The Inventivity Pod

“Every imagination is distinct,” says Dan Hunter.  “It is a conglomeration of what you’ve experienced, what you want to achieve, and what you remember.”  Can imagination be measured, and what does it have to do with creativity and invention?  How do teachers develop imagination in their students, and how is it elicited in the workplace?  Host Richard Miles talks to Dan Hunter, the inventor of the Hunter Imagination Questionnaire, known as H-IQ, the first assessment of individual imagination and ideation.  Dan is also an accomplished playwright, author, songwriter, teacher, and comedian. 

“Every imagination is distinct,” says Dan Hunter.  “It is a conglomeration of what you’ve experienced, what you want to achieve, and what you remember.”  Can imagination be measured, and what does it have to do with creativity and invention?  How do teachers develop imagination in their students, and how is it elicited in the workplace?  Host Richard Miles talks to Dan Hunter, the inventor of the Hunter Imagination Questionnaire, known as H-IQ, the first assessment of individual imagination and ideation.  Dan is also an accomplished playwright, author, songwriter, teacher, and comedian. 

TRANSCRIPT:

Intro:   0:00Inventors and their inventions. Welcome to Radio Cade, a podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade who invented Gatorade in 1965. My name is Richard Miles. We’ll introduce you to inventors and the things that motivate them. We’ll learn about their personal stories, how their inventions work, and how their ideas get from the laboratory to the marketplace.

Richard Miles:   0:00Imagination. What does it really mean? Can it be measured? And what does it have to do with creativity and invention? I’m your host, Richard Miles, and my guest today via the miracle of Zoom is Dan Hunter, the inventor of the Hunter Imagination Questionnaire known as H-IQ, the first assessment of individual imagination and ideation. He’s also accomplished playwright, songwriter, and teacher. Welcome to the show, Dan.

Dan Hunter:   0:00Thank you, Richard

Richard Miles:   1:04So, Dan. This show is produced in Florida. I live in DC, You live in Massachusetts and we’re conducting the interview via a technology created in San Jose, California. Imagine that.

Dan Hunter:  1:04Yes, exactly.

Richard Miles:  1:17So I neglected to mention in introducing you that you are probably the world’s foremost authority on what makes Iowa funny.

Dan Hunter:   1:25I’ll claim that honor. Yeah, I am a native of Iowa and lived there until about 20 years ago.

Richard Miles:   1:32And you’ve written a couple of books on it as well. Sort of specifically humor and Iowa, right?

Dan Hunter:   1:36Yeah, Three books. “Let’s Keep Des Moines a Private Joke,” “The Search for Iowa” and “We Don’t Grow Potatoes,” and, the last one is, “Iowa. It’s a State of Mind.”

Richard Miles:   1:47Is this taken well by native Iowans that they like the ribbing? Or do you get some push back?

Dan Hunter:   1:52No. I made my living for about 17 years, performing throughout the Midwest and primarily Iowa. I think Midwesterners, they appreciate humor about themselves, and they recognize that they have a calm humility about them, for the most part. Occasionally you get a crackpot, I mean one person once sent me back one of my books stapled 100 times.

Richard Miles:   2:14Like I said, that’s an interesting side hustle. But I guess it wasn’t a side hustle a while.

Dan Hunter:   2:20No, it was my main work at the time.

Richard Miles:   2:22So, this is not a show dedicated to Iowa humor, as much as we, we could talk about that, but to showcase the stories of inventors and entrepreneurs, and at the root of most of those narratives are seeds of imagination and creativity. But the problem is imagination, sort of one of those amorphous words that a lot of people use and a lot of them use it differently, I thought. Let’s start by defining imagination itself, How would you give a fairly precise definition of imagination? And then we’ll go on after that to talk about the questionnaire you develop.

Dan Hunter:   2:54I think it’s very important to distinguish between imagination, creativity, and innovation. Imagination is what happens inside a person’s mind and imagination is something that we all have. It’s part of being Homosapiens. It’s part of our evolution, and people use their imagination every day, often unaware that they are using their imagination. So the concise definition of imagination is, it is the ability to predict outcomes, visualized scenarios, and to engage in counterfactual thinking. So those three aspects are part of our daily life. I mean, you might be thinking, What am I gonna have for lunch? Should I go to downtown tomorrow? Where should we go on vacation? All of those involved predicting an outcome and visualizing this scenario, and it’s universal. Everybody does it now, you might ask yourself then, Well, what’s the difference between, say, me and Albert Einstein? Now, if you are trying to visualize where you left your car keys and you might visualize, Gee, do I see them in my mind on the kitchen counter? How do I see them by the back door? You’re using the same channels of visualization that Albert Einstein used because there’s no special channel for visualizing the universe. And the difference between most of us and Albert Einstein is that Albert Einstein practiced this his whole life, and he channeled his imagination to achieve his goals. He was able to visualize how light moved through the universe and how it might be bent by an orb or a solid body. He could actually visualize that in his mind, and that was the key to his success. So what about creativity? Creativity is defined as something that’s original, novel, of value, either aesthetic or utilitarian. And so it is actually a designation, and not of what goes on inside your mind, where you generate ideas, your imagination. It’s a designation that applies to your idea. Bringing your idea forward. Creativity is a designation given by others. It could be in your domain, it could be in your family. But the designation of creativity is not from you, can I use a metaphor?

Richard Miles:   5:04Sure, of course, I love metaphors.

Dan Hunter:   5:06This is a baseball metaphor, but then again, we are in America.

Richard Miles:   5:10This is as close, as we’ll come baseball, probably in 2020. So go ahead.

Dan Hunter:   5:14So imagination, creativity, and innovation. Imagination is when the batter is on deck in that little batter circle and warming up. Now, he or she could be thinking about anything, but we hope that she’s planning on a strategy, an idea to implement at the plate. She might be thinking ill bunt it down the third baseline, or I’ll try to hit it over the right field. Or maybe I’ll try to hit a home run. However, this is internal thinking imagination. She could be thinking about anything. She could be thinking about chicken pot pie, Cadillac Eldorado. It’s all internal at that point. Now, we hope that she is applying her imagination towards the goals of the game. Now, when she comes to bat, that is the chance to implement her idea. Now they’re too arbitrary white lines in baseball that extend into infinity, in theory. Those are the foul lines, and if you hit the ball outside of the foul line, no matter how powerful you hit it, it doesn’t count. Now it’s the same way with creativity. Your idea has to fall within the expectations of your domain within the expectations of society, be within the rules of the game. And so creativity, then, is when your idea works, and it’s recognized by people that it works and that it adds value within the game. Innovation is then when you have a tangible result the success like reaching first base air coming around the home plate. Now what I started to say is, the DaVinci is a very good example of this Leonardo DaVinci because we know from his notebooks that he had extraordinary ideas for somebody who lived in the late 15th early 16th century. Among them were human propelled helicopter, a set of flying wings. Now those ideas were only in his notebooks. They never were produced. The Duke of Milan could see no value in them, and so they were not useful. They weren’t deemed creative. They weren’t in the expectations of the Duke of Milan.  Now skip to the second half of the 19th century, when a lot of his notebooks were found after being lost and during the end of the 19th century the question was not, can human beings fly? The question was when, because from about 1850 on, there was a great race to become the first self-propelled flying machine, and we know who finished first, which was the Wright Brothers. But so the time when they found these notebooks it was great excitement because the expectation was we will be able to fly and DaVinci’s ideas are considered creative. And in retrospect, in the last 20 years of the 21st century, museums have built replicas, particularly of the helicopter, and it doesn’t fly. But nonetheless, it’s what’s interesting about that. So all ideas begin in imagination, they can’t begin anywhere else. And therefore, if you channel your imagination, if you use your imagination, you will have ideas that maybe recognizes creative or they may not depending on the audience and the time of society.

Richard Miles:   8:19You talked about, Einstein talked about DaVinci so clearly there are people who develop this skill better than others. but It’s not something that someone is totally lacking imagination. Just give an example from the other end of the spectrum. We have, ah, a brand new eight-month granddaughter, and what’s fascinating is to see her develop. And you can kind of see her understanding the world increase, including imagination. One example, where in the last month to six weeks she now understands that if somebody disappears from the room, they don’t disappear from the world. When she hears, noises or footsteps coming from outside the world, she looks expectantly so clearly she knows that somebody is gonna pop around the corner based on the steps. So that’s the prototype of beginning to imagine yourself right in different spatial areas or different time periods and so on. So you and others have developed a questionnaire that can really get at the fine tuning assessment of somebody’s. Is it their potential to imagine? Or is it just a snapshot of where they are on that spectrum of, say, being an eight-month-old baby who figures out that people exist outside of the room? And Einstein or  DaVinci?

