize, you know, maybe go to three shifts a day, do whatever they have to do to make more ventilators, but it's getting the components into the companies to assemble into a ventilator. So, you asked the key question , are we going to continue to make $20,000 ventilators, which after this is over, hopefully are gonna sit in storage somewhere, or are we better off looking at some of these other ventilators that are not quite as sophisticated, but require less parts? FDA clearances is a lot simpler. And I don't really know the answer . When I heard about the ventilator shortage, I just started scratching my head and calling up my colleagues who still are either working with her consult with the companies that make the ventilators. And they said, the problem is parts. The problem isn't that there aren't people to make ventilators. The problem that they have identified is that everybody needs parts at the same time. And because these are expensive products and you're only turnover a few ventilators a year in a hospital. Normally, in other words, over the past, I would say decade or two people have used ventilators a lot longer than they used to so that they don't have to buy this capital equipment, which is so expensive. So, the one thing that I see missing, or that I haven't heard about is who are the people looking at the alternatives to $25 - $30,000 ventilators, because I'm sure knowing friends of mine and colleagues who build ventilators, that they don't have to be that sophisticated and understanding the underlying lung disease created by this virus who had made me believe that you don't need quite that level of sophistication.

James Di Virgilio:

Well , I think you're definitely articulating that correctly. Dr. Lampotang was telling us that his ventilator could probably get 60% of the capacity, the ability of , of the $50,000 ventilator. And it costs him $300 to make it. It's also rather disposable, right? The parts are a hundred total dollars plus other stuff. So hospitals could just throw a part of it away and spend a hundred bucks to get another one. So you don't have to worry about issues when it comes to the ventilator cleanliness or transmission of disease, interesting stuff. But I think that raises the next question that you're touching on, which is complicated and it has to do with supply and demand. So why 15 years ago, did we not produce a lot of ventilators? Well, one, you still had the same supply and demand issue. You didn't have enough supply to make enough of these $50,000 ventilators. And to what you said is also true hospitals, can't simply outlay lots of capital to buy ventilators because for every ventilator they buy, that's something else they can't buy. They have to steward their funds correctly. And only in the event of a surge, would you need even enough of these ventilators? And like we just talked about, you may not even need the Cadillac ventilator. So now what are we to do? If there's no supply for the ventilators that we know how to make, what happens next, incomes, someone like Dr. Lampotang, in comes someone like you and your story noticing a need, and then fixing that problem, creativity, innovation come in, they take the place of going on, but sort of this rigid structure. Hey GM, Hey 3N, Hey, go make these things seems great. Sounds good. But it's not really even possible as you are mentioning. And I think the good news is, as you've said, continually, especially from a medical perspective, there are other solutions and these other solutions not only work in the U.S. but they can help people across the world that don't have the same resources we have to hopefully effectively treat their patients. And the transport piece. I want to touch on that because this is interesting, right? We know in New York city, we've got an issue. We have all these patients in ICU's and in hospitals. And if we have to get them from one hospital to the other one, and they're on ventilation, how do you get them there? In comes the transport device you're mentioning, if we have enough of these transport devices, Dr. Melker, are we then able to help efficiently spread out our COVID-19 cases to get use of ICU beds and other maybe even States that aren't being utilized. Is that a realistic transportation alternative?

Dr. Richard Melker:

The answer is clearly, yes. The provisor is can the companies that make those ventilators gear up quickly enough to dramatically increase the number of those ventilators that are available, or are they having the same part problems that we are a lot of our components aren't even made in the United States anymore. And we all know the story about why that's happening. Let me give you a little anecdote, which always brought this to my attention right after 9/11, I was starting to work with a company up in Bowling Green, Kentucky to make a detector for a drug that we use for anesthesia. And the original application of that detector was to detect nerve agents. So it was used by the military and developed by a brilliant scientist. And he formed his own company because he couldn't get anybody to fund it. So he built his own company. I mean, that's what you call entrepreneurship. So anyway, he was making these detectives for nerve agents for the military. After 9/11, he got called up by the military and was told every component that you need to make these 24 hours a day, seven days a week. So we can have them in the subway systems. We can have them anywhere where nerve agents might be used to kill Americans. You have priority for everything you need. And what he did was put together a list of the components and the companies that were making the components. He went to three shifts and within two months he was shipping a hundred to a thousand times as many of these detectors systems. And they're still running today in the New York subway system and all over the United States. So that's what the system is geared to do during a warfare situation. The government can tell people who have components that are needed to protect the American people, that they must supply those components for the good of the country.

