From Corin Frost’s house on Gorham Street, it’s a straight shot to University Hospital. When she looks out her window, it hits her.
“I think about how many health care providers are driving by on their daily commute while I'm sitting here able to be safe inside,” Frost said.
Outside, a pandemic is raging. As of Monday, the U.S. had 579,005 confirmed cases of COVID-19, the disease caused by the novel coronavirus, including 3,555 in Wisconsin. Complications due to the disease are confirmed to have killed 22,252 in the U.S., including 170 in Wisconsin. Dane County has had 344 confirmed cases and 12 confirmed COVID-related deaths.
Frost might be staying indoors, but she isn’t standing idly by. Instead, she’s spent evenings and weekends in her upstairs studio designing and sewing her own version of a powered air purifying respirator hood, used by medical professionals during procedures likely to make a patient cough. This type of hood, often used by hazmat workers, fully covers the head and connects to a battery-powered device blowing air through a filter. It’s one of many pieces of medical equipment that health care providers are begging for.
As COVID-19 spreads, hospitals and essential workers need more medical and protective equipment than current supply chains can provide. Those shortages could mean more COVID-19 infections and deaths.
Frost is just one in a small army of local makers and designers — from engineers and inventors to sewists and 3D-printing hobbyists — seeking to fill the gap. Their efforts range from building protective clinic furniture to creating a face shield design now being manufactured across the globe.
They’re part of a global movement using the skills and materials on hand to devise solutions to this crisis. It’s uncharted territory, and many questions remain about who’s qualified to take on which problems. But the enthusiasm and creativity of these makers reveals much about their community and offers hope where help is in short supply.
For weeks, governors have asked the Federal Emergency Management Agency to help them obtain additional supplies and called on the federal government to send reserves from the Strategic National Stockpile, which holds supplies, medicine and devices for disasters. But on March 31, the New York Times reported that the stockpile of protective equipment had been nearly exhausted, leaving states to address remaining shortfalls on their own — just as supply chains are running dry. Gov. Tony Evers has asked all companies and organizations that have large supplies on hand to donate or sell them to the state.
With shortages making headlines, the acronym PPE — personal protective equipment — has become part of the American lexicon. Among the most sought after items is the N95 mask, capable of filtering out viruses and bacteria, which the Centers for Disease Control and Prevention (CDC) recommends for all health care providers caring for COVID-19 patients. But the CDC has also offered lower “contingency” and “crisis” standards, advising that health care workers may need to reuse or forgo N95s in some situations.
Meanwhile, shortages of a life-or-death apparatus, the ventilator, led to nightmare scenarios in Italy, with doctors forced to choose which patients to save. In New York, some patients are already sharing ventilators, and a Wisconsin committee is considering how to triage patients if its ventilator supply proves insufficient.
At the hospitals run by the University of Wisconsin, it’s Bob Scheuer's job to keep supplies stocked. The director of materials management for UW Health told the Cap Times his job has never been more hectic.
“We are struggling every day to get the items we need,” Scheuer said.
His team runs a calculation for each item. “Given our current usage rate and what we have in inventory, how many days can we go without getting any more supply in? Any time we get down into the single digits … is cause for concern,” he said, and some days, “it gets pretty close.”
As of Tuesday, 38% of Wisconsin hospitals had no more than a week’s supply of N95s, according to data compiled by the Wisconsin Hospital Association. Without new supplies, 43% percent would run out of gowns and 35% would run out of face shields within a week. The state has 354 patients on ventilators and 1,229 ventilators, including those already in use, as of Tuesday. According to Wisconsin Department of Health Services predictions, the number of COVID cases will peak between April 23 and May 23.
GE Healthcare has already increased its ventilator production, including at a facility on Madison’s east side that has shifted to 24/7 production, pulling in workers from facilities across the country and hiring more. And President Donald Trump has invoked the Defense Production Act, ordering auto manufacturer General Motors to begin producing ventilators and instructing an as-yet-undisclosed set of manufacturers to increase N95 mask production to 39 million over the next three months.
But even the most experienced manufacturers may not be able to increase the supply fast enough. The New York Times reported in March that 3M and Honeywell had increased production of N95 masks, but it could take months to hit ramped-up production goals.
Upping production means hiring more workers, sourcing additional raw materials and extending a factory’s production. All that takes time, so hospitals are considering other ways to fill the gap.
Called to duty
Lennon Rodgers directs the Grainger Engineering Design Innovation Lab at the University of Wisconsin-Madison, where students learn to use emerging technologies to design solutions to problems.
Often called “makerspaces” or “fab labs” (fabrication laboratories) they have proliferated in the last decade as tools like 3D printers and computerized machining devices have enabled desktop manufacturing.