Dan Hunter:   9:26First, let me address one of the differences between Einstein and DaVinci and most people. Everything that goes on in your brain is neural connections. Neural networks, where the synapses process an electrical charge inside the neuron converts it to a chemical at the synapse, and then it goes to the next one. What we know about the plasticity, the neural plasticity, the brain is that the brain strengthens how you use it. In other words, practice improves that network in your brain. There’s a classic study of 24 jugglers, and 12 of them had to learn how to juggle, and the other 12 had the great challenge of not learning how to juggle, what happened? Well, there’s actually an increase in the gray matter on the dorsal lateral side of those who learned how to juggle the brain structure itself changed by the learning. The non-jugglers had no change then. This is curious because, of course, the jugglers, the new jugglers, they did it for the month that they were required to do. And most of them stopped because they realized that being able to juggle was not going to increase their chance of passing on their DNA to anyone. So they stop juggling they came back six months later, and that growth in the brain in the gray matter had disappeared. The brain had rerouted that gray matter, those neurons for other tasks. So if you want imagination, you have to practice it, like Einstein did. Or like DaVinci, who walked the streets with his notebook constantly drawing constantly writing his ideas. Now HIQ, which I developed as a solo project. It does not compare your imagination to mine, and the reason for that is is that every imagination is distinct. Even identical twins who share the same genome will not have a similar imagination. It’s that imagination is that conglomeration of what you’ve experienced, what you want to achieve, what you remember. So it’s those three aspects and, you know, from literature and elsewhere that people remember events quite differently, so they have their own understanding of it that informs their own imagination. So the HIQ. The idea came to me when I was working to try to increase the importance of creative work in the schools, and my first thought was, well, we need to have some way of keeping score because Americans value what we can measure, particularly in the schools, and so those things that are immeasurable, such as creativity. They get overlooked or sidelined because they don’t fit into the equation. They don’t fit into the algorithm. So my thought was, if we could establish a measurement that would increase the importance of the creative work, I won’t go into my original idea, which was almost implemented in Oklahoma. But it was similar to something the CDC does. A CDC examines at-risk populations like postnatal, neonatal elderly,  youth at risk. They actually measure behaviors to determine potential outcomes. And that’s what the original index was going to do. But as I thought about it, I realized couple of things one. The most important thing is how you use your imagination and getting students to channel their imagination towards their goals. And so the HIQ is based on four sessions, none longer than eight minutes. So it’s easiest schedule inside of a classroom, and you can do it shorter doesn’t have to go the full eight minutes and has very simple prompts. There’s no secret sauce just like that, no secret sauce between Einstein visualizing and you. It is the same skills, so that prompts ask, you know what are you doing with your imagination? What do you want to do? What do you hope to achieve? And then at the end of the first session, if you’re invited to write as many ideas as you can and it’s not an English test, you don’t need to be grammatically correct as long as you can remember your ideas from what you write at the end of the first session, the software seals your ideas up in a virtual envelope on stores it. Then you have an incubation period 3 to 7 days. Now, if you didn’t like your ideas in the first session, doesn’t matter because you’re gonna have three more sessions and the human brain being what it is. You will either consciously or subconsciously ask yourself, Why didn’t I have any ideas so it gets easier as you go along? Second session is visualization. The third session is on change and invention and discovering again every time your ideas air sealed and stored at the end of the fourth session, all your ideas come back to you. And you assess the idea is on a liquored scale, 1 to 10. That’s what gives you the score. It’s not a diagnostic test. It doesn’t say you’re creative and you’re not because we all have imagination. What it actually measures is how engaged you are with your ideas Now that is valuable to the individual. It’s also a former metacognition because you examine in that time period how you generate ideas where you get your ideas and you focus on the notion that, yeah, I can generate ideas. That’s my responsibility. For the schools they get a score in the aggregate, what that allows them to do. And here’s the measurement part that allows them to determine what changes occurring with these students in terms of their imagination. So you have on opening sessions, say, at the beginning of the year, and that’s a benchmark. You can take it again at the end of the semester or at the end of year. One school wants to start with the incoming freshman, and so it’s a very distinctive questionnaire and is very different from existing creativity tests. I’m sure you’ve seen some of those the nine-dot test and others, but the thing that puzzles me about the other creativity tests is that they are designed by an expert, administered on one day, and then evaluated by that same expert. So aren’t we really measuring whether or not you fit the experts’ idea of creativity? There’s no chance for you to find your own imagination, which is what HIQ does for you.

Richard Miles:   15:24So, Dan, I think I understand how the test works. But let me just see if I do understand. If I were to sit and take the test and in session one, what exactly is the questions? Like what I wanted to believe Is that kind of

Dan Hunter:   15:35what do you hope to do, create, or achieve in the next few months?

Richard Miles:   15:38So let’s say I said, okay, I’ve got a great idea on a manned mission to Mars, right? Okay, and then in session two, I could say either that was a stupid idea. That’s not going anywhere, or I come back and say, Well, I’ve done some thinking about it, and we need to establish a base on the moon first, and then we need to build stuff on the moon. And would that be evidence that I was engaging with my idea as opposed to just tossing it out? Or where would I fall on the spectrum then of imagination?

Dan Hunter:   16:06I would say that you are engaged with your imagination when you get to that point, when you’re starting to ask yourself what else? If you just say, go to Mars and those are the sorts of ideas that floats through your mind quite frequently. But it’s far better that, as you point out, that when you become engaged with the idea and you start exploring the ramifications, what are the nuances? What are the different angles? And you feel yourself gaining interest in momentum. That’s when you’re engaged with your imagination. Now let me share with you what high school students at Conquer Academy wrote when they first did the HIQ, one student wrote that she wanted to write an in-depth essay on the treatment of adolescence and state mental hospitals. She also wanted to develop an algorithm to imitate Stuxnet and to see if it will could be damaged by a computer virus. Now those were pretty ambitious. Then the next questions answer Right after that, I want to get pretty your glasses. I need new blue jeans. Now, the point of that is that that’s how imagination works. It’s not something you reserve for the glory ideas. It’s something that occurs every day, and the glory ideas come along, too. Not that often, but something you use every day

Richard Miles:   17:15You used earlier the great analogy of hitting between the foul lines. You could power the ball over the left-field bleachers, but if it’s left of the foul line, people may be impressed. But it doesn’t go. How does imagination translate into the type of curriculum that we teach, if at all, or testing or improving imagination and then in the workplace? Because you can imagine no pun intended, you could be in that workplace, have all these great ideas. But if your employer says I want X, Y and Z from you 9 to 5 and you go hey no, no, I got a great idea for M. They don’t want to listen, that’s not what they’re paying you for. You have somebody like that would give up or they don’t do it.

Dan Hunter:   17:52In that case, M, would be a foul ball.

Richard Miles:   17:55Right, exactly, yeah. So let’s start with schools. Are there types of schools that do this better in terms of encouraging that imagination to develop into creativity to develop in the action or are they all getting a failing grade?

Dan Hunter:   18:07I don’t think they get a failing grade. Really. It comes down to the individual teacher when I give workshops to teachers and I asked them or I suggest ways that they can increase student imagination. One of the touchstones I come back to is if you give an assignment to your students and you know ahead of time what it’s gonna look like when it comes back, then you’re not increasing their imagination. So I’ll tell you a story. That’s a good example of how you could teach for creativity. When I was in fifth grade, I had a science teacher, Miss Dixie Douglas, and she wanted to teach us the anatomy of the human body, and she could have had us memorized the bones. But instead, she said, make a skeleton. How do you do that? We can’t make a skeleton, she said. You can use anything you want on. She gave us a break, she said. The skull, which has 40 some bones in it. We could just have one piece for the whole skull and it’s extra bones, so people went out and I got a coat hanger and straight out, I put empty spools of thread for the vertebrae, little pieces of felt for the pad in between. I used the inside rollers of paper towels for the arms, the only in the femur, and everybody had a different approach. Now my head was the hardest one to do, and so I kind of tried to shape it out of Styrofoam. It didn’t look very good, but she didn’t say how to do it. She just said, come back with it. Well, at the end, one friend of mine came in and hit the skull ahead. That he had on his skeleton was a head of lettuce, and again, who could have predicted that? And again, it’s a head, so it works. So my reaction is that people who are teaching for creativity are allowing students to be responsible for their ideas and moving the responsibility for imagination off the teacher and onto the student. Another good example of that was a high school teacher in Oklahoma who got tired of high school students complaining about high school. Well, she said, that’s it, I’ve had it, plan your own high school. You got six weeks, everything from the ground up, and stopped, so they had to figure everything out. And so what you see in that process is taking in questions, recognizing where you need information, exchange, and collaboration with each other and it’s very much like a business should work. I’m going back to the business part about the guy who came up with M when they wanted X, Y and Z. The biggest short come in any group of humans is the failure to listen. And so, that person, maybe his idea may be completely whack-a-doo, but somebody at least has to listen to him.

Richard Miles:   20:41Then let’s talk about some of the variables in the aggregate that you think may influence the stock of imagination, creativity, and a given country or culture. Are there things that you see happening on a large scale that seem to point towards well, that is good in enhancing or missing more creative, imaginative responses, Whereas that is not, one example that I’m sure you’ve seen a lot as well is when my wife when I first started the Cade Museum, we talked to a lot of inventors and entrepreneurs, and we go to their offices and we asked him for over their origin story of the invention. And we noticed on their bookshelf the books that they had were all over the map. They weren’t just on their particular discipline. They had books on history and the arts and cooking and sports and everything. The other thing that we did notice and it wasn’t s significant relation, but an awful lot of particularly the physicians and engineers and we talked to were amateur musicians. And so it seemed to us on our very small sample side of several dozen, maybe up to 100 of these folks, that this ability to see outside of your particular training seemed to have an effect because again, we’ve got a lot of great researchers. But not very many of them actually become inventors. There was an additional variable of play in spurring them on to the next level of actually creating a new technology or product or idea whatever. And our thesis was that it was training in the arts of the ability to see outside of their own training, that supercharged the creativity you had. Do you see anything like that? In your experience, in your research playing out citywide or statewide, globally, in terms of the variables that go into this?

