Source of article: intellectual things (ID: zhidxcom) , author: Xinyuan, the original title :: “The gap in lifesaving ventilator is difficult to make up! “The truth about the supply chain in one article”, the source of the title picture: Visual China

One hundred thousand hot! The continued spread of the new coronary pneumonia epidemic has transformed the world into a giant ICU. Severe patients are waiting in line to use a ventilator to renew their lives, but the ventilator has been severely in short supply.

According to the report of Fortune magazine in the United States, The number of existing ventilators in global medical institutions only accounts for about 9% of the total demand . Global ventilator manufacturers are running at full capacity, and domestic ventilator manufacturers that have steadily promoted resumption of production have become the life-saving straws of the world.

▲ Ventilator inventory and demand in some overseas countries (as of March 28)

According to the data released by the Ministry of Industry and Information Technology on April 8, China ’s ventilator manufacturers have supplied nearly 29,000 sets of ventilators nationwide of which nearly 18,000 are supplied to Hubei, including 3000 ventilator Taiwan; Supply nearly 18,000 types of ventilators abroad, including more than 4,000 ventilators. All enterprises are working overtime and negotiating with international purchasers in accordance with the principle of marketization.

Previously on March 31st, Andrew Como, Governor of New York, USAPublicly stated that New York has ordered 17,000 ventilators from China, but because other states are also snapping up, it is estimated that only 2,500 units will be available.

▲ Como thanked China for donating 1,000 ventilators to reach New York JFK Airport

At the same time, more than a dozen car companies around the world announced the conversion of ventilators. For example, Ford Motor Co., Ltd. and General Medical Co., Ltd. plan to produce 50,000 ventilators in 100 days. Has an additional FDA approved ventilator.

However, in the face of heavy epidemic data, these increased production capacity is still a bottleneck.

How hard is it to make a ventilator? What factors limit player entry? What are the positions of domestic ventilator suppliers who have received orders for the epidemic in the market? What are the main suppliers of core components such as chips and compressors that restrict the capacity of the ventilator? We tried to find these answers.

The life-saving “inflator” of critically ill patients in the new crown

Severe and critically ill patients with new coronary pneumonia may have symptoms such as respiratory failure, shock, and coagulopathy. Without the assistance of a ventilator, serious organ failure and even death may occur.

According to statistics from the American College of Respiratory Diseases, the widespread use of ventilators has increased the success rate of clinical rescue by approximately 55%.

Ventilator, commonly known as “electronic pump”. The ventilator imitates the breathing rate of a person. When inhaling, the gas with different oxygen content is pressed into the alveoli by high pressure; when exhaling, the carbon dioxide in the body is pressed out at low pressure.

The current medical ventilator is the highest level of three types of medical devices, which are divided into invasive and non-invasive.

▲ Monthly supply of Chinese ventilator during the epidemic (as of March 3)

Invasive ventilator is mainly used in the intensive care unit (ICU) to treat unconscious patients with severe respiratory failure . Invasive ventilator requires intubation through the mouth, nose, and trachea. This process may cause facial injuries and cross infection in patients. It is also very cruel and painful. The trachea is like being cut by a knife. It must be sedated to sustain it.

Non-invasive ventilator has no incision and is mainly used in patients with mild to moderate respiratory failure who are conscious of breath . It is used in hospitals and family settings. During use, the patient can speak normally and the comfort level is much higher than the invasive ventilator.

Because New Coronary Pneumonia lacks antiviral drugs, the treatment of New Coronary Pneumonia patients is mainly symptomatic, the use of nasal catheters or non-invasive ventilator for severe patients, and critical patients require invasive ventilators .

In the past, people ’s demand for ventilators was not large, but as the new crown epidemic traveled around the world like a death train, the number of newly diagnosed cases in the world exceeded 80,000. The cumulative number of diagnoses in the world exceeded 143 In 10,000 cases, the demand for ventilators is expected to be close to 1 million, while the total number of existing ventilators in the United States, Germany, Britain, France, and Italy is only more than 200,000.

