On March 20, as the coronavirus situation in New York City headed toward a full-blown crisis, Madiha Choksi grabbed a taxi with two Flashforge 3D printers and as much filament as she could fit.
Choksi, a research and education technology librarian, had received an urgent email the night before from Pierre Elias, a cardiologist at NYP-Columbia University Medical Center. Elias desperately needed to make more protective gear for hospital workers who treated COVID-19 patients. He hoped that Choksi, the administrator of Columbia University's 3D printing laboratory, could help.
"The email was very long and very worrying," says Choksi The Verge. Usually she could help. "But I don't have printers," she recalls, "and we were already on the third or fourth day of remote work."
"The email was very long and very worrying."
Fortunately, Columbia handed over its printers. "Within a few hours, they said," Yes, of course, "Choksi worked on making prototype face shields in her home by modifying an open source design by Budmen Industries and the plastic visor that holds the shield and with a piece of foam-like material resting on her forehead, 3D printed between, and used supplies purchased from Staples to break up about six units, which she then passed on to Elias the day after she received the doctor's email.
"He took her straight to the hospital and tested it," she says, "and he came back and said," Can we have 1,000 more? "
Photo: response from the COVID manufacturer
The U.S. continues to struggle to respond to the COVID-19 pandemic at both the state and federal levels. For example, DIY efforts by academics, hobbyists, manufacturing experts and professional companies have joined COVID hotspots such as New York City to meet the needs of healthcare professionals and others at the forefront of response efforts.
Some of these initiatives are highly organized and involve partnerships across state borders to source materials and use industrial-quality manufacturing facilities. But almost everything started in the living quarters of people with access to a 3D printer and the ingenuity to put together emergency measures because the existing supply lines had difficulty keeping up.
“In a perfect world, we have nationwide coordination where we have hotspots, and we focus resources there to protect healthcare workers and patients. And if that wears off, we'll send what's left to the next location, ”says James Hudspeth, assistant professor of medicine at Boston University and COVID response manager at the Boston Medical Center.
"The sign reminds you not to touch your eyes or touch your mouth."
This ideal world is far from reality. Face shields, which Hudspeth says are rarely used in standard medical environments outside of surgery and very select procedures, were second in demand after face masks, which were also in short supply. “One way to get infected is to touch surfaces and then touch the face or mask. The sign reminds you not to touch your eyes or touch your mouth, ”explains Hudspeth.
The problem is that shields are only made by a limited number of manufacturers, some domestic, but many overseas. And large manufacturers only ship units in batches based on orders from procurement offices of large medical facilities, as well as from local and state authorities.
“We have a central supply and some states have the supply. However, it is not possible to determine where privately produced or purchased products are going, ”says Hudspeth. "States are fighting each other for this care, and every hospital in the country is doing the same." This has caused doctors, nurses, and healthcare workers across the country to get as much PSA as possible, regardless of where they come from.
"States are fighting each other for this care, and every hospital in the country is doing the same."
A face shield of the DIY variety typically consists of a molded or printed plastic semicircular visor, sometimes also called a holder, which is often attached to a piece of foam that lies on the forehead by gluing. The device is then attached to a long sheet of transparent plastic that is directly over the face.
Everything is held together with a rubber band or similar elastic device. This is an easy way to protect a person's face when interacting with a potentially COVID positive patient. These shields can be manufactured inexpensively, easily disinfected and then reused. Nor are they as complicated or tied to legal restrictions as breathing masks, for example.
The lack of regulations for face shields has made them an attractive option for large and small manufacturers looking for a way to get involved. In early April, Apple CEO Tim Cook announced that his company would make tens of millions of face shields for California healthcare workers. A tutorial on how to assemble the devices is now available on the Apple website.
Apple supports the global response to COVID-19. We have now sourced over 20 million masks through our supply chain. Our design, engineering, operations, and packaging teams also work with suppliers to design, manufacture, and ship face shields for medical personnel. pic.twitter.com/3xRqNgMThX
– Tim Cook (@tim_cook), April 5, 2020
In the Pacific Northwest, Nike, headquartered just outside of Portland, reused materials and manufacturing processes for its running shoes to make face shields. Countless other companies, from Jeff Bezos-funded Blue Origin rocket outfits to Alphabet's Life Sciences division, rely on resources to make emergency face shields.
Efforts are not limited to shields, but also extend to face masks and even ventilators. Razer, the manufacturer of game accessories, even built its own automated facial mask production line in Singapore, which was equipped with vending machines for distribution throughout the city-state.
It doesn't hurt that of all PPE that are in short supply during COVID-19, face shields are among the easiest to manufacture – a single unit can be made from basic materials using a 3D printer or even a laser or water jet cutter. "The nice thing about shields is that they are easy to make relatively quickly," says Hudspeth. "People with larger 3D printers and a relatively simple piece of plastic that is flexible enough to bend can make face protection."
Almost two months after receiving this first, desperate email, Choksi and her colleagues at Columbia University, Alex Gil and Moacir P. de Sá Pereira, are now conducting a DIY volunteer action called COVID Maker Response. To date, the group has assembled more than 19,000 face shields and distributed units to over 50 facilities, including hospitals, clinics, fire departments, and other groups of first responders.
The business is now almost factory-like in size and sophistication. They moved from Choksi's apartment to 92nd Street Y, a historic community center on Manhattan's Upper East Side. They have two official manufacturing partners: Tangible Creative, a 3D printing design company based in Newark, New Jersey, and Brooklyn-based 3D printer maker MakerBot.