Dan Hunter:   22:16That’s difficult, I don’t see anything that happens consistently in schools or government or business. I think that there’s a lot of lip service to wanting this so called innovative workforce. But I don’t see a concentrated effort to get there, which I believe would involve changing fundamental attitudes in the schools. I think that is essential mean that has to happen because we are teaching students preparing them for jobs that don’t yet exist using technologies that haven’t been invented. So what should we teach them? We should teach them the ability to generate their own ideas, and as you point out, combine disparate items to see something freshly, to see something new. I think that when you talk about the inventors and engineers and doctors you talked about with the variety of books on their shelves playing music, I think it comes back to the word curiosity. That if you have a natural and innate curiosity, you’re gonna try things and find things that other people don’t, and you have to be able to look. In one of my creative workshops. I used to talk about how much the subconscious controls our moment to moment daily lives. And to exemplify that, I would ask everybody in the room to be quiet and still, this would usually be in a classroom or some kind of business room, and say, do you hear any sounds that you hadn’t heard before? Well, there’s usually a very strong buzz from the fluorescent tubes, and they all hear that now on. My point is that’s been there since you first walked in. And I once did that with a group of composers, and they had all already heard it because that’s their bent in life is listening to sounds. But yes, I think it’s very important to have a broad interest and the aspect of music to get back to that something very interesting about music. But I don’t think we fully understand why. But when you play music and sometimes when you listen to music, it engages almost all of your brain when you do that and they’re not many functions that do that, and we don’t really know why it does that. But it has a powerful effect on music is a great mystery. Another point I might make about the connection between musicians and ideas. When you play music, you have to focus and it takes you out of the current world, and your entire conscious mind is focused on playing the music. The next notes on ideas often come when we shift our focus away from the problem itself. And I think that’s something that music does. Or people say they get their ideas in the shower. I have a friend in New Mexico who gets his ideas mowing the lawn. It’s almost as if you shut down the conscious activity and your brain will generate ideas. However, I would point out Pastor who said ideas Air favored by the fertile mind. You have to have a prepared mind to get ideas. In other words, I’m not going to get an idea about how to do a Mars Rover. I don’t think about it, but I think about plays and so I’ll get an idea for that. Or I’ll think about how to talk about creativity, and I’ll get an idea for that.

Richard Miles:   25:20So one of the things that I’ve been wanting to do, at the Cade Museum and this, this will warm your heart. Dan is I’ve always thought comedy was a fascinating example of creativity and invention. In that every joke, at least when it’s told the first time, by definition is a surprise, right that if you land a punch line, you’ve got to take people by surprise. And that’s what triggers that laughter and so on. And it’s why comics have to change their material right because if you never change your material, you’d be out of business after a couple of years or sooner.

Dan Hunter:   25:48It’s very interesting, because how to understand comedy is also a mystery. We don’t really know why we laugh or why we laugh from an evolutionary point of view. There was a scholar in Alberta, Canada, who claimed that he found the 10 most funny words in English, and his view was that if you just be used those words, people will laugh. Well, I wrote a piece on In all 10 words are on there, and it’s not funny has to do with the lack of surprise right on the funny word. If it’s put in the right place and surprises you, it can. I think comedy is very close to that, because again, in comedy, you have disparate things, put together reversals or the unexpected twist. And I think it’s the same with inventions that to use a cliche that moment of what if we did this in this in this or what? If we didn’t do this, how would that surprise us? How would that change things? And I think again it goes back to curiosity. I used to work with farmers and carpenters and there was always this, let’s just try this, what the hell, see if that works, you get a kick out of it if it doesn’t.

Richard Miles:   26:54right? Yeah, and the other interesting about comedy too is it’s context matters, right? You’re not gonna really land a joke unless people see a little bit of themselves or their neighbor, their family member in that joke, which is one generally doesn’t usually transfer across cultures or nations very well, because people have no idea what they’re making fun of.

Dan Hunter:   27:11Well, I give you a very interesting example. I was once doing a show in northeastern Missouri for 800 farmers sitting on folding chairs, drinking coffee in a high school gymnasium. I was supposed to make them laugh, and I started it, and I have been doing it for a few years, so I had an idea what worked with farmers and what didn’t. So I started up my usual show and nothing, still throughout the room. I could feel cold sweat rolling down my back. What? They’re not laughing, so I didn’t know what to do. So suddenly I just stopped and I hit the guitar and I muffled the cord silence across the room and I looked out around everybody, and I said, I leaned on the microphone I said, You know, this stuff is funny and one woman, about 12 rows back started to giggle, and then it spread all over the room, and that was fine for the rest of the show, so they didn’t know it was supposed to be funny that they were supposed to laugh.

Richard Miles:   28:06They were taking you seriously.

Dan Hunter:   28:07Yes, yeah, and when you talk about context, every performance, even exchanging jokes on the street, everybody has to know their role. And we all know that we’ve laughed at jokes that weren’t that funny because we were in a social situation and trying to make people feel good. But that context is everything. Ah, lot of communication resides in the listener, and the listeners expectations.

Richard Miles:   28:31So, Dan, my last question was going to tell me a joke. I can’t lift past the opportunity. We are recording this in April 2020. We’re in the midst of this Covid19 pandemic. I wanted to give you a chance to share your thoughts. If you have any on the role of creativity, for better or worse and time are going through, I’ll just give a couple of examples. I mean, obviously a lot of people are trying to work on things like vaccines or new types of treatments. But at the other end of the scale, you have entire ballet companies choreographing things online or symphony orchestra in the same thing. How is creativity playing a role in the extraordinary circumstances we find ourselves right now.

Dan Hunter:   29:11What is pretty consistent in this is that the creativity doesn’t disappear, doesn’t go underground and vanishes. It’s there one of the pieces I wrote in my newsletter or about the homemade masks and the way people use them to express their individuality. The act of being home alone is an active imagination. How are you going to deal with yourself? What you gonna think about? How do you pass the time. I think there’s a lot of opportunity for people to maintain their imagination and even increase it going to your library shelf, getting the variety of ideas out of there. There is one area I would like to speak out against, though, if I can. I think online education. We’ve been thrown into this national experiment completely unprepared as teachers, parents and students for online education, and I think that is a chilling prospect. First off, I know from the surveys the students don’t like it. Some teachers don’t really object to it. But the heart of the matter is that school is a place where you generate ideas and where you think about issues and where you learn. The home is a place where you play with your dog or yell at your brothers and sisters. I think that we can’t let whatever success or money can be saved by online education. We can’t let that disrupt regular classroom education when the virus passes by, because so much of what we do in school is not just learning skills or data or content. We also learn how to make friends how to get along with each other, how to resolve conflicts. We watch teachers as they model being an adult. So I think that the online education is merely a temporary parachute.

Richard Miles:   30:52Well, we’re certainly gonna have lots of testimonials from parents, said Wow. This is a lot harder than we thought, trying to do that also with supplementing various online things. And so I think there may be a little thirst to get back to the very personal with others and in front of others.

Dan Hunter:   31:06Yes, and I think for parents to realize how hard it is gives him a better appreciation for teachers. And we need to go back to the question of what’s wrong with our schools. It’s not the curriculum, it’s not the books. It’s. We need to pay teachers more to get good teachers. And if we care about education, then teachers should be well paid.

Richard Miles:   31:26Well, I can’t think of a better note that ended on that. So Dan, thank you very much for joining me this morning and hopefully the next interview we could do in person and best of luck to you and look forward to talking to you in the future.

Dan Hunter: 31:30Thanks, Richard. Take care.

Outro: 31:31Radio Cade is produced by the Cade Museum for Creativity and Invention, located in Gainesville, Florida, Richard Miles is the podcast host and Ellie Thom coordinates inventor interviews. Podcasts are recorded at Heartwood Soundstage and edited and mixed by Bob McPeak. The Radio Cade Theme song was produced and performed by Tracy Columns and features violinist Jacob Lawson.

Does UV light kill COVID-19? How can we best use it? Is it expensive?  

Terry Berland, CEO of Violet Defense, whose UV solutions are currently being used in operating rooms, hotels, schools, ambulances, food processing, and athletic facilities and Jim Thomas of Kirenaga Partners and The Central Florida Tech Fund join the program to discuss all things ultraviolet light. 

Does UV light kill COVID-19? How can we best use it? Is it expensive?  

Terry Berland, CEO of Violet Defense, whose UV solutions are currently being used in operating rooms, hotels, schools, ambulances, food processing, and athletic facilities and Jim Thomas of Kirenaga Partners and The Central Florida Tech Fund join the program to discuss all things ultraviolet light. 