▲ The difference between the configuration of severe and critical wards for the treatment of new crown infection

The ventilator is not enough, what should I do if there is a power outage again?

The Governor of New York, Como, who angered the US federal government and screamed for a ventilator, introduced and personally demonstrated the emergency “alternative plan” on March 28: Oxygen is supplied to patients with impaired breathing. This airbag is commonly known as “hand-pinch the ball”.

▲ Como showed “hand pinching the ball” at the press conference

“It needs someone to squeeze the airbag constantly. This looks simple, but if you operate it for a long time, you will understand how difficult it is.” Como said, “Although it is relatively simple, but you need Many people operate on a patient 24 hours a day. “

Christine Middlemiss, the UK ’s chief veterinarian, also wrote to all registered veterinarians across the country, requesting them to provide feedback on the list of veterinary respiratory equipment in their respective institutions in case they are needed.

Global urgent! Emergency expansion of ventilator manufacturers at home and abroad

To what extent are global ventilators scarce? ToAs an example of the well-known international ventilator manufacturer Hamilton, Switzerland, the ventilator will be transported as soon as it is off the production line, and even the office employees have been on the production line in order to catch up.

According to the research report of Dongxing Securities, the total daily production capacity of the five major internationally renowned ventilator manufacturers is about 301 units, and it is difficult to meet the epidemic prevention needs of their own countries in the short term, let alone foreign orders.

In addition, American car companies such as Ford, GM, Tesla and others have been approved to manufacture ventilator equipment. On March 27, Trump also named GM and Ford on Twitter to urge them to produce immediately Ventilator.

▲ President Trump urges Ford and GM

On April 7, Tesla used a video to show a prototype of a ventilator built with its electric car parts, and introduced the overall workflow:

The air enters the mixing chamber through the intake duct. The mixing chamber mixes oxygen and air, then passes through a valve body that creates a pressure waveform and a volume waveform, then passes through a series of sensors, and finally passes through a filter to enter the patient ’s lungs.

The gas mixed with carbon dioxide in the lungs will enter the exhalation valve through the exhalation tube and a set of sensors. The exhalation valve will adjust the air pressure in the lungs to keep the patient’s lungs at a positive pressure.

▲ Working Diagram of Tesla Ventilator

The outbreak of demand for medical ventilators has brought spring to Chinese ventilator manufacturers. Previously, the top three domestic hospitals mainly purchased international ventilator brands such as Philips and ResMed, and the outbreak provided a free promotion platform for domestic ventilators.

Because China’s medical equipment industry started late, the market has been controlled by foreign manufacturers for a long time, but in recent years, a few domestic medical ventilator manufacturers have gradually highlighted their surroundings and established national brands on a global scale.

In the 2019 domestic top ten ventilator sales rankings, domestic brands include Mindray Medical, Shenzhen Coman, and Yi’an Medical .

▲ Ranking of China ’s Ventilator Sales in 2019

Because of China ’s effective national defense control, domestic ventilator manufacturers have already resumed production and production in an orderly manner. Overseas orders are coming like snowflakes. Some domestic manufacturers ’orders have already been scheduled for the second half of the year.

As of April 8, China ’s major ventilator companies have cumulatively supplied more than 27,000 units, of which nearly 18,000 units were supplied to Hubei, including 3,000 ventilators, and nearly 18,000 types of ventilators were also urgently provided abroad. Taiwan, containing more than 4,000 ventilator.

At present, foreign purchases are mainly based on invasive ventilators. Mindray Medical and Yi’an Medical are the head players of invasive ventilators in China. According to the information recently announced by the Ministry of Industry and Information Technology, There are currently 21 domestic enterprises that can produce invasive ventilators, of which 8 products have obtained the EU mandatory CE certification .

