A manufacturer of medical ventilators says Canada should have stockpiled the machines after Toronto's 2003 SARS outbreak, given they are now harder to come by as hospitals around the world scramble to buy more with the outbreak of COVID-19.

Ventilators are mechanical breathing machines that help patients with damaged lungs get enough oxygen to live. Since COVID-19 can harm the lungs, the devices are critical to the survival of people hit hard by the virus.

There are now five presumptive cases of COVID-19 in Nova Scotia, and the provincial government has ordered 140 ventilators to boost the province's supply of about 240.

But Eric Gjerde, CEO of Airon Corporation, a U.S. company that manufactures ventilators for sale in Canada and abroad, said those machines should have already been on hand.

"Your government and Ministry of Health should have hundreds of ventilators in storage," he said in an email.

"These ventilators can sit in boxes for years, with no maintenance. When they are needed, you just attach oxygen and you are good. It is just frustrating that governments can't think ahead and be prepared!"

SARS, or severe acute respiratory syndrome, was caused by a coronavirus that spread through much of the world in the early 2000s, killing hundreds of people including 44 in Canada.

Nova Scotia has ordered 140 ventilators as it prepares for an increase in the number of COVID-19 cases. (Jean-Pierre Clatot/AFP via Getty Images)

It could be hard for companies to meet demand for ventilators as the need skyrockets worldwide during the COVID-19 pandemic.

It typically takes three to four weeks to fill an order, according to Canadian supplier McArthur Medical Sales. But during the pandemic it is "very difficult" to estimate when machines will be available, said Frank Fiorenza, a product development manager at McArthur and a respiratory therapist at the Ottawa Hospital.

Some European countries struggling with coronavirus, like Italy and Germany, are clamouring for more ventilators to treat severe cases of the illness. Italy, which as of Sunday had more 1,800 deaths due to coronavirus, recently issued a tender for an additional 5,000 ventilators.

Dr. Robert Strang, Nova Scotia's chief medical officer of health, said ventilators are expensive and over time they become outdated and can't be used.

"Just creating a big stockpile of ventilators thinking that whatever time in the future you might have them may not be the wisest thing," he said Monday.

He said 11 years ago during H1N1 pandemic the province did increase the number of ventilators. Under normal circumstances those old machines would no longer be used, he said, but during the current outbreak they might be put into service in some fashion.

Fiorenza said other provinces have similar caches of old machines. In Ontario, he said 16 hospitals have at least 216 ventilators that act as a pandemic reserve. However, he said health authorities need to make sure they have enough respiratory therapists to run them.

"If nobody knows how to use them, if nobody knows how to run them it's irrelevant. You're not going to be really saving lives if people are on machines and the operator doesn't know how to work it," said Fiorenza, who is in self-isolation at his home in Ottawa after returning from a family vacation in Jamaica.

Supply chain problem

Right now, Airon has received large orders from U.S. emergency organizations, which has eaten up its production capacity for the next several months. As such, the company has stopped all international shipments, including those to Canada. It can make 20 ventilators a week.

"The main problem is the supply chain. We do just-in-time manufacturing and have very lean component supplies in stock. That's the hard part, getting our custom parts made and delivered in an emergency," said Gjerde.

World Health Organization warned last week of global shortages and price gouging on ventilators and personal protective equipment, and urged companies and governments to increase production by 40 per cent.

A survey in 2009 showed there were almost 5,000 mechanical ventilators spread out in 286 hospitals across Canada.

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