Before the pandemic, Rodgers spent his days helping students design and build “everything from race car parts to biomedical devices,” but with a single email, he was drafted into the PPE-making force. On March 16, Rodgers received a message from UW Health University Hospital asking if he could help make 1,000 face shields. The shields are worn over surgical or N95 masks to protect from respiratory droplets that contagious patients might cough or sneeze out, and, unlike items like N95s or ventilators, they can be built without specialized materials or medical knowledge.
That night, following a trip to Home Depot and an hour of work, Rodgers made a rough version but his wife, an anesthesiologist, told him it needed work (“For a construction worker, it would’ve been great,” Rodgers said). He enlisted the help of Jesse Darley of local product design and engineering firm Delve, and Brian Ellison of Blue Mounds-based 3D printing firm Midwest Prototyping, to fashion a prototype.
With approval from UW Health’s infection control department, they settled on a design that used just three materials — clear polyester film for the shield itself, elastic for headband and foam to cushion the user’s forehead — and could be built using only scissors, an X-Acto knife and Ziploc bags.
They named the design the Badger Shield and published the drawings and instructions online as an “open source” document, allowing others to use it for free. They also compiled lists of suppliers selling the raw materials and created an online form where workers could request face shields, and companies could register as shield producers.
A few days after that first email, Midwest Prototyping delivered about 1,000 Badger Shields to UW Health. Less than a month later, the design has been picked up by manufacturers around the world, who estimate they can produce more than 2 million shields each day.
Getting under the hood
Within days of finalizing the Badger Shield design, the team was already working on its next COVID-inspired design at the request of UW Health: a powered air purifying respirator, or PAPR hood, designed to protect health care workers during procedures like intubation, which can cause a patient to cough or vomit.
The hood would be sewn, so Darley tapped Corin Frost, director of visual communications at Delve, for her sewing and clothing design expertise.
In her home studio, Frost spent hours reverse-engineering the hoods, trying to create her own simple and functional version. She’d often prepare two versions in a single day, leaving each on her porch beside a container of disinfecting wipes. Darley would come by, stand ing on her porch as he wiped each prototype down and tested it out, offering suggestions to Frost from the other side of her storm door.
“It's almost like I was coming out of the fitting room at the Gap and saying, ‘Hey, does this one look okay?’” Darley said.
When a couple prototypes were ready, Darley would drive to University Hospital, where a handful of doctors and nurses would take a break and meet him at a loading dock to try them on. They offered feedback, such as: Tthey wanted the fabric to extend to protect their necks, or noted that the air wasn’t blowing over their heads as it should.
The nurses hadn’t used PAPR hoods before, Darley said, but the hospital aimed to provide them to all health care workers.
“You can see this kind of fear in their eyes of what the situation is like,” Darley said. “So this is hopefully one tiny, tiny piece to make them feel safer and actually be safer.”
Designers at Clothier Design Source, a clothing designer and manufacturer in St. Paul, Minnesota, adapted the model for mass production, and it has since received approval from UW Health.
The team is awaiting a purchase order from the hospital but has already lined up local professional sewists to sew a small number of hoods, Darley said. For larger production, they’re in talks with a New York sewing company that sews Marc Jacobs designs. UW Health will be their first client, and Darley expects to make the first delivery by next week.
3D printers at the ready
Across town, consultant Keith Fuller was reading international news and anticipating shortages. It wasn’t until he read about a hospital in Italy where someone had fixed a broken ventilator by 3D printing a replacement valve that he realized he could help.
“And it occurred to me, ‘OK, if it's as simple as that ... I know people with phenomenal expertise in 3D printing,’” Fuller said, and emailed Nick Shepherd, the owner-operator of New Glarus based 3D printing startup GLW Technologies.
For Shepherd, the pandemic’s threat was tangible: His wife works at a nursing home and his mother runs a long-term care facility.
“In my immediate family, I have two people who are in very high-risk zones,” Shepherd said.
Shepherd set about creating a design for a 3D-printed mask with a detachable N95 filter. He’s also working with Green County Economic Development and local banks to secure a warehouse space where they could manufacture COVID-19 PPE in a clean environment.
Projects are also underway at both of Madison’s community makerspaces, which closed under Evers’ “safer at home” order but continue to allow access to PPE-makers.
At Sector67 in the Atwood neighborhood, volunteers recently worked with a Madison pediatrician to improve a Plexiglas droplet barrier that she and her Group Health Cooperative team had built for safer COVID-19 testing.
Sector67 members are also producing Badger Shields, prototyping a hood to cover patients while health care workers intubate them, and considering options for a fan system to provide filtered air for the PAPR hoods Frost and her team are developing.