TRANSCRIPT:

Intro: 0:00

Inventors and their inventions. Welcome to Radio Cade and podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida, the museum is named after James Robert Cade , who invented Gatorade in 1965. My name is Richard Miles. We’ll introduce you to inventors and the things that motivate them, we’ll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

James Di Virgilio: 0:39

Welcome to another COVID-19 edition of Radio Cade . Today, we’re going to talk about UV light. It has been described as nature’s disinfectant. Does it solve the COVID-19 crisis? Can it help us move forward with disinfecting things? For Radio Cade I’m James Di Virgilio, my guest today, Terry Berland, CEO of Violet Defense, a UV light company, and Jim Thomas of Kirenaga Partners and the Central Florida Tech Fund. Gentlemen, thanks for joining the show. -Absolutely great to be with you. Now Terry, in 1910 in Marsay, France, UV light was essentially first used as a disinfectant or so it’s credited, you have a very interesting background in a lot of things. Tell us a little bit about how you are qualified to do what you’re doing and how you’re running Violet Defense.

Terry Berland: 1:26

So let me start with my first job out of college. I was undergraduate at Notre Dame and I needed to pay for my last two years of school. And so the Navy came to me and said, why don’t you come teach nuclear engineering for the Navy as the Naval nuclear power school in Orlando, Florida, and in exchange for that we’ll pay for your last two years. So my first job out of college was actually teaching nuclear engineering, never in a million years did I imagine that what I learned there, which is all about photonics and radiation would actually play out some 25 years later. From there, I went to graduate school. I was a partner at McKinsey in the healthcare practice I spent about 13 years on wall street , uh , was part of, kind of two major transformations, one, the bear, Stearns, JP Morgan transformation, the other one, the Lehman brothers and Barclay’s transformation. I then went to work for the largest hedge fund in the world, an organization called Bridgewater. And then about five years ago, partner Dave Scalzo and I spun out to actually start a venture capital firm called Kirenaga Partners within three months of actually starting that decided I could do that anywhere. And so I relocated back to where I had started my working career in Orlando, and I ended up coming across Violet Defense as one of our first Florida based investments back in 2016. I started as the interim chief operating officer, as well as the lead investor. And then in 2018 , uh , the chief science officer and founder asked me to step in to be the CEO, so he could step back into the science role. And so I’ve been the CEO of the company for the last two years,

James Di Virgilio: 3:00

And I understand a lot of very interesting things have been happening. The bulk of today’s discussion we’ll be discussing UV light, what Violet Defense is doing to help further that study. But first, Jim Thomas Central Florida Tech Fund, tell us about the mission behind this. It’s a very interesting thing, especially for the state of Florida to have something like this.

Jim Thomas: 3:18

Absolutely I’m originally born and raised in Los Angeles, grew up in California. My first career was in politics, so got to travel around, see a lot of things and really see the transition of, you know, I thought I was going to save the world through policy and government really saw it was technology that I thought was really gonna make the biggest difference wanted to get out of California and took a look around the country and just didn’t want to go to traditional Chicago or New York or anywhere on the West coast. And just discovered central Florida, moved here about 10 years ago and seeing the richness of the schools throughout the I four corridor the talent. It was just so impressive. Got to do things like run the regional chamber of commerce here in Orlando, and just see so much opportunity. I met Terry about five years ago and just loved his and Dave’s philosophy about why to fund early stage companies, how to do it and how to do it the right way and was just so impressed with that. So we just stayed in contact over the past five years or so, and just help each other out where we could. And then about a year ago we started saying, what would really change the ecosystem in central Florida is more professional capital and at the right level. And we said, let’s come together, let’s be real specific, let’s call it the Central Florida Tech Funds. We’re not just saying not just early stage, but let’s really dig in on early stage in central Florida. And it’s just been such a great, great ride. We’ve really launched about six months or so ago. And we have these companies in mind like Violet Defense and Ecospheres, which does environmental remediation. And then all of a sudden COVID-19 happens. And technology that’s been developed like Terry just said over a decade ago, all of a sudden becomes really a part of the global conversation. So that’s what we’re excited to continue that work with the tech fund, but it’s to be involved with companies like Violet Defense.

James Di Virgilio: 5:13

Yeah, outside of COVID-19, I’d love to have a discussion one day, obviously all about the power of early stage funding and venture capital, the importance to not only the state of Florida, but the country and the world, but one thing COVID-19 shines a spotlight on is, people solving problems, creativity, innovation, entrepreneurship, right? Often the fastest way to solve a complicated problem is to have people working on it creatively, enter in Violet Defense. This is not a new company I’ve been around since 2012, UV light, not a new thing. We already established that for over a hundred years. We’d known it’s been something useful, but for the listener out there, what is UV light Terry? Is this sunlight, is this something different? And how is it useful?

Terry Berland: 5:56

Yeah. So UV stands for ultraviolet, which basically means below the violet spectrum in a color chart, it’s invisible to humans basically starts at about 400 nano meters and goes down. It breaks into three categories, UVA UVB, UVC. UVA is the stuff that will penetrate your skin and it can give you skin cancer. UVB is the stuff that generally gets your skin hot it gives you sunburns. UVC, which is actually called germicidal UV is kind of a fabulous germ killer, but most of it is actually blocked by the ozone layer. So we don’t get a lot of it from the sun, but it is essentially kind of the highest energy version of UV from a safety perspective. It’s also the one that is easily stopped. So it won’t go through the skin on your arm, it won’t go through a shirt, won’t go through glasses. So it’s less concerning to us. It’s substantially more concerning to single celled organisms, like the ones we’re trying to kill now.

James Di Virgilio: 6:54

What data indicates that UVC is effective at killing viruses, things like influenza, what do we know about UVC’s abilities?

Terry Berland: 7:02

Well, so as you had mentioned, the first test on UV and the antibacterial capabilities are actually as far back as 1877. There’s a report from Down’s and Blunt that started that discussion. In 2000, actually, the U.S. Army did an entire kind of compilation of all of the research that had been done on UV and its effectiveness today. And water treatment actually particularly around the world uses UV quite consistently and has for a very long period of time. So there’s actually a lot known about UV and its killing effects. If you take, for example, the most recent discussion about COVID, COVID is actually one of the easiest viruses to kill. So it is what’s called an envelop virus, which means it has a lipid layer around the outside that’s actually easily destroyed by exposure to UV because the UV photons basically break it down. And then once it’s broken down, the germ dies. So UV’s been used, for mold, mildew, viruses, parameciums, bacteria so it’s just a function of how much energy and that’s a function of time and distance from your light source.

James Di Virgilio: 8:13

How can we best apply UVC if I’m sitting in a room and you’re sitting in the same room with me and you cough, is it possible to have a UVC light in there shining on us? Or is this something that’s not safe for a human body to absorb?

Terry Berland: 8:25

Ideally the current versions of UV, which is A, B, and C, you use the disinfection when people are not in the room. So the way something like that would work is we’re sitting in the room, we have a room outfitted, for example, with a Violet Defense light in the ceiling, because ours are designed for installation, for mounting, as well as mobile deployment. And we’re like, you know what? We need to clean the room so we would get out, we would hit the button, we would start our UV disinfection device and the disinfection device would clean room. All of our units, as well as most of the industrial units that are out there in the healthcare space. If we were to walk back into the room, there’s motion detection, built into all of the units to automatically turn them off until that motion disappears again. And so that’s how you would typically use a UV device today. There is research coming out of the University of Columbia in particular, under Dr. Brenner, that is looking at far UV. So that is actually below UVC. It’s not naturally in creation, but with the right type of bald mechanisms, we might be able to create it. That one, you could actually sit in the room and not have to worry about any exposure, cause it would even be stopped by just the liquid layer that covers your eye. So there is a lot of study about UV that could be run when people are in the room, but the current technology doesn’t allow it.

James Di Virgilio: 9:42

So currently, it’s application to COVID-19 is this famous photograph of a bus in Shanghai, like a UV lit up station with UV lights on it almost looks like a futuristic techno photo. At the end of the day, that bus is sterilized from any of the activity that’s going on and those surfaces that maybe would have had COVID-19 on it that still would have potentially been infectious are no longer, correct?

Terry Berland: 10:05

It’s interesting that you pick that picture. That picture is a fabulous marketing picture, but actually does very little to clean the bus. So if you notice the bulbs were on the outside of the bus, and so they clean the outside, but the sun has been cleaning the outside all day long. So the real concern that you have with pathogens is when you can’t get sunlight to them. And so that’s now when you’re talking about indoors, right? So inside the bus and there are UV devices that are being used to clean inside buses, they’re also being used to clean COVID masks. So one of the other interesting pictures for your listeners, if they would like, is to go look up the Nebraska protocol for UV disinfection of 95 masks, it has two large UV devices. And in between it is essentially your grandmother’s clothesline with UV masks being held on by clothespins , but we’re allowing UV exposure to both the front and the back side of the mask, to allow people to reuse it instead of having to throw them away.

James Di Virgilio: 11:01

Now, what I’ve seen on the reusage of mask, is the risk is that if I miss shine, UV light on even a tiny corner of that mask, I could leave some of the virus on there, right? -That is correct. So you have a shadow issue.

