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Medical Devices

“I never dreamt that I would actually be living through a pandemic,” said Deanne Bell, an engineer, television host, and founder and CEO of the education technology company Future Engineers, in her introductory remarks at the forum. “I remember the first time going to the grocery store when covid-19 happened, and the shelves were depleted. I didn’t want to make eye contact with anyone. I questioned the safety and security of my own mask. There were so many unknowns. It was new, it was real, it was scary.”

Yet the world responded quickly, spurred on by scientific research and engineering creativity. “It’s crazy to think about how fast all of this has happened,” Bell said. “Innovation at speed. We were in a race, for sure.”

PROTECTIVE GEAR

The most immediate need was for multiple forms of personal protective equipment (PPE)—such as face masks, face shields, gloves, and gowns—for healthcare and other frontline workers. One of the most successful short-term approaches for meeting this need was additive manufacturing, also known as 3D printing, Walt observed. 3D printing made possible the rapid prototyping of design alternatives and the mass manufacturing of devices such as face shields and masks.

Engineers also designed technologies to sterilize PPE so that it could be used multiple times, reducing the pressure on supplies, along with

devices such as personal protective booths and patient isolation hoods that could isolate healthcare workers from patients. For example, the use of personal protective booths at Massachusetts General Hospital reduced the need for protective gowns by almost 98 percent, Walt noted.

Walt drew several lessons based on experiences with PPE during the pandemic. First, all aspects of engineering were required to meet the needs that arose. Devices had to be rapidly prototyped and produced, which is where additive manufacturing proved so valuable. Also, the reliance on global suppliers of chemicals and other materials created serious shortages that resulted in public health risks. “Such critical supplies should be stocked well in advance of the need, or domestic supplies need to be available,” Walt said.

Cheng highlighted AstraZeneca’s commitment to ensuring continued supplies of medicines and other products to healthcare workers and patients while maintaining the safety of its employees. She reported that the company rapidly implemented safety and cleaning protocols, changed its shift patterns, deployed its business continuity plans, and went “straight into crisis management mode” to respond to the pandemic. It reengineered ventilation systems, used 3D printing to produce safety devices, and manufactured hand sanitizers in bioreactors. It maintained connectivity with digital solutions such as augmented reality devices and smart cameras to allow technical troubleshooting sessions to be conducted virtually. It asked its China team to document measures taken after the disease appeared and derived lessons that could be shared across its global manufacturing and supply networks. As a result of these and many other actions, AstraZeneca’s manufacturing facilities remained open and at near full capacity throughout the pandemic, despite the many new procedures that had to be instituted.

Cheng also emphasized the importance of a multifaceted response to the pandemic, both within and among organizations. “This virus does not respect borders, it doesn’t discriminate, and it can only be defeated with a global response involving more than one company, more than one institution, more than one government. It takes all of us.”

THE STANDING COMMITTEE ON EMERGING INFECTIOUS DISEASES AND 21st CENTURY HEALTH THREATS

Walt noted that he has served on the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats, which the National Academies of Sciences, Engineering, and Medicine established to respond to the pandemic at the request of the White House Office of Science and Technology Policy and the Office of the Assistant Secretary for Preparedness and Response at the US Department of Health and Human Services. The committee was asked to be ready to respond on short notice to requests from the federal government to assess and consider the science and policy implications of an emerging infectious disease or significant public health threat. “We were charged with providing long-term guidance, not only on the present crisis…but the next one and the one after that,” said Walt.

Since its creation in early March 2020, the committee has issued, on very short timeframes, rapid expert consultations on the spread of the virus on surfaces, the occurrence of severe illness in young adults, the effectiveness of social distancing, the spread of the virus in aerosols, and other topics. Under normal circumstances, reports from the National Academies take much longer to produce, but these were done in a different way, with the committee writing reports in a matter of days and peer review being done just as fast. “Sometimes we’d get a call—say, at 10 o’clock at night—we’d get started, and either the next day or the day after that we would have our expert consultation ready,” Walt said.

As an example of the committee’s impact, Walt noted that, the day after the release of the committee’s report on aerosol transmission, President Trump recommended that the public wear nonmedical face coverings. “We don’t know if there’s a direct line drawn between the committee’s work and what the president said, but we were in touch with OSTP, at the White House, who were in direct contact with the president and his staff.”