About a mile away, at The Bodgery makerspace in the former Oscar Mayer plant, inventor Jesse Ransom is collaborating with other local makers to 3D-print an alternative to an N95 mask, perhaps based on CPAP masks used by people with sleep apnea.
Meanwhile, in his parents’ basement in Sun Prairie, UW-Platteville senior Andrew Kaiser is making face shields by 3D-printing visors and attaching overhead transparencies, using a design he found online. So far he’s donated shields to senior care facilities and a taxi service for the sick.
He’d like to increase production, but his two printers break down regularly. “It's really just a cheap hobbyist kit sort of thing,” Kaiser said, “but we're trying really hard to keep our production going no matter what.”
Other makers bring a more traditional tool to the PPE push: sewing machines. Some hospitals have posted their approved patterns for cloth masks, including ones that could cover and extend the life of N95s or hold alternative filters.
Many sewists have leapt at the chance to help, but the effort has sparked controversy. Studies show cloth masks don't offer the same protection as disposable surgical masks, and even standard surgical masks are made to protect patients from providers’ germs, not the reverse.
Some say such masks are better than nothing if supplies run short, but others worry they’ll provide a false sense of security and let hospitals off the hook for sourcing standard PPE.
Jane Schirmer, a sewist and nurse who worked during the SARS and H1N1 outbreaks, said health care workers shouldn’t be asked to compromise on PPE.
“Nurses are not screaming, ‘Please sew us pretty masks.’ They are saying, ‘Get us N95s. Protect our lives and our families’ lives,’’” Schirmer said.
Her husband, Joe Schirmer, a retired occupational safety expert and co-author of the book “Essentials of Modern Hospital Safety,” believes hospital administrators and government officials should be doing more.
“These masks in some sense mask the failure of the system to deliver the goods that are needed to protect workers and the public,” Joe Schirmer said.
When the couple saw some hospitals calling for cloth masks, they emailed friends and family, imploring them to use their phones instead of their sewing machines to call on the federal government to release millions of masks from the national stockpile and invoke the Defense Production Act.
This isn’t like World War I, where volunteers were needed to wind bandages, or World War II, where workers kept the factories running on the homefront, Jane Schirmer said. “Our factories are intact and our infrastructure is intact. We could do the same things that were done in both those wars by ramping up production and really effectively distributing them.”
Lorraine Torrence, president of the Madison chapter of the American Sewing Guild, had seen the requests from hospitals and debated whether to mobilize her more than 70 members. But she heeded the Schirmers’ advice, calling on members to demand the government increase supplies. Rather than make masks, she set to work sewing several dozen surgical caps and booties following a request from a nurse at Milwaukee’s Froedtert Hospital.
But developments in late March changed her stance. Not only is the national stockpile nearly empty and the Defense Protection Act already invoked, but the CDC has now instructed all Americans to cover their faces when they go out in public.
Meanwhile, after initially wavering and then opting not to accept homemade mask donations, Madison area hospitals have announced they’ll accept them for nonclinical uses, such as for patients being discharged or for nonmedical staff. And the city of Madison wants them too, for employees in its parks, streets and water departments.
Torrence is now ready to endorse mask-making, whether for health care workers or anyone else. “It's a no brainer for sewers,” Torrence said. “We like to sew, we have the skills, and the need is so desperate.”
Build with caution
To Kevin Eliceiri, director of the Morgridge Institute for Research FabLab, it’s no surprise to see makers mobilizing.
“Helping is ingrained in what we do,” Eliceiri said. “This is just a call to arms on a bigger scale, and it's getting attention because of how devastating this pandemic is looking to be. But the reality is these guys do this every day.”
While Eliceiri specializes in designing for biomedical contexts, many of these PPE-makers don’t. One after another, makers told the Cap Times that each person should know the limits of their own resources and expertise and should choose projects accordingly.
“It would be very difficult to quickly build a ventilator with the reliability of the GE machines,” UW’s Rodgers said. He suggested that those who want to help make ventilators consider taking a temporary job with GE, in a role he likens to Rosie the Riveter.
Likewise, said GLW Technologies’ Shepherd, not everyone should attempt to design and build an N95 mask, which uses electrostatically charged fabric to filter air. Some have tried using vacuum HEPA filters, but Shepherd said they don’t allow as much diffusion, making breathing more difficult. Instead, Shepherd plans to use the same filter material used in standard N95s; he's obtained enough to make more than 2,000 masks once he receives an order from a health care provider.
He’s currently waiting for his mask design to be approved by the Veterans Health Administration and added to the National Institutes of Health 3D Print Exchange, a clearinghouse of printer-ready designs. He said he won’t print anything that isn’t vetted by a “registered medical authority.”
“We wouldn't put out a false sense of security ... which is the number one concern,” he said.