Terry Berland: 11:14

Yes. You have a shadow issue and you have a duration and exposure issue. And the way you deal with that is a combination of just long enough runtime, but also multiple point sources. So one of the challenges with the existing UV technologies is they tend to be very big units. Look at a company like Xanax. They have $125,000 unit. It’s about 60 to 70 pounds at its height. It gets to about six to eight feet, but it’s a single point source. And so the problem is if anything is in its way, the other side of that won’t get cleaned. Now imagine if you could take that same power and break it up into 20 different point sources that are located throughout a room. And now, while it may be blocked from the light coming from the left, it’s completely exposed to the light coming from the right. And that’s why if you look at the way, rooms are lit, rooms are rarely lit with one big light in the center. They’re lit with a bunch of distributed lights that give you multiple point sources. And that’s actually how you deal with the shadowing.

James Di Virgilio: 12:18

So you could place the N 95 mask in a room that you can ensure, hey, this lights being hit from all these angles. All of this light is the UVC light that’s going to take these pathogens away. And then a single use N 95 mask becomes something that can be used repetitively, which obviously is going to help. I’ve also seen hospitals are using, and this is not the right description, but sort of like a Roomba that they put into a room that then cleans the whole room, clean surfaces, cleans tables, cleans chairs, applications like that as well.

Terry Berland: 12:45

Yes. And again, those are actually valuable, as long as the pathogen that you’re going after is very close to the device. The challenge, particularly for something like COVID is it can stay in the air for awhile . And so, there’s great value in surfaces infection, but if you don’t clean the air above that surface, within a short period of time, that surface is going to be recontaminated. And so that’s why at least the devices that we have, we call them Sage, which stands for surface and air germ elimination.

James Di Virgilio: 13:14

Sunlight has been talked a lot about as a potential source for helping you mention this on the buses, naturally cleaning things off it’s nature’s disinfecting . It’s great for water, right? Whatever purification and treatment, you can leave it out there for six, seven, hours and it’s going to do its job. But from what I’ve read, it seems like the consensus is sunlight is not really strong enough to kill COVID or at least consistently is that accurate?

Terry Berland: 13:35

I wouldn’t say it’s not strong enough. It’s missing the particular spectrum of UV that you need for viruses. So bacteria is pretty readily killed by a UVA and UVB. Essentially what it does is it heats up the surfaces of the cell wall and the bacteria die. So think about it as a super sunburn for things like viruses, they’re harder to kill. And so what you need to do is you actually need to destroy the DNA and the RNA of the virus that requires UVC. The sunlight produces a ton of UVC. Our ozone layer blocks it almost all out. So while it is produced, it never gets to the surface of the earth. And so it’s not so much that the sun isn’t strong enough it’s that we actually have a blocking layer, which if we didn’t, by the way, we’d have other problems, but a blocking layer in the ozone that basically keeps that germ killing for germicidal UV from actually coming from the sun and getting to the surface of the earth.

James Di Virgilio: 14:30

Right . And like you mentioned, that’s a good thing because UVC would essentially fry our skin extremely quickly. If we’re just getting overexposed hits to it.

Terry Berland: 14:38

And, all of our plants and most of the animals that we eat and a whole bunch of other things. Yes.

James Di Virgilio: 14:44

Right. So then applying UVC is like you mentioned that’s why has to be an empty room, right? This is not safe for humans to be contacting yet interesting research going on, on a way to do that. So with that being said, we’re looking at a post-exposure room as a disinfectant, is this solution any better than just washing our hands and wearing a mask and going about our daily life? How does the average person not in a hospital benefit from this type of technology right now?

Terry Berland: 15:11

So washing your hands is really good for getting rid of something that is on your hands when you’re near a space where you can wash your hands, but you’re going to touch surfaces all day long. The door handle, when you walk into your office, the button on the elevator, the fork and knife that you got at a restaurant. And so the value of having disinfection devices like this is that they can clean and keep clean what we call the everyday spaces, such that you aren’t susceptible to something that somebody else might have left. So by washing your hands , you’re doing a really good job of making sure that you’re not going to give it to somebody else. And if you subsequently touch your eyes or something like that, you’re not going to give it to yourself, but it won’t change the fact that you could actually be carrying COVID and they just have a recent report about this on the bottom of your shoes. So somebody just coughs under the floor 10 minutes ago, the virus is still alive. I just walked over the top of it. I’ve now picked that up on the bottom of my shoe. In fact, I can’t remember who did the report, but they were talking about some of the most significant contaminated spaces. And one of them was actually just the bottom of women’s purses, because they set them down on all these spaces. And so if you had a UV light like ours, that was constantly cleaning that floor, whether it’s every day or every six hours that you at least go back to ground zero at some point in the cycle and then it has to build back up again.

James Di Virgilio: 16:40

Okay. So clearly you get a reduction it’s obviously not perfect. Like you mentioned, if I go somewhere in the middle of the day and it was cleaned last night, all the people that have interacted with those surfaces during the day, that bacteria and that viral material is going to be there that night, you flick it on UV light does its work, next morning, good to go. But obviously if you’re doing this every day , you are reducing the number of viral agents that are there, that’s the idea.

Terry Berland: 17:03

That is correct, and, if you know that there’s a contaminated area, you don’t actually have to wait until the overnight cycle to catch it you can do spot disinfection and that spot disinfection is particularly enhanced when you have a high power device, that’s the size of a book, as opposed to an 80 pound device that’s five feet tall.

James Di Virgilio: 17:23

I’m thinking of the New York subway right now. And I don’t know how they disinfect the subway right now. How often it’s done, if it’s done, when it’s done, but what would this, -I do! That’s what I figured you might. So one, let’s start with that. How is it done now? And then two, how could UV light and someone like Violet Defense change, maybe forever, how it’s done.

Terry Berland: 17:43

So we’ve actually were asked by the New York Metro transit authority to come up and speak to them about how to use our technology on their buses, their subway cars and the Metro North train cars. So today, the disinfection is done with wipes and individuals in masks, and in some cases they’ll do a full spray down where they actually have people in hazmat gear and they try to get to them as regularly as they can. But the solution is almost all chemical in nature. And so it’s subject to the people on there, being able to both from a timing perspective, that diligence perspective, being able to wipe down every space that you want to, that’s not going to get, for example, underneath the train car seat, because you’re not going to get people down there that are going to be wiping from the underside. So they’re going after the high touch areas. And then, frankly, up until six to eight weeks ago, not sure there was a lot of thought about what would be required past that. So when we were there, we had talked to them about, was actually using our devices with mobile stands that you could actually place, think about a subway car and think about three double-sided units. One that’s flashing toward the backside, one’s flashing toward the front side, just set them up so that essentially you create a UV light bath inside the car. If you turn them on, they closed the car, you let it run its cleaning cycle, and then you move them to the next car.

James Di Virgilio: 19:07

And cost-wise , is this a more effective solution? Would this cost them less money than having manual work to basically clean all the trains down? Or are these lights so expensive? And the devices that deploy them so expensive that it winds up being a more expensive solution?

Terry Berland: 19:20

So, the technology prior to our Violet Defense solutions , that would have been absolutely more expensive. For example, if you were going to do the same thing was I’ll use that extra because I know their pricing. If you were going to use that you do three Xanax machines, you’re talking $375,000 worth of infrastructure on a car that you would be moving from car to car, to car. Our units, even at retail to clean that same car would be under $20,000.

James Di Virgilio: 19:48

So then you could essentially envision buying a lot of these and then you could have them clean the cars for something that may even be equal to the cost they’re spending right now? Is this something that’s, that good that it’s equal spend New York, you’re going to get more disinfected?

Terry Berland: 20:00

So, we would contend likely once they figure out what they can stop doing in the interim, we were just, you know , I think by far the lower cost option for supplemental, and then they largely shut the mass transit system down. And so now kind of went by the wayside for a little bit, but I know certainly when we’ve looked at, for example, schools as a great example, since our units don’t require maintenance and the operating cost on them is pennies a day. Our small units only use about as much electricity as a 60 watt light bulb when they run and then it’s a two watt LED when they don’t. So you’re literally talking pennies a day to run these. If they’re installed where you have no labor, once you buy the units, the overall cost over the life cycle is in dollars a day. You can’t get anybody to disinfect a room for dollars a day.

James Di Virgilio: 20:48

So this is potentially like a ginormous step forward in the world of disinfecting everything, I’m thinking stadiums, airports. I mean anything where people are gathering down the road, you could imagine this becomes the standard of how you disinfect a room. -Yes. What would the contrarians say? Are there people out there who say, hey, this isn’t going to work, this isn’t worth it, this is a waste of time, or is this just universally accepted as the way forward?