James Di Virgilio:

Indeed. And we saw that invoked multiple times this week, really by the president with regards to the dope act, right? And vote on 3N and whether or not you think it's good for the president to be able to have such a power or not something you're saying remains true, which again comes down to that wall of supply and demand. And in your story, there were enough supplies to be able to ramp up in the ventilator story if there's not enough supplies, the beauty of entrepreneurship and human innovation is, creativity allows us to tweak things or find alternative ways to do it, to get maybe almost all the way there, and sometimes even improve the situation that we are in which I think is just an interesting story of people, right? And that comes down to whether you think as a society, we should predict ahead of time, what's going to happen, stockpile things, or you think, Hey, we can very quickly respond to what's happening, tactically. And that's the most efficient way to do it. Those are obviously debates for a different style podcast , but I want to ask you a medical question. Obviously, you think about things. You are the director of EMS, you've run departments, hospitals. When this starts happening, COVID-19 comes on board, they're meeting, they're getting together. They have disaster plans . What if we have overflow, how much overflow do we have? Where can we send people in the event of a shortage? These are the types of exercises that are being done by hospitals across the country, correct?

Dr. Richard Melker:

Correct

James Di Virgilio:

And then in the event of an actual shortage, do you feel like the hospitals would be able to work with let's like, let's take Gainesville here with private practices and say, well, you've got a certain bed because you're an into an ICU and Shand's has doubled the surge capacity. Or do we feel that we still even utilizing all of the available rooms , space, buildings we have would not be able to handle a surge. Are we that deficient when it comes to facing something like COVID, or is there a way to plan to be able to expand our capacity?

Dr. Richard Melker:

So the United States has had repeated warnings that this was going to happen. We had SARS, and then we had the middle East respiratory syndrome and epidemiologists, and the military have been telling our governments. This is just a matter of time. We lucked out with SARS. Ebola was kind of a different story. It killed people so fast that you had a ventilator the next day, but particularly the Coronaviruses. And remember, we're not even talking about an attempt intentionally to harm the American people with a biological weapon. This was just a mutation that occurred in a virus, which every year people would get upper respiratory infections with. But it mutated this time into a virus that we have absolutely no natural defenses for. So if you read what epidemiologists have written, the United States has not paid enough attention to this. And I know everyone wants to believe that we have the best healthcare system in the world, and that could be a debate for a show by itself. But we got caught with our pants down. We were very slow to react. We did not, and still today have not on a national level, done all the things that we have to do to minimize the loss of life. And I think there are people in the administration now who are going people aren't listening to us. We, you and I are sitting in the state of Florida and our governor, our governor did not issue look orders, and still, it appears somebody has to twist his arm to get him to do anything. Now, I don't want to get into the political reasons for that, but when you have an epidemic like this, where days matter and accumulate down the line in deaths, every governor in the United States on the first day should have issued proclamations that people need to stay at home, social distancing, everything else. And the proof of it is that where that was done in the United States, we're going to have far fewer deaths than in areas of the United States, where the governors waited and to say on national television, that you didn't know that there could be asymptomatic carriers of this disease after everything that all of us see every day in the news is beyond my comprehension.

James Di Virgilio:

Well, you raise a lot of the current points that are going on right now. Obviously, why did we not prepare for this? Why are we slow to react to it? You can study the Spanish flu, right? Influenza of 1918 to see that very much the same things happened. We have cities like St. Louis that instituted social distancing, and actually largely avoided a lot of the significant deaths that other cities at the time like New York didn't do. And then we have this one, which is different. The benefit of COVID is it's a lot less deadly for people without underlying conditions that are young, very, very deadly for those underlying conditions. How do we respond? What do we do? But here is something, and for me, I should full disclosure I'm a very small government person. I believe in people taking care of what they can reacting locally reacting quickly. But I think you have to look at what the government spends money on and say, what's important. You know, we've spent $1.5 trillion on a fighter jet program that is basically still defunct, 1.5 trillion. And I don't even agree with the idea of stockpiling things for the future because we can't predict the future. But at the very least, if you're going to take taxpayer dollars and spend it, you would think spending it on the health and welfare of your citizens would be a potentially important thing to do. And here we are, like you said, in this quagmire, because it's a rope, right? If we pull too far in one of the rope, we're going to lose the economy, we're going to have a depression. You're going to have difficult things. And if you pull too far, the other way, too many people are going to die and we're stuck with this very difficult, complicated problem to solve. And now the question is looking forward, what do we do? And I think what's interesting about today's discussion with you and Dr. Lampotang is obviously people, real people, you and I, and others that have real expertise that can help are able to find solutions to these problems. If we can empower them to solve them right now. And what you said is true right? Every day, we wait to react to what we now know is real, is a day that we're wasting. And I think that maybe is the saddest narrative out of all of this is there's a lot of voices out there, but unless we're able to react to something quickly and less and less cooler heads can prevail to address the problems, what are we left with? What do we do? Where do we go? So in your opinion, are we at a critical risk right now with hospital capacity? If we get surged, are we to the point to where we wouldn't have alternatives or solutions to be able to treat people, is it as bad as some people say it is?