In addition to vetting, responsible manufacturing requires high-quality materials, production environments set up to prevent contamination, and quality control standards, Shepherd said.
But even with these precautions, makers know they’re on shaky legal ground. Several have consulted with lawyers or attached disclaimers to their designs.
“If it comes down to somebody in our backyard needing critical medical care, and they can either get it from someone who has an uncertified product, or they can get nothing, I gotta believe that those people will take that uncertified product,’” said Fuller, the consultant.
Despite all his warnings, Shepherd’s not barring anyone from this effort. “Maybe it's not always an N95 mask, but I think everyone is doing an important and essential role, and we’ll need everybody, I think, in the coming months,” Shepherd said.
Makerspaces can produce some items if they take the right precautions, Shepherd said, and anyone can design. It’s not just about PPE, Shepherd said. Products like 3D-printed hands-free door openers could reduce the virus’ spread in public places.
Another challenge facing local makers: how to produce enough to fill the enormous gap.
Rodgers knew from the start that maximizing the Badger Shield’s impact would require industrial manufacturers. “It doesn't matter how great you can make it, if you don't have a factory to do large scale production with materials, you're very limited,” Rodgers said.
Ford, which has halted auto production, is now producing more than 100,000 Badger Shields a week at Michigan factories.
Also on the list: a factory in Rodgers’ hometown. His mom asked if the hospital near her home in Sterling, Illinois -- CGH Medical Center -- could get some face shields too. Minutes later, Rodgers saw an email from Wahl Clipper, a global producer of hair clippers, saying they’d tweaked the design and produced 1,000 shields. The company’s factory was, by chance, also in Sterling.
“I'm like, ‘Sweet. Can you send them to CGH?’” he said. He calls these fortuitous matches “an interesting dynamic I’ve never seen before.”
Back where the Badger Shield began, Midwest Prototyping cranked out 50,000 shields last week and anticipates 75,000 this week, including at a new Mount Horeb facility dedicated exclusively to the project. By the end of the week, Ellison anticipates the company will be producing the powered air purifying “Badger Hood.”
But even industrial manufacturers have hit obstacles. Every one of the three materials needed for the Badger Shield has run out at some point, forcing the team to search for alternative suppliers.
“The biggest thing that keeps us up at night is just the supply chain,” said Ellison.
Multiple makers told the Cap Times that while mass production requires manufacturers, major players likely wouldn’t have filled this gap fast enough on their own.
“Big companies like a 3M or a Ford, it takes time for them to ramp up production and especially to the scale that justifies making that business decision,” said Rebecca Alcock, a graduate student in biomedical engineering and assistant manager at the Grainger makerspace.
Algorithm to the rescue
Requests for Badger Shields poured in from as far away as Chile and Australia, while manufacturers from the Philippines to South Africa have put their workers and machines to the task.
As of Monday, more than 308 companies or individuals, located in 14 countries and 39 U.S. states, have registered as Badger Shield manufacturers seeking to be matched with requesters. In total, those manufacturers estimate they can produce more than 2 million shields a day. On the buying side, 272 organizations in five countries and 41 states plus Puerto Rico, have submitted requests to purchase around 5.37 million shields.
To match supply and demand equitably, Alcock worked with operations management experts Justin Boutilier of UW-Madison and Auyon Siddiq of UCLA to create a software program that prioritizes requests by urgency and proximity to manufacturers, in real time.
While standard PPE channels prioritize hospitals, Alcock said the algorithm is designed to also get supplies to smaller medical facilities and less-visible essential workers like nursing home aides and garbage collectors.
That in one week, a team of just three people had managed to create a program that could handle requests for millions of shields, is “inconceivable,” Alcock said. They still tune the model daily to be sure they’re prioritizing correctly.
“We hold a great responsibility,” Alcock said. “So we want to make sure we build the model in a way that is doing the people justice who need it, in making sure we're getting them as fast as we can to the places that need them most.”
So far, production has kept up with demand, though they’re still trying to find the right large supplier for New York City, which requested five million shields. The challenge now is visibility — trying to reach more workplaces so they can request shields if needed. They’ve even begun crowdsourcing, asking people to add their local hospitals, nursing homes or police stations to a list so that Alcock and her colleagues can offer to match them with shields.
Soon, the Badger Shield team may add a second item to its list — the Badger Hood.
But already Alcock and her collaborators are looking beyond this pandemic to the next time PPE could be in short supply. They’ve applied for a grant to continue developing their algorithm for use in “future demand spikes,” like when a hurricane hits the Gulf Coast or a volcano erupts in Guatemala.
“Unfortunately, it took this global pandemic to necessitate creating a tool like this,” Alcock said. “But now that it's here, how can we make it better? And how can we be ready to use it right away in the future for catastrophic events … so that PPE shortages are minimal?”