Terry Berland: 21:13

I wouldn’t say it is universally accepted. I think the contrarians are having most of their arguments unwound. So the primary push back was that even at dollars a day, it’s not needed, just never had a problem, that was big enough to matter. And for a lot of the places, for example, that are shut down and all their employees are now getting laid off, they still don’t have a problem today, but, the world isn’t going to let them operate on that trust me, my place is good, going forward. We have embarked in a completely new world with the impact that this had. I mean, you would have imagined that something like swine flu might have done that because we had almost a billion people in the world who got it, but we never really changed our behavior on the back of swine flu. This has changed everybody’s attitude. And so whether it’s our devices or somebody, else’s the idea that you’re going to have to have a multilayered solution for disinfecting spaces in order to be able to return to normalcy, I think will be the standard. And so now it’s not about whether the cost is worth it versus not doing anything, it’s going to be is this a less costly and more effective solution than the other solutions? Because I have to have something. And that’s why we do believe that it will become the standard for a whole lot of spaces and stadiums are great examples of it. You know , we’re now in use of the orange County convention center. We’re in the back of ambulances. I’m expecting that these things will become instead of retro devices, they will be integrated into and built as part of the solution and you take the subway car. Now, if I had the ability to build these in, I don’t need tripod and any labor, I parked the car for the night, I hit a button on my way out, the doors closed and it auto runs a disinfection cycle overnight with no labor required. That is guaranteed to be both a less costly solution and a higher quality solution than what they’re dealing with today.

James Di Virgilio: 23:08

And then down the road you can imagine this being installed in homes as well, right? It just, as you build your house, you’re going to wind up having these lights here. You can set up, like you said, the motion sensor cycle or whatever is going to wind up being safe. And every night you flip those on and that could become something that gets applied there. I mean, this is an endless application cycle, essentially, as you’re mentioning it, if this is done correctly, right?

Terry Berland: 23:27

Yes. And as you mentioned that, I have the first installed version of this in my master bathroom at home. It’s actually been there for two years. It runs full time, and basically what it does is when I walk into the bathroom, it sees me, it turns on the bath fan. When I walk out, it finishes as fast fan cycle and immediately goes into a disinfection cycle. I can also cycle it in a day and have it just run a cycle. And that’s actually where our smaller unit came from because we had installed this and then my young daughter came in and she was coughing from school and she was coughing all over the bed and my wife asks , how do I get the unit that’s in our bathroom into this room? And so we basically just went from being an installed bathroom version into a mobile version, which is called the micro . And that’s actually where the original micro came from

James Di Virgilio: 24:14

And thinking of home use, because this is, what’s getting a lot of coverage now is what most people are doing first effective. Let’s assume we don’t have the micro. We don’t have something that’s UVC. If I’m just shining a UV light, a black light, something like that on my bed at night or in my bathroom. Am I actually achieving anything for COVID?

Terry Berland: 24:30

Nope. You’re probably seeing things you don’t want to see, but you’re not going to kill anything. So, UVA by itself, unless it’s very intense and your black light isn’t going to be, it is not going to produce any meaningful kills for bacteria or viruses. In fact, there were some early companies that were trying to make claims about using something just outside the UV space of four or five nano meters space and what they found is for a room you would need to have those units shining 24 hours a day to get something like an 80% reduction, assuming nobody entered the room to infect it again.

James Di Virgilio: 25:03

This is good myth -busting, so, effectively here we know for sure that shining your own UV light is not going to do anything to stop the spread of COVID in your home or elsewhere. So that’s not a productive practice. Is there something I can get? Can I purchase a UVC light that I can do what you’re mentioning with, is that on the market yet?

Terry Berland: 25:20

We just brought one to market. So if you are on our website, there’s actually a button called Sage at home. So we’ve created a consumer level version of the product, which is about half the price of our industrial product that you can actually use at home .

James Di Virgilio: 25:35

And is there like a training program to go through it? There’s if I just shine this at a family member of mine, am I going to wind up injuring them or hurting them or what’s to make of that?

Terry Berland: 25:45

So, we do have in all of our instruction manuals, the safety precautions, you’re not supposed to stare at it, right ? Don’t touch it while it’s running and so we can’t stop people from doing crazy things like that. Now, it also has the same motion detection protection, so if you were trying to shine it at somebody and they were waving their hands or putting their hand in front of their face, you would not even get it to run because the motion detection would keep it from operating.

James Di Virgilio: 26:09

Interesting. I’m thinking of so many questions of things this may or may not do. Like what if I’m sitting still and you shine it at me, I guess people would have to know, right? This is not a toy. Like, you can’t mess around with something like this because UVC rays are very powerful.

Terry Berland: 26:21

Yes. Although as we’ve described, we designed ours to kill germs, not people. And so you’ll get more UV standing in the parking lot for 30 minutes than you would sitting six feet from our unit for 30 minutes.

James Di Virgilio: 26:32

Aha. So you’ve built in something to lessen the effect of this, from what you may read about it. If you’re Googling UVC, you’ll read this thing will fry your skin in five seconds. But your model of the home model, not as intense.

Terry Berland: 26:42

Not as intense. And actually, even the statement that UVC will fry your skin is just a complete inaccurate statement. So UVC can’t get through the dead layer of skin. So I’ve read some articles where basically people are saying, if you will fry your skin in seconds, it’s just a lie. The biggest issue for UVC is actually exposure to your eyes because there you don’t have dead layer of skin to protect it. So there’s a lot of myths out there that are trying to get people scared of UV. But the practical reality is, the way our units work, which is very different than most of the other UV sources out there. You could have using a UVC bulb, a real problem, because it produces invisible light, you don’t know unless you’re particularly attuned to it, that you may be staring at a UV bulb cause you can’t see it. So you would have real risks that you could stare at it for some extended period of time and create a problem. Ours is what’s called pulse Xenon. So when we produce our UV, we’re not just producing UV. We’re also producing a very powerful, bright flash that is the entire visible spectrum, all the way into the infrared space and also in UV. And there’s no possible way you can keep your eyes open during that flash. So it’s very easy because of the device that we use for people to know that this is producing UV. And it’s also really hard for you to have any extended eye exposure issues. Cause you can’t keep your eyes up. There’s not a challenge for people to try it, but it’s one of the built in safety mechanisms we have based on our design.

James Di Virgilio: 28:10

I love when moments like this happen, when I’ve asked you a plethora of questions and you think of all of them and that’s what good entrepreneurship problem solving is. I feel like often in our society, we think that people discover new things, rather haphazardly. Hey, I’ve stumbled upon this idea I’m going to put it out to market and kill a bunch of people and I’m not thinking of what’s happening, but in fact, most of the time, it’s exactly what you just said, right? You think of all the questions that a reasonable person would think of and you go out and you solve them. What if that happens? What if this happens? How do we fix this? How do we do this? And the innovation level that you’re describing today is obviously very pioneering. You’re very much in the frontier of this curve, but I think it’s also reassuring for people out there that maybe fear innovation. They may view innovation as something to be afraid of because this is going to be dangerous per se .

Terry Berland: 28:53

And there are products and I will be the first one to say, there are products on the market place where people have grabbed the UV bulb off the rack, the UVC bulb off the rack, and then they put a racking cart on it and they run it to market. So one of the things I would suggest to everybody who’s listening to this is ask for the safety certification , ask for the testing certifications and ask them for all of the user manual information that shows you that they’ve thought about this. So like, one of the things that nobody other than us actually thought about that we can tell, is because ours is a strobe, do we have the potential to trigger somebody’s photosensitive epilepsy. So even if I’m not directly in the room, if I see this flash in the back, I can actually trigger an epilepsy event. So the answer is no ours won’t because we’ve worked directly with getting the guidance from the national epilepsy foundation ours only flash once every six seconds. In order for you to have a photo epilepsy event, the needs to be anywhere from five to six flashes per second. So we’re more than a 10 X difference away from what’s required. But it’s another thing that if you read our user manual, you’ll see that we thought about, and we incorporated before we rolled the product out to market.

James Di Virgilio: 30:01

Hmm. There’s just so many applications of this. And yet, like you mentioned, as a frontier market is, you have to be careful with it. And I think the education Terry you’ve given today has been fantastic. It’s pinned wide ranging, full covering. It’s been one of the main topics, right? Vaccinations, masks, ventilators, and you think of UV light. And so I think fantastic work describing not only what UV light is and how it works, but also the upsides downsides and what’s out there and applicable Terry Berland, CEO of Violet Defense, Jim Thomas of Kirenaga Partners and the Central Florida Tech Fund, all of this stuff being possible with entrepreneurship and ideas and ways to move the world forward, to solve real problems that we’re facing today with COVID-19. Thank you both for joining us. Unfortunately, we’re out of time. I know we could discuss way more, but thanks again to your efforts, not only in the state of Florida, but also to the U.S. And the rest of the world and attempting to solve very real problems that we’re facing.

Terry Berland: 30:49

It’s a real pleasure, thank you for the time.

James Di Virgilio: 30:51

Oh Thanks Jim, and for Radio Cade I’m James Di Virgilio.

Outro: 30:55

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida. This podcast episodes host was James Di Virgilio and Ellie Tom coordinates inventor interviews. Podcasts are recorded at Hardwood Soundstage, and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinist, Jacob Lawson.

What is a vaccine? How long will it take to get one for COVID-19? Are there are other alternatives? What about herd immunity? 

Our guest is Dr. Peter Khoury, the President and CEO of Ology Bioservices Inc.  He is an expert on vaccines and biologics and during his 30-year career, he has worked for the Bill & Melinda Gates Foundation, Merck, and Baxter International. Dr. Khoury has involved in international forums on vaccines, pandemic planning, and biodefense preparation.  