Both companies supply the only 3D printed visor to which the shield is attached. After Choksi received the parts in bulk, a group of 10 to 12 volunteers, mostly medical students, assembled the shields in four-hour shifts and took them to hospitals by taxi or car.
Photo: response from the COVID manufacturer
Image: COVID Maker response
Gil and de Sá Pereira, both data librarians and scientists who specialize in areas such as data visualization and digital mapping, have experience of rapid crisis response during their academic careers. Now Gil is processing incoming face protection requests and spending the whole day communicating with hospitals. And de Sá Pereira helps manage the company's resources and ensures that Columbia's funds are used as efficiently as possible. The rest of her limited free time is spent helping other groups in the U.S. and overseas to start their own DIY operations.
"When this whole thing hit, the main thing in most of our thoughts was the lack of PSA, which was pretty shattering in those early days," said Jason Hill, an emergency doctor at Columbia University's Irving Medical Center. "In particular, I had a pretty crazy time overnight, very early, when I had to intubate," he says, referring to inserting a tube into the body, "in the middle of the night without one of the face shields. It was early and no one expected the rush to be so intense at that time, and we blew up all of our supplies during the day. "
Stephen Nicholas, a retired doctor treating patients during COVID-19, watched PSA deficiency quickly become a crisis of its own.
"After the first distribution, they were all gone immediately."
"I can't tell you how terrible it was," he says of the situation in late March. His hospital started using a special "777 Gold" emergency code over the speaker when a COVID-19 patient stopped breathing and immediately needed staff attention. The "gold" was telling hospital staff to wear adequate PPE because of the increased risk of infection, but the building burned through its supply of face masks at an alarming rate. "There were periods every 20 minutes that were heard overhead," 777 gold "."
Nicholas, a former professor at Columbia University, heard about Choksi's efforts through his daughter, a medical student at the school. Gil began to help the doctor coordinate face protection supplies for his colleagues. "After the first distribution, they were all gone immediately," says Nicholas. “The second batch was 200. I was no longer there in a day and a half. Next, there were 500, and that took about two days. “He says the lack of PPE is no longer a problem as most workers have their own shields that they can repair and hold on to.
Hill, the emergency doctor, also found his way to Choksi's group through word of mouth. As the crisis accelerated, every doctor realized that buying more PPE as soon as possible would be critical to the safety of healthcare workers. COVID Maker Response is now helping to supply its hospital with hundreds of these shields every week.
"Every few days, I will use some colleges to assess the need for our special emergency rooms and intensive care units. We will stop by and drop a box of about 200 of these face shields," he says. “When I walk through the emergency room, the vast majority of people I see wear these face shields. At this point it really feels like we have a surplus, which is a wonderful thing. "
"At this point, it really feels like we have a surplus, which is a wonderful thing."
COVID Maker Response is far from the only operation like this. Choksi and Gil tell me that they have had contact with at least three others in New York City alone and continue to send messages from others across the country and even overseas who are interested in doing the same.
Countless groups have also come together elsewhere in the United States, usually near schools and libraries that have the space and resources to set up these makeshift factories. Some, such as Washington's 3D Face Shield Hub and Illinois' PPE network, have taken similar approaches to coordinating massive, factory-like volunteer work, ranging from individuals in their homes to corporate partners and universities.
"It is not part of our model to become the only provider of face protection," says Gil. "The idea of this distributed base model is to help others do what you do so that a lot more distributed teams can come together to make an impact. Of course, this happens when neither industry nor city steps in."
Photo: response from the COVID manufacturer
A hurdle for PSA-producing projects is knowing when to stop them as more conventional manufacturing methods continue to increase. Choksi and Gil say they still get requests for more face protection every day, and the shortage will continue as long as the novel coronavirus continues to overwhelm the US health system and its hospital, as well as other frontline workers.
"I think we'll just keep going until the need wears off," Choksi says. "There are so many other efforts that we're hearing about, and until we get no more requests, our plan is to just keep going. Full steam ahead until the requirements are met."
For Choksi and her partners at COVID Maker Response, the willingness of her volunteers and partners to continue helping was one of the few glimmers of light in an otherwise terrible and often gloomy situation. She says that the maker community and 3D printing in general have shown that their expertise and ingenuity can fill gaps and help vulnerable communities in times of need.
From left to right, the core volunteer group consisted of Jess Ho, Rin Allen, Elisa Mala, Joe de Jonge, Madiha Zahrah Choksi, Rajat Sethi, Matt Car, Victoria Colozzi and Cullen O Brown.
Photo: response from the COVID manufacturer
“I think the situation really showed what 3D printing can do. This is not a long-term mass production, but a need for very fast production, tailored and highly customized items, ”said Dave Veisz, Vice President of MakerBot Engineering, who is now working closely with COVID Maker Response. “(COVID-19) has just shown vulnerability in the global supply chain. The fact that these parts are so urgently needed has opened our eyes, as has the fact that many of these parts come from only a handful of factories. "
Veisz says that under normal circumstances, you would simply inject a face mask design and have a factory rotated to mass produce it. "But these things take months," he says. "It has opened the eyes of the public that 3D printing can be used as an emergency solution for such emergencies and can be used to start production for the article."
According to Choksi, the novel corona virus was the situation that the manufacturing community is proud to come together to fight. "It is very well organized and mobilized, moves quickly and repeats itself. If there is an emergency, a crisis response is required, there is an open source file that is available to everyone," she says. "We are just humble and thankful that we use our minds and expertise and just go. "