Dr. Richard Melker:

So I would say that in Gainesville, I can only speak about Shands, but Shands is prepared. In other words, we've had enough time in Gainesville to know what works and what doesn't work. So for instance, whoever was the first person who said, you know, we have all those anesthesia machines that have a ventilator in them. We can jury rig the anesthesia machine and turn it into a ventilator. Okay. Well, if you have 26 ORs , you just got 26 ventilators. Okay? And I'm not going to talk much about the issue of sharing one ventilator with more than one person, because that's a quagmire, it's been tried, they tried it in Italy, they're trying it here. And as you know, the news reports, what they're told and by and large, most reporters, even reporters who focus on the healthcare field are not going to have the level of sophistication to know which of these things are gonna work and which ones aren't, but I'm scratching my head a lot and going well, that wasn't a good decision. But if we talk about North central Florida, I can tell you because I get the emails every day that Shands is prepared. I think South Florida, with the elderly population and so many people living in high rises, where the only way they can get up and down is in an elevator, which is just an incubator for the virus. I think South Florida is in huge trouble. And I believe that the time that we've lost is going to translate into a huge number of deaths. I mean, it's a horrible thing to say, and it's a horrible thing to even believe. But I was trying to put all of this into something that I could write for lay people to understand. And I think I'm correct. And if I'm wrong, somebody is going to let me know. But despite the fact that we have the first amendment and we have the freedom of speech, if you yell fire in a movie theater and there isn't a fire and somebody gets injured, that's not covered. However, if there really is a fire in a movie theater and you run out and don't tell anybody else, don't pull the fire alarm, don't, you know, there's a fire, you have no liability. And so, you know, I'm thinking, well, what are we going to do to these governors who didn't respond appropriately to the threats , but you really can't because the fires occurring and they didn't do anything about it. So when I was thinking of some way to put this into terms that people would understand, because there are so many people now who are fearful of the government, they're fearful of the information they're getting. They're getting mixed signals every single day. In one news conference, you can cut different people. Different speakers can contradict the person who spoke just before them. How are the American people going to understand the seriousness of this and the fact that not only can they die, but if they're young and relatively healthy, they can be responsible for the deaths of many, many people and never know it to me. It's just frustration. You wake up every morning and you go, Oh my God, we're just not doing it right. We are not taking this seriously. We are so behind the eight ball. And there are a million reasons why, and I think some of them are legitimate. And I think a lot of them aren't legitimate, but that doesn't matter. The simple fact is we have to a very large extent, created this scenario.

James Di Virgilio:

A lot of things were said there that I think are echoing. What a lot of other experts are saying. I want to ask you this. What do you make of having to deal with limited information, right? Because on one hand you take information. We have the data I'm looking right now at NYC Health's, daily data summary on Coronavirus deaths and in New York city. Right now we have 26 people that have died with no underlying health conditions. We have 1400 that have died with underlying health conditions. If people look at the data and they say, well, I have no underlying health conditions. I'm safe. I should be out there developing herd immunity while the at risk patients should be isolated or staying away. What do you say to that solution? Or is that nonsense? And it doesn't matter what happens to economies or work life, we have to do this to save lives. Like what's the scale? What I'm not hearing people tell me is what's the scale? What percentage are we looking at? If we isolate a certain part of the population versus everyone, 20%, 30%, 50%, what's the prudent course of action. I think I would hope right, most Americans want to do what's best for everyone. I want to do what's best for my neighbor. And what's best for the world around me. How do we know what the right course of action is given maybe some of the difficulty of interpreting the data, what's the right move in your opinion?