In order to speed up production, Mindray Medical attempts to open new production lines, expand employees, optimize processes, and other measures in parallel. Yi’an Medical has transformed the production lines for anesthesia machines and surgical beds into ventilators. According to previous public information, orders for Mindray Medical and Yi’an Medical have been placed after June and August respectively.

The tightness of ventilators also contributed to the surge in related stocks.

The current A-share listed companies involved in the supply of ventilators include Mindray Medical, Yuyue Medical, Aerospace Changfeng, Fosun Pharma, Zhongding, Shenzhen Technology, etc. Among them, Mindray Medical is unique in exporting medical ventilators overseas.

▲ The pattern of medical ventilators exported by Chinese brands overseas in the first half of 2019

The market value of Mindray Medical, a leading domestic medical equipment company, has exceeded 320 billion yuan, which will suppress the Ningde era and stabilize the position of the new “one brother” in the GEM market value.

Aerospace Changfeng, which has a relatively small sales volume of ventilator, issued a number of risk warning announcements, indicating that its severe ventilator does not have domestic and foreign sales qualifications, and there is no mass production plan this year. From April to April 7th, it closed 9 daily limit boards, with an increase of more than 155%.

▲ Aerospace Changfeng issued a risk warning announcement

Generally, the price of high-end invasive ventilator is about 350,000 to 400,000 yuan, the mid-range price is about 200,000-250,000 yuan, the low-end reliability is low, and the price is less than 150,000 yuan. However, during the epidemic, the profit margin of ventilator sales has been ridiculously high.

According to Caijing, during the epidemic, a ventilator with a normal price of US $ 20,000 per unit was quoted by the dealer to US $ 36,800.

Gap is difficult to fill, ecological barriers for respirator

At first glance, global ventilator manufacturers are trying their best to expand production. Tesla, GM, Ford, Rolls-Royce, Dyson, Honda, Nissan and other car companies are expected to switch to ventilator production one after another. There is hope to fill the gap of the ventilator?

The wish is beautiful, but the reality is very difficult.

First of all, professional high-end ventilator players are scarce.

Before the epidemic, there was less demand for ventilator purchases, but the critical technology threshold was high, and high R & D and production costs were required. This makes the number of manufacturers with a certain scale that can produce high-end invasive ventilators globally countable.

In the past, the ventilator industry was relatively niche, and the demand for medical institutions was limited. Last year, domestic sales were less than 20,000 units. There may be more than a dozen large hospitals and no more than five small hospitals. The actual usage is not high. And the service life of a ventilator is usually more than 6 years, and the replacement cycle is also relatively long.

Second, it takes time to produce a ventilator.

Even for professional ventilator manufacturers with rich experience, it takes a certain time to expand the production line, and it takes time to produce each ventilator. It is difficult to keep up with the rapidly increasing demand in the short term.

The world-famous “Made in China”, which is famous for its speed, has doubled its pressure in the face of a huge ventilator gap. Many domestic ventilator manufacturers say they have reached the capacity limit.

Under the condition of ensuring the supply of key components, China ’s invasive ventilator weekly production capacity is about 2200 units, which is less than 1/5 of the world ’s production capacity. It is not realistic to meet the needs of global epidemic prevention and control.

Cross-border enterprises face more difficulties and need to break through technical barriers, rebuild production lines, improve supply chains, pass quality inspection approvals, etc. If they start from zero, mass production may take 1 year half.

From the perspective of technical barriers, the ventilator is a knowledge-intensive high-tech industry. The components used in the ventilator are generally standard parts in the industry. The accuracy of ventilation control and the synchronization between man and machine are good or not. It depends on the manufacturer’s own software and hardware. Technical strength.

This is also a relatively weak link for Chinese manufacturers. Foreign manufacturers have mastered a large number of core technology patents, and domestic companies are in smart design, ventilation, noise reduction, etc.The R & D level of core technology is limited, and the independent innovation capability of high-end ventilator is relatively limited.

