In January, light years before most people were paying attention to COVID-19, Jeff Stewart saw the early signs of serious trouble.
Stewart, a 1990 graduate of The Dalles High School who in 1995 and 2005 appeared in championship contests on the TV quiz show Jeopardy, had worked years ago studying how respiratory viruses might spread through a community.
The novel coronavirus discovered in Wuhan, China, in late December had alarming hallmarks: a high transmission rate, high hospitalization rates, and no vaccine or treatment to slow it down.
In the beginning, each person with COVID appeared to be infecting four others, now it’s between two and three. “That’s really bad,” Stewart said, especially because nobody has immunity.
It was becoming clear the hospitals of the world would not have enough ventilators to accommodate the surge of critically ill COVID patients who needed mechanical help to breathe.
The numbers were showing about 20 percent of those infected needed to be hospitalized, and about six percent needed ventilation.
If 100 million Americans got infected—140 million is cited as a worst-case scenario— that would mean 20 million would get hospitalized, and six million would need ventilators, but the country has about 160,000 ventilators, Stewart said.
Stewart, a pharmaceutical consultant in North Carolina for the last 12 years, posted an idea to Facebook a couple weeks ago: what about converting the commonly available CPAP machine, used to treat sleep apnea, into a ventilator?
He soon learned that CPAP (continuous positive airway pressure) machines, which force a steady flow of air into the nasal passage at high enough pressure to overcome obstructions, would not suffice.
What he did learn, however, is that a hospital-grade biPAP (bi-level positive airway pressure) machine fit the bill. BiPAP machines are also used for sleep apnea, but they have two pressure settings, higher for inhalation, lower for exhalation.
“It breathes with you,” Stewart said, “So it’s more like a ventilator.”
He noted, “These are hospital biPAPs. You can’t do this with the home machines.”
Normally a biPAP machine uses a mask, but masks raise concerns about aerosolization, or turning infectious physical substances into airborne particles that could spread the virus.
But intubating patients, or putting a tube down their throat instead of putting a mask on them, reduces the aerosolization risk down to that of a ventilator.
The biPAP “can keep some patients off of ventilators, and every ventilator spared is one that can be used for someone else,” Stewart said.
Through his work at Syneos Health, one of the nation’s largest pharmaceutical solutions companies, he linked up with a colleague, a physician who is a lung specialist.
Dr. Keith Robinson told Stewart he’d used biPAPs as a pinch alternative to ventilators for years.
Stewart soon learned that doctors fell into two groups: one that said, ‘of course we use biPAP to ventilate,’ and another—in fact, the vast majority—who think the idea is crazy and maybe dangerous.
They don’t like the idea because of aerosolization with masks, and the risk for spreading the virus. But, “You don’t have a mask if you have a tube,” he said.
Stewart has helped lead his company’s lightning-fast effort to provide education to hundreds of thousands of doctors about the viability of biPAP use.
Robinson, Dr. Peter Polos and Stewart authored a white paper that has been seen at the White House and the CDC. It’s also been read by the British prime minister’s office and is being forwarded to that country’s National Health Service, he said.
The beauty is that hospitals have biPAP machines on hand. “These machines are sitting around in maintenance closets in hospitals, potentially in higher numbers than ventilators themselves,” Stewart said.
Also, the FDA just approved off-label uses like this in emergency situations, he said.
His company just put up a website, covid-bipapinfo.com, with a pamphlet for doctors to download. An instructional video is coming soon.
They’ve sent letters to 770,000 physicians, and they’re invited to post in a physicians-only Facebook page with 135,000 members.
Talking to Stewart about COVID produces a mixture of hope and doom. He’s advanced the idea of using biPAP machines for ventilators, which offers a glimmer of light, but he also notes that the math on the spread of the pandemic is dire.
With deaths doubling every three days, even if not a single new infection occurred from today on, there would still be an exponential wave over the next month of already-infected people who simply haven’t gotten sick enough yet to need hospitalization.
“Even if you stop three weeks ago, it’s still growing, and it’s not just growing, it’s doubling every three days.”
So in 15 days, it would be 32 times as bad as it is now, or 32 times the number of patients on ventilators. “It won’t be enough, not even close,” said Stewart.
But of course infections are still occurring, with each new case infecting about two more.
But social distancing, or staying home and not going out except for essential needs, and then staying at least six feet away from others, can combat the spread.
“Think of it as a forest,” Stewart said. “If you spread the trees out, no forest fire. It doesn’t mean the fire isn’t hot, it just doesn’t have anywhere to go, and that’s what social distancing does.”
The problem is that not much we have now can stop the worst-case scenarios—of 70 million to 140 million infections in the U.S.—except social distancing at a rate much more than is being done in the U.S., he said.
“We’re Americans, right? That’s one thing the Chinese were able to do, with a totalitarian society, was order people to stay home and people had to obey, and did.”
In fact, he knows people in the local Chinese community who are thinking of going to China because it’s safer there.
One note of optimism he offers to parents is that people of all ages are dying “except for the very young.” There’ve been almost no hospitalizations or deaths in the under-9 group.
Officials around the country have floated the idea of loosening social distancing orders in coming weeks. Stewart said, “that’s really not smart.”
If the virus continues without the brakes applied by social distancing, potentially millions of people would need hospitalization. With under 200,000 ICU beds nationwide, “It would mean that all the people, instead of going to the hospital, they don’t have any bed, they have nothing. And it sounds terrible but true: They will die in their homes, choking to death.
“So stay home, and wash your hands.”
Stewart’s parents talked to the Chronicle about their son’s work. It isn’t the first time Jeff has taken significant steps in the medical world, his father Joe said. As a student at Princeton, Jeff wrote a paper that changed how autoimmune disease is studied.
He posited that it wasn’t hormones, but the X chromosomes, that explained why autoimmune disease was more prevalent in women. Three later studies proved him right.
“He didn’t do it for financial gain, he just did it and it feels good that he was able to help,” Joe said.
His mom Sharon recounted how she’d read to her children, and a story about Corrie Ten Boom, who rescued Jews from the Nazis in World War II, struck a chord with Jeff.
She learned later that he figured that’s why he wanted to help others, even if it was dangerous.
“It’s all about helping people, that’s the bottom line for him,” she said.