Dr. Richard Melker:

Okay. First of all, you're asking the question that is the most difficult to answer. And the one that keeps me awake at night, but let's look at what happened in China and whether we believe they're true statistics, or we don't believe their statistics. And we think they should have notified the world sooner, which I believe they should have. What they did to control deaths was taunting . If you look at other countries and we haven't talked about testing, and I think the biggest single failure of the United States healthcare system has been the screw up of telling people, anybody can get a test anytime they want over two months ago and today, not even being able to do surveillance so we know how to answer the question that you just asked. But if you look at the countries and they're not all dictatorship , so they're not all totalitarian South Korea because they tested and identified very quickly those patients with the virus and quarantined them they have kept their death rate extremely low. Okay. Now, what did it take to do that? What rights in the South Koreans give up to do that? Not nearly as much as what we're going to give up, having not done it. Singapore is a very interesting country as anybody who's ever studied, their governmental system would know about, Singapore has also managed to have much better control over the spread of the virus. Now the Philippines pick out a slightly different take on it. They're just going to shoot you. So we're not going there, but we do have examples of countries that have reacted quickly. And in my opinion, appropriately, and the key to everything was testing. Knowing who had the virus and who did now, what do you do once you have that information is the question you're answering. And I don't know the answer, but for a very short period of time in England, they decided that they were going to go with the herd immunity we're dealing with this and they very quickly gave that up and they're in big trouble now. So I think the big problem with the herd immunity solution is that not only are we going to wipe out the elderly population and I can see a lot of younger people going well, that's Medicare, that's all the things that I didn't want to pay for anyway. But the reality is that younger people are dying as well. And I don't think people appreciate the fact that what we call elderly today. Isn't that elderly. I was thinking the last couple of days, because I'm in my seventies now. But if I died 10 years ago from whatever, cause what technology I developed after that that's being used like crazy now we'd never had been developed. And so I don't know the answer to your question, but I just, in my gut have this feeling that the herd immunity solution isn't going to work. It sounds like a good idea. Now there's a piece of news that came out today, which obviously your listeners won't hear today, but it's very interesting information from Scripps Institute in California. And what they did is they got an individual who had the original SARS Coronavirus back in 2002. And they took the blood from that person. And they found that that person still could have immunity to Coronavirus and that the antibodies in the blood of that person actually worked against the new novel virus. Now, if that pans out, that means we may have, because the antibodies are so similar and we now have the capacity to replicate antibodies very quickly. We have the potential maybe of getting to a vaccination very quickly. Now, I'm sure there are a lot of differences between using an antibody that's already developed versus most vaccines are either killed or attenuated bacteria or viruses or organism that you're trying to develop immunity against. But it's really exciting to me that somebody who had the original SARS still has immunity 18 years later. That's a pretty good vaccine.

James Di Virgilio:

Yeah, I'd say so. Right? And this is SARS II something that I think has gotten lost from this.

Dr. Richard Melker:

Yeah. I don't think people realize that the original name was SARS COVID II. We've seen this picture.

James Di Virgilio:

Right. We got a glimpse and it didn't, as you mentioned get transmitted as far

Dr. Richard Melker:

And the messenger came and we shot.

James Di Virgilio:

We did. And I think what's interesting is the conclusion for me is the data, right? If you talk about innovation, you talk about entrepreneurship. You talk about moving humanity forward. That always has to come from good data. You can't improve something unless you understand how something works and why it works and why maybe it could work better. And I think that's the big problem that we have as you said, is without the data, the thesis of, Hey, let's let the younger people go out. It looks like healthy, young people aren't dying. Let's send them out into the world. Could be a good one the thesis of keeping everyone apart from each other could be the best one. The real problem is like you said, what do you do when you don't know? And that's where I think you see this middling response. And certainly it's something we actively could have done much, much better was to figure out who has it, who doesn't have it give clear messaging to those that have it to stay away. We dropped the ball on that. Something you mentioned, we'll be on our next episode, we are going to talk all about vaccines and vaccinations, which is obviously the big solution to this problem as far as mitigating the top end risk. And obviously Dr. Melker, thank you for joining us today. Great discussion on a wide range of topics. We appreciate your efforts in the field of medicine, as well as in the field of ventilators. We know that your expertise has been very helpful and hopefully will continue to help those as we go through this. Thank you for joining us on the program today. It's been fantastic.

Dr. Richard Melker:

I enjoyed it also, and I hope that we move forward more quickly to resolve these issues. Thank you again.

James Di Virgilio:

For Radio Cade, I'm James Di Virgilio.

Outro:

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida . This podcast episodes host was James Di Virgilio and Ellie Thom coordinates, inventor interviews, podcasts are recorded at Hardwood Soundstage, and edited and mixed by Bob McPeak . The Radio Cade theme song was produced and performed by Tracy Collins and features violinist, Jacob Lawson.