A pipeline for problem-solving

The COVID-19 Engineering Response Team tackles projects the pandemic throws its way.

Duke has one surprising place to look for its quick response to the COVID-19 pandemic: the Ebola outbreak of 2014-15.

Matthew Stiegel, assistant vice president for occupational and environmental safety for Duke University and Duke Health, says that during the 2014-15 outbreak Duke was a designated transition center that might have had to hold an Ebola patient in the United States. “We had to prepare just in case we got someone at Duke and we’d have to hold them for forty-eight hours,” Stiegel recalls. That meant a lot of work figuring out how to completely decontaminate not just a patient room but also an ambulance. Basically, steaming the environments with vaporized hydrogen peroxide (VHP) did the trick. Duke had also learned how to similarly decontaminate rooms in the Regional Biocontainment Lab of the Duke Human Vaccine Institute. That meant they were ready.

Then came COVID-19. The shortage of N95 masks that complicated early response in the United States gave Duke a straightforward problem: to decontaminate and reuse face masks that until then had been treated as single-use throwaway items.

Antony Schwartz is biological safety officer for Duke University and Duke Health. When it became evident that personal protective equipment shortages were going to be serious, he knew that VHP was working at Duke and looked up research on using it for masks. He found a paper by the Battelle Memorial Institute, an applied-science nonprofit, which had in 2016 successfully tested using VHP to treat N95 masks, though nobody had tried it in the real world. It seemed like a good time.

They did. They outfitted a room with racks for the masks, used a special biological indicator (a small steel disk that contains a million or so spores that are much smaller and harder to neutralize than the coronavirus), and found that the process fully decontaminated the masks, wherever they were in the room. They applied for and received an Emergency Use Authorization from the U.S. Food and Drug Administration, and they can now decontaminate masks up to ten times. The process seems to work many times more (after thirty cycles the straps start to fail), but ten is the limit the FDA authorized.

Workers often use masks for only a moment at a time. Instead of discarding them after a single use, they put their own mask in a labeled paper bag and reuse it during their shift. At the end of the shift they place it in a collection bin. Merely reusing masks is making a difference, and the decontamination multiplies that. They’ve published papers on the technique and procedure they’ve developed and spoken with caregivers all over the world, helping them do the same.

It’s not just masks, though. There is at least another dozen or so projects undertaken at Duke to solve the problems COVID-19 has flung its way. Eric Richardson, associate professor of the practice in biomedical engineering, points to the interdisciplinary Design Health program of the Pratt School that brings together people from the schools of business, engineering, and nursing to solve problems in health-care technology. In response to the current crisis, that program transmogrified into the COVID-19 Engineering Response Team, with the help of the Office of Information Technology and other interdisciplinary partners as different constituencies came forward with needs for medical equipment.

It took a moment to find their way. “You don’t just jump in and solve the problem,” Richardson says. “You have to understand the problem first. Early on there were a lot of people yelling at us to design ventilators or sew masks. There was a lot of reactionary thinking. What the team did well was sit back and understand what the anticipated needs are.”

They slowed down, prioritized needs, and developed a sustainable long-term approach: “basically a pipeline to continue to handle projects and requests as we go.”

The first project involved surgical needs for PPE for surgeons dealing with COVID-positive patients: full Dustin Hoffman-in-Contagion-style suits, which control air flow. The hospital did have hoods surgeons wear during joint replacement surgery, and orthopedic surgeon Melissa Erickson brought them to Richardson and asked whether his group could find a way to make something work. With help from the 3D printers in the Innovation Co-Lab (the creativity incubator that connects the Duke community with programming help and technology resources), they could. “We were able to take that idea from concept to clinical implementation in a couple of weeks,” Richardson says. “Whereas that usually takes a couple of years.”

A team of around forty people, mostly students, has been working all summer on various projects. Around a dozen are now in the pipeline, including 3D-printable face masks; some 70,000 have been printed out, and the design has been downloaded by more than a hundred other organizations. A simple pressure-negative chamber for COVID patients nears approval, and many other projects are moving along.

Now the team has a website, where people can submit requests or ideas and volunteer.

Richardson is glad the team has been able to accomplish so much so quickly, but “we’re aware of what hasn’t been done. It could always be done faster or better, so we’re aware of that.” Regardless, the team was built for the long haul, which is a good thing.

“The beginning was a sprint, but now we’ve hunkered down into a marathon.”

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