Walt particularly emphasized the importance of the social and behavioral sciences in both shaping and implementing the committee’s recommendations. For example, social and behavioral studies have

demonstrated that members of the public need to perceive that public health messages have value to themselves and their families for those messages to lead to behavioral changes. “We’ve seen, for example, that going down the street and telling somebody to put their mask on has almost the opposite effect to what is intended,” Walt observed. “There are now ways to engage with people, in a very deliberate way, that come from good behavioral sciences, that encourage them to begin to take responsibility.” The committee has forged a strong collaboration with the Societal Experts Action Network to draw on the social and behavioral sciences in formulating its recommendations.

TRANSPORTATION NEEDS

Daniel Work, associate professor in civil and environmental engineering, electrical engineering, and computer science at Vanderbilt University, discussed the transportation system as a critical consideration for the distribution of not just medical devices but diagnostics and therapeutics during a pandemic.

In a pandemic, as at other times, the transportation system is responsible for moving essential supplies and essential workers. But transportation systems underwent major disruptions due to covid-19, with the most dramatic impacts on the high-density modes of air travel, public transportation, and rideshare services. Ridership numbers fell between 60 and 70 percent compared to what was expected, which constituted a “dramatic and important” drop, said Work, because declines in ridership affected the ability to bring in revenue to continue to operate those services.

The impact on other transportation services was not as extreme. For example, 63 percent of the economic value of freight in the United States is moved by truck, and long-haul truck traffic was down just 5 to 10 percent during the pandemic. Nevertheless, if the operators of trucks get sick, their ability to move people and goods is put at risk.

An important indicator to measure during recovery from the pandemic is whether a discrepancy arises between the rate at which people are using higher-density modes, such as public transit, and lower-density modes, such as single-occupancy vehicles. If so, the result could be “a perfect storm,” said Work. Some 30 to 45 percent of commuters who previously traveled to work began working at home during the pandemic. If those commuting numbers stay low, fewer vehicles will be on the roads. However, if the pandemic causes a permanent shift away from

high-density modes of commuting to single-occupancy vehicles, the result could be increased roadway congestion as people start working in offices and factories again. Before the pandemic, congestion was already costing Americans between $70 billion and $80 billion annually due to lost time and fuel, and that number could increase. “It’s going to be really important to pay attention to these numbers,” Work said, “because we could be setting ourselves up for a scenario where congestion is overall worse, which will ultimately impact our ability to effectively move goods and supplies.”

FUTURE DEVELOPMENTS IN TRANSPORTATION

Before the pandemic, three revolutions were occurring simultaneously in transportation, said Work: the automation of the vehicle fleet; the development of shared transportation modes such as rideshare, carshare, and bikes; and the electrification of the vehicle fleet.

Taking each of these trends in sequence, Work pointed out that automation offers a way to reduce not only operating costs but the human toll of 35,000-plus fatalities that occur on roadways every year. Automation was not available at a scale to help in the response to the covid-19 pandemic, but it may provide resilience for the next pandemic.

Shared vehicle systems could be safer than the current mix of transportation modes. But shared vehicles need to be designed to be safe, and this increased safety needs to be communicated to the public if people are to use such systems, Work observed. Meanwhile, the pandemic has taught valuable lessons in how to manage public transportation and air travel. For example, researchers have been studying the transmission of the virus in high-density transportation modes to learn more about the future of shared mobility.

Finally, environmental considerations have made it essential to reduce the carbon footprint of future transportation systems, and vehicle electrification offers a major opportunity to do so, Work observed.

One scenario for the future of transportation that combines all three of these trends is a fleet of electric robo-taxis that can deliver people wherever they need to go. However, in urban areas this will require put-

ting multiple people in those vehicles to move large numbers of people efficiently. If people cannot be socially distanced in such vehicles, these transportation modes might serve well during normal times but fail in a future pandemic.

Work also pointed out that the transportation system can change in ways that are hard to predict. For example, the employment status of rideshare drivers becomes an important consideration during a pandemic, since companies can have more or less leverage over their drivers in instituting public health measures depending on whether they are employees or nonemployees.