What is a vaccine? How long will it take to get one for COVID-19? Are there are other alternatives? What about herd immunity? 

Our guest is Dr. Peter Khoury, the President and CEO of Ology Bioservices Inc.  He is an expert on vaccines and biologics and during his 30-year career, he has worked for the Bill & Melinda Gates Foundation, Merck, and Baxter International. Dr. Khoury has involved in international forums on vaccines, pandemic planning, and biodefense preparation.  

TRANSCRIPT:

Intro: 0:01

Inventors and their inventions. Welcome to Radio Cade the podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade, who invented Gatorade in 1965. My name is Richard Miles. We’ll introduce you to inventors and the things that motivate them, we’ll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

James Di Virgilio: 0:37

Welcome to another special edition of radio Cade. I’m your host James Di Virgilio. Today we’ll be discussing vaccinations and COVID-19, there’s a lot of information, misinformation questions that you have that we have. And with us today, we have an expert in the subject of not only vaccinations, but also manufacturing them. Dr. Peter Khoury. He is the president and CEO of Ology Bioservices Inc and that is located in Alachua, Florida. He’s been involved with vaccines and biologics for a majority of the 30 year career employed by organizations, such as the Bill and Melinda Gates foundation, Merck and Company and Baxter international. Dr. Khoury has been an invited speaker for many international forums concerning vaccines. Pandemic planning, biodefense preparation, and has worked on global threat programs against biologics with many ministries of health and oversight committees for large events, such as the Olympic committee. Dr. Khoury, thank you so much for joining us today.

Dr. Peter Khoury: 1:34

Thank you for inviting me.

James Di Virgilio: 1:35

So the role now that you and Ology are playing in the COVID-19 crisis is essentially to manufacture vaccinations amongst other things which are going to unpack, but it seems prudent to start with asking a simple question, but one that is now talked about a lot. What is a vaccine?

Dr. Peter Khoury: 1:54

Probably the simplest answer is a vaccine is a protein that stimulates your immune system to induce immunity or induce antibodies. It’s exactly as if you were exposed to the disease. So when a healthcare worker gives a vaccination, they’re exposing your immune system to something that looks very similar to a particular virus or bacteria, which helps your immune system then react quickly when you’re exposed to the real infection, it has, what’s called immune memory and it remembers, ah , I’ve seen this before and it starts immediately in a sense, producing these antibodies to fight that infection.

James Di Virgilio: 2:46

Now , these viruses, I’m a big fan of game theory are essentially alive in a sense, right? They’re adapting, they’re changing and your body’s doing the same. So if you get a good vaccine and it produces the proper, it’s possible that the virus then counters that with a different response of sorts, right? Depending on what we’re looking at,

Dr. Peter Khoury: 3:06

It’s amazing that a virus can be that smart, that it quickly can adapt, or it’s in a sense survivor of the fittest. It’s just like an antibiotic. When you have antibiotic resistant organisms, let’s say you have a hundred bacteria and you put an antibiotic on it. It kills 99 of them, but there’s one that has a genetic sequence that makes that a little more difficult to kill. And if you don’t take the full 10 days of the antibiotics, that one tends to still live a little bit and start rowing . And all of a sudden you’ve got a big colony of this that is intermediately resistant. And then you take another dose of antibiotics for another 10 days, but only take five days of it. And you think it’s gone away out of those hundred. There’s one that’s now resistant. So it’s surprising how bacteria or virus can quickly adapt. It’s a numbers game is really what it is. There’s genetic mutations that will cause one of those virus to have mutated enough that it’s getting around your immune system in there for it’s called drifting and shifting when it does that. And you see that with influenza in a sense every year. And it’s a big guessing game on which strains of flu are included in the flu vaccine every year. If you’re lucky, you end up targeting a protein in the vaccine that does not mutate, and then you’re golden , you don’t have to worry about.

James Di Virgilio: 4:42

And that’s a lot of what’s going on right now with COVID-19. So on one hand, you read articles, we’ve found the sequencing, we know what’s going on. And then on the other hand you read yet, but that’s really a small portion of the battle. We don’t know how it’s going to react when it’s put into live testing with human patients and subjects. When we’re talking about vaccinations, how successful against a novel virus like this one, which I believe shares a genome with SARS one to a large extent, but how successful are we? Once we identify step one, this is what it looks like and is at getting it to actually work in people.

Dr. Peter Khoury: 5:17

That’s a great question. We are very fortunate as it seems that this Corona viruses not doing any real shifting or drifting at all, and you are correct. So the SARS and mirrors virus, so the sudden acute respiratory syndrome in the Mideast respiratory system viruses were also Corona viruses, which are a, I think it’s a genus or a species of virus themselves. And this is just another one. Now this one, for some reason, the human to human transmission has really taken off. And that’s why we’ve now see this pandemic. And they watch this pandemic cascade around the world. If there were this shifting or drifting, they’d be able to take samples from different areas and find out when they run a DNA gels, that there has been some changes in the sequences, but they’re not seeing that at all. So that’s very fortunate that we don’t see up that allows them vaccine R and D personnel to try many different approaches to developing a vaccine. And the most common youth approaches in the past were what they called an inactivated vaccine or killed vaccine, which they take it and they either irradiated or they chemically treat it till it’s killed. And then they inject it into you and your body will develop antibodies against that, or what’s called a live attenuated vaccine, which they select specifically for a strain of that virus that when you’re infected with it, you get what’s called a subclinical infection. You develop antibodies, but for some reason you don’t end up getting the fever and the respiratory problems and all of that. Instead, you just sorta produce the antibodies for it. And so those are widely used, but there are now some very complicated ways of addressing tough issues with vaccines. HIV for example, that’s been around since early eighties and still, there’s not a vaccine available for that. I always look at that as the big mystery for developing a vaccine, we were awarded a contract for what’s called a DNA vaccine, and this was with a company called Anovo. And this is one of those very complex approaches, which we feel very confident will work, where they take a piece of DNA that codes for what’s called a spike protein. They put it in a plasmid in, this is then put in a syringe and injected using a special type of what’s called electroporation, where it opens up your cell to take in this little piece of DNA in this circle called a plasmid and it uses your own cellular system to make the protein. So your body starts producing this protein, some of your cells do. And then your other cells that normally produce antibody will see this protein being made and start producing antibody against it. So it’s a unique approach. It can be done very quickly and low cost, and that seem important thing. And one of the reasons why this approach is being looked at.

James Di Virgilio: 8:41

Now, how often would this type of approach be used and things people are familiar with vaccinations for like an influenza. And , and if you don’t know anything about vaccines and you’re more like me, like you mentioned, there’s like seven or eight or nine or 10 different types. There’s different ways you can create a vaccine. This is one of them. How often has this been used successfully in other.

Dr. Peter Khoury: 9:02

So it’s very novel. I don’t know of a DNA vaccine yet that has been put on the market because it’s such a new approach. And in fact, if you look at all the vaccines that have been available for the last 30 years, all of them basically fit into five different approaches. The two that I had mentioned, and then there’s conjugation. There’s, polysaccharide, there’s another one that is escaping me just basically four or five different ways that vaccines are currently manufactured. So some of the ones that people are talking about now are these very novel biotech approaches that appear to be safer, faster, lower cost, ways of vaccinating. So I’m excited that this innovations finally being used and may produce a vaccine that is both affordable, can be produced in large quantity and available may be sooner than some of the older methods used.

James Di Virgilio: 10:04

And let’s unpack some of that because if we were to find using a traditional method, the actual vaccine that works, we have to go through these different phases. So step one, we’re going to start with maybe animal testing or something similar. I know chicken eggs tends to be a big one with a lot of things, but you can’t do that with coronavirus. So that’s a problem that doesn’t work. And then I know that in only 16% of the cases, do you make it from phase one to phase three, with a working vaccine? And then how often does your vaccine work? It might only work 50% of the time. And is that good enough? Right? So you have all these hurdles to overcome. That’s why it takes a long time. 18 months tends to be the soonest. People think it can happen. How different is that with your solution potentially.

Dr. Peter Khoury: 10:44

So ours also about 18 months, just the clinical study. So not talking about the preclinical animal studies, but when you actually get to the point where you’re starting to inject it in humans, it’s usually between six and eight years to get through the phase one, two and three. So phase one normally is just a very small study with a few adults to make sure that it’s safe. And they do some where they look at the effectiveness on those few people. And if no one kills over in a sense, or they’re getting some kind of immune response and there’s at least something that they can measure, they’ll go into phase two, which is larger, maybe a couple hundred people in some of those are age appropriate. Then. So if they’re trying to go down to infants, they’ll then throw in a few infants into that study and they’ll do, what’s called a dose ranging study and look at what’s the optimal dose that you would use for them. And they really start looking at the side effects and other things cause they have a larger pool to draw from once that’s through and they get the go ahead to go on to phase three, they go into this much larger trial than some of these, especially with infants can be tens of thousands because they’re trained to pick up the background noise, a very small number of crucial side effects that potentially could happen. And they’re taking very detailed measurements of how safe and effective it could be. Once it gets to that, it goes in front of the FDA. It gets approval for use or rejected, but usually by then, they’ve spent hundreds of millions of dollars. Hopefully it gets approved, but even then many companies commit to what’s called a phase four study, which is a post-marketing commitment to follow up with people that have been vaccinated and also submit to the FDA. Anytime there’s adverse events, send them information. So they keep track of it also. So it’s very useful. I’ve got to say for every vaccine that goes through, there’s probably 50 that don’t make it to the market. So there’s a lot of money spent on R and D. Our government’s been very good at funding, quite a bit of novel R and D, which has been great. Healthcare is expensive. There’s no doubt. We’re one of the few countries that really support innovative research and development. And I hope that people still continue to do that. I think that any shorter than a year and a half to do those studies, you would have to do it on what’s called a patient name basis where people would have to sign a form and say, I understand it hasn’t been fully tested, but I’m willing to take it untested because the risk benefit ratio to me is such that I’m willing to take on that risk.

