Tuesday 14 April 2020

COVID-19 death statistics questioned and Dyson's ventilators still not approved.

The ONS will release more figures today on the death statistics in Britain for coronavirus victims.  It comes as some people begin to call into question the way in which the government compares our figures with those of other countries. This matters, not just because it influences the way the pandemic is managed but also politically too. If we do indeed finish with the highest death toll in Europe it will take some explaining.  Alberto Nardelli at Buzzfeed is one of the those asking questions.
The government has always claimed the comparisons are made on a like-for-like basis but in the official chart of Global Deaths Comparison, the number of deaths in the UK is those who have died in hospitals only (11,329). The figure for France is 14,393 but as Nardelli points out:

"The chart does say that due to reporting lags comparisons may not be like for like. However, the French figure includes both hospital deaths and deaths in care homes. So it's not just a reporting lag, but something else".

France publishes both figures, so you can actually do a more accurate comparison if you wanted to. The figure for hospital deaths from COVID-19 since March 1 is 9,253, quite a bit lower than ours. One wonders whether this is just an error or a deliberate attempt to make the figures more presentable. We shall see.

A few weeks ago there was a mad rush to get ventilators, with the government apparently ordering 10,000 from Dyson, a vacuum cleaner manufacturer, on 26 March. Note these are not the CPAP machines to aid breathing, but ventilators for intubated and sedated patients who are seriously ill. The BBC reported that Dyson had engineers ready to work night and day on it but units were not expected to be delivered quickly. The BBC said, "It is thought that even if regulatory approval is forthcoming, it could take a couple of weeks to move from prototype to the device being made in significant scale".

Nearly three weeks on and Peter Foster is reporting that not a single device has even been approved for use.
In the thread he links to the actual specification for ventilators as set down by the government, presumably via the NHS. You can see it HERE.

I am well used to reading initial specifications for complex systems but the one issued by the government for these ventilators would have most engineers of my acquaintance frightened to death. These are machines not for making or analysing something but systems with life or death implications for some people. They are not devices knocked up in a weekend. 

The specification combines medical gases, pressure regulation and flow rates, battery back ups, electrical and electronic systems all packaged together in a reliable, failsafe unit small and light enough to sit on a patient's bed but able to withstand being dropped on a hard floor without damage. It must be intuitive to use by medical personnel who are not necessarily experts in handling ventilators and it mustn't emit radio frequency or electro-magnetic interference either.

Four ISO or BSI standards are listed which bidders are asked to consider as "helpful advisory standards for now". The Medicines and Healthcare Products Regulatory Agency (MHRA) would apparently lead an exercise to define "which can be ‘safely’ relaxed for this emergency situation".

These standards are respectively 48, 28, 109 and 140 pages long. No doubt they will also refer to other standards and use terms that a vacuum cleaner maker will be unfamiliar with. They would take a week to read and get a shaky understanding of the issues involved.

Even if the bidders were given an existing design to dismantle and examine in detail they would have difficulty in designing a unit in less than months.  A real engineer probably wouldn't attempt it even if lives didn't depend on it.

It does not surprise me in the least that the companies coming up with designs haven't managed to get regulatory approval.

It is reminiscent of the film: Flight of the Phoenix where James Stewart flies a plane mackled up out of the wreckage of a crashed Dakota by Hardy Krüger. It's the sort of thing politicians and particularly British ones, managing directors, journalists and film makers think engineers can and do do.  They don't.

I daresay Dyson could do it - eventually and after several prototypes have been made and proven to work for months on end, without problems of any kind in a variety of different circumstances while skilled operators did their best to break it or provoke a serious failure. After that it might be approved for use.

On Dyson's Wikipedia page, the development of his first bagless vacuum cleaner took five years and 'about' 5,127 prototypes. This is for a vacuum cleaner.

The idea they could ever come up with a novel design and begin manufacturing quantities of life saving machines in a fortnight is fantasy. It is a surprise not that they haven't been able to do it but that they actually thought they could.

I would bet my life that the makers of existing units have spent years developing their systems, improving them step by step, gathering experience and honing the design to eliminate faults and shortcomings to get to a system or range of systems all approved for clinical use by regulatory bodies all over the world. This is what genuine engineers do.

This is all wrapped up again in British exceptionalism isn't it?  The notion that if we just put our mind to something we could produce a better design than anyone else simply with a bit of grit, determination and bulldog spirit.
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