Recently, US medical device giant Medtronic has also disclosed the complete design drawings and production manuals of portable ventilators to facilitate new entrants to speed up production.

▲ Design Drawing of Medtronic PB560 Ventilator

This is obviously good news, but the issue of trust capital also has to be considered. After all, the technical barriers that large medical equipment companies have spent decades building have easily put technical drawings under pressure.

From the perspective of production cycle , domestic supervision of high-end medical equipment is strict, and the admission and certification cycle is long. Yuyue Medical, a well-known domestic non-invasive ventilator manufacturer, revealed that a medical ventilator completes the entire process of R & D project establishment, testing, clinical verification, transformation and upgrading, core manufacturing, algorithm optimization, and medical registration. At least 10 years .

In addition, according to Yuyue Medical, it may take up to 40 days to produce a ventilator in the normal state. It is more difficult to measure how much time cross-border companies spend.

Many domestic ventilator manufacturers are now expanding their production capacity, and their production capacity has increased by more than ten times compared to the past. However, whether they can achieve steady growth in production capacity is also largely subject to the supply of upstream raw materials and components .

China ’s suppliers do not have an advantage in many core components . The prerequisite for many domestic ventilator manufacturers to increase production and supply in time is sufficient reserves and supply of core raw materials and components.

Most of the upstream suppliers of ventilators are coincident, and it is inevitable that they will face the pressure of tight raw materials during large-scale expansion . Due to the sudden outbreak of the epidemic, many suppliers have difficulty adapting to the soaring demand, logistics restrictions, etc.The problem also puts pressure on the ventilator supply chain that relies on the global division of labor. Some suppliers have experienced shortages of capacity and extended delivery times.

Most of the cross-border manufacturers that are currently public are internationally renowned car companies, and basically choose to cooperate with professional ventilator manufacturers.

For them, the production capacity should not be a problem, and the pressure on the supply chain components should be relieved relatively quickly. In addition, under the special circumstances of the epidemic, many governments have lowered the approval threshold and shortened the approval process.

However, the ability to quickly transfer the production experience of professional ventilator manufacturers and the ability to train a sufficient number of professionals in a short period of time are still the challenges faced by current cross-border manufacturers and new players.

After all, the ventilator is for patients. In case of trouble, it is a matter of life.

Who can supply the core components of the ventilator?

A ventilator is equivalent to a precise gas delivery industrial control system, with thousands of parts. Most of them have been made domestically, but there is still a clear gap between China’s core parts and components and international standards.

Due to the high precision requirements of medical ventilators, the entire machine may not work properly if any one of the parts is faulty. The current domestic ventilator is at the core of compressors, chips, sensors, solenoid valves, oxygen sources, etc. Parts still rely heavily on international suppliers distributed around the world.

For example, the chips of Yuyue Medical come from Germany and other countries. The turbines of Yi’an Medical Ventilator are all imported from Switzerland. The sensors of Probotech ventilator are from Anglo-American. At least 30% of the raw materials of ventilator of Anbao Technology depend on import.

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▲ Disassembly drawing of ventilator parts (source: venteclife)

1. Compressor

Compressors are a key component to help patients ventilate. Non-invasive ventilators mostly use turbo-type ventilators, and invasive ventilators mostly use air compressors.

At present, the compressor suppliers selected by many ventilator manufacturers include Thomas (Thomas) and Gardner Denver in the United States. span>, Switzerland Micronel, Germany EBM and Taiwan Delta etc.

2. Chips and sensors

Chips and sensors play an important role in respiratory equipment.

Different types of sensors can be used to help control pressure, airflow, temperature, and humidity, as well as provide smooth motor control output. The chip is the “heart” of the entire circuit system and is responsible for adjusting the fan in real time according to the collected sensor data to ensure that a proper positive air pressure is generated.