James Di Virgilio: 13:39

And that’s something like Ebola, right? When Ebola came out, people were saying, well, we can’t even have a control study because nobody wants to placebo. Just give me a chance with this vaccine versus letting this run its course, which creates difficulty in developing a vaccine. How often are these vaccine side effects worse than what we’re dealing with? Is that something that’s frequent or is it pretty unlikely that even a testing vaccine is worse than what someone would already have?

Dr. Peter Khoury: 14:04

That’s a great question too. The only one that I can think of that they had some problems with. And if you go back and look at the data in hindsight, they had overreacted. Some was with the original Rotavirus vaccine, which is a terrible issue. It’s a diarrheal disease that infants get. And when they first did the studies, the studies looked fine, but it wasn’t picking up these incidents of what’s called intussusception, which is when the intestines fold in on themselves. And once they started using it widely around the United States, within the first two or three months, I had all these infants die of this intussusception they immediately pulled the vaccine from the market. People were in an uproar, but more children died of Rotavirus. And another great example is when you look at polio vaccine, so polio, which still hasn’t been eradicated, there’s still a few places around the world that have polio. They were using oral polio vaccine for years, but in one, in a million cases, when a child gets oral polio vaccine, it converts back into wild type polio. And the child actually ends up getting polio. So one in a million children end up getting polio from the vaccine, but the other 999,999 children are all protected and fine, but they were so upset about that one child that a lot of money has been spent to develop alternate vaccines for polio.

James Di Virgilio: 15:41

Yeah. I find that to be interesting. And I’m really glad we’re talking about this now, because to me, everything in life is a risk reward continuum. It’s very rare that you get a very pure two. Plus two is four here all the time. This is the obvious decision. Most often, it’s that sort of decision. Well, if we do nothing, we have this. And if we do something it’s possible that we have this side effect, we don’t know, but what is better than starting with our baseline. And that’s a really good contextual answer. So it sounds like the majority of vaccines are not generally super risky, worse than what we’re trying to fix, but maybe they’re not as effective as others. So if I’m a company, big pharma or otherwise, and I want to manufacture this, right, we have the lab that discovers the vaccine. They come to me and they say, James, we want you to manufacture this. How likely am I to take this on? Because the numbers seem very low. It seems likely I’m going to lose a lot of money and not all of these outbreaks we’re dealing with. Come back again. So maybe I develop a vaccine and now it’s sort of just gone. How likely is it for companies to want to fund these initiatives?

Dr. Peter Khoury: 16:39

That also was a great question because all we know right now is that we’re having a pandemic and we’re not clear whether it’s flattened out or not personally, I don’t think it has yet. And I think still may be the worst is yet to come. And I hope it doesn’t act like a influenza, a pandemic where you get a small wave. And then a few months later, maybe this fall or a little later, you get a much larger wave that travels around the world and will kill hundreds of millions instead of a million or two. So I’m just hoping this does not happen or that it takes on the route that influenza does where it’s North hemisphere for half the year, then goes down to the Southern hemisphere, then swings back up to the North. They’re not quite sure because we haven’t had the experience yet with this Corona virus. What they do now is it’s not like SARS. It’s not like MERS where it was here for a few months and then suddenly just sort of disappeared. This just seems to be staying. So with that, the question is, will it become a yearly vaccine for people. Will there eventually be some drifting of it. So they’ll have to be a new vaccine every year. How profitable will it be for companies? Will companies start looking at other emerging infectious diseases and start the research and development earlier, or will the government fund that early research and development? Because there are emerging infectious diseases around the world that we don’t have in the United States, but make some background noises in other areas that could easily be the next coronavirus . So when do you start investing in that? So you’re a year ahead of where you are now.

James Di Virgilio: 18:32

And that’s a great topical point to discuss. You mentioned something earlier about research being done, and I’m not sure how many people know this, but the medical research done in the US and innovative work like you’re mentioning is a hundred times or whatever the number is. It’s so significantly more than anywhere else in the world. If you look at that graph, it’s the US and everyone else is tiny. I think Germany is second on that. And their infinitesimal compared to what’s done here. There’s a lot of negative emotions around what big pharma and other stuff does. And we’re not going to get into that. Other than to say that it is a fact that so many dollars in this country go towards trying to solve these problems. And then here we are with things that are unpredictable to a certain end. Now you worked for what maybe now has become the most famous right kind of foundation. There is with the Bill and Melinda Gates foundation, looking at trying to solve this problem. Bill Gates has been beating this drum for a long time. This is the biggest threat to humanity. What you just mentioned was sort of getting ahead of this. Is there a way for us, was there a way for us, will there be a way for us to sort of prescriptively try to get ahead of some of these things you just mentioned, things that are bubbling up elsewhere, we know kind of exist. How do we do that?

Dr. Peter Khoury: 19:34

So there actually is a list that is kept by the government. The CDC has one, the world health organization has one . If you go on their websites, they talk about emerging infectious diseases. And in fact, the Gates foundation has an area that focuses on these emerging infectious diseases also. And so people do keep tabs on those large pharma, looks at them and says, there’s no value to us because we lose money, investing on things that we think are going to be valuable, but it’s just hard to solve the problem. You think of the billions of dollars that have been spent on HIV vaccine instill of course one is not available. So they think about that, but then they look at something that’s just emerging, especially if it’s in the developing world, they say, it’s just not worth that someone else should fund it. Gates foundation, fortunately does, which is great. The welcome trust is another, that does. So there are some that do that funding. The US government will fund some of them. If they feel that there may be a threat of it, either coming to the US especially some of the vector diseases that are transmitted through ticks or through mosquitoes, or could be used in biodefense, which is another area that people don’t pay that much attention to. We remember the anthrax scare and what happened. Then that’s another area that I think probably needs more focus from all governments. So both pandemic planning for other things than just influenza in also good preparation for biodefense.

James Di Virgilio: 21:17

And there’s this interesting thing. When you think about humanity, that always strikes me. I’m an investor professionally, and with investing, nothing is black and white. It’s a lot of study of people and behavior and things that we know to be true. And one thing that is definitely true is we’re not very good at predicting anything as humans. In fact, we’re the most accurate at predicting the weather and we can go about 48 hours before that falls off a cliff of actually being significant statistically. So when it comes to these really complicated problems, I often think of the three body problem. You can know A, and you can know B and you can know everything about factor A and factor B, but you can’t know C you just can’t know where it is. And I think people sometimes pale to understand how complicated and chaotic these systems are. And just because we know A, and B does not mean that we can ever predict C, it’s not easy. It’s not simple. It’s not a one week or one month process. And even with our best foresight efforts, we may never get the prediction. Correct. And then there goes a lot of money into something that may yield nothing, right? And you’re kind of always doing this where, like you mentioned, do I put my dollar? So now that we’re facing COVID-19 and actively, we know we need to solve this problem. The engines are running, the creativity is going, innovation is happening. You are mentioning something that’s brand new right now with regards to trying to save this. And then there are also some other techniques out there. Tell me about using plasma from recovering patients to protect the most seriously ill what’s going on with that.

Dr. Peter Khoury: 22:41

Yea I know that that has been on the news and it is an effective way of treating. So what they do is they take convalescent plasma from patients that have recovered, because it has antibodies in it. And those include antibodies that protect against COVID-19. And it’s a fast way of developing. What’s referred to as hyper immune state, where you have more antibodies than normally your body would produce. So they take the most ill people in, they’ll put in this convalescent plasma, which they know contains these antibodies while they contain a lot of antibodies and other things. But for sure it contains the antibodies that help that person recover from COVID-19 and it boosts their immune system of the target patient. That downside is the possibility of their body in a sense rejecting it, it can cause a negative immune response due to something in that plasma or in this has happened in the past a yet to be identified foreign item, which could cause issues to recipients later on. And that’s with anything that’s blood related. I mean, we saw it with HIV at the very beginning where people were getting blood transfusions, you saw with it mad cow disease at times where prions were transmitted through blood transfusions, but there is another solution. And actually we’re working on it. We were given a grant to work with the Vanderbilt University medical center to produce what’s called a monoclonal antibody. So what they do is they take the antibodies from a convalescent patient, and they’re able to find out which specific antibody is the one that works the best. And they clone only select for the cell or the piece of DNA that produces that protein, that codes for that antibody. And they’re able to replicate that in produce just that one antibody, and you can do it in big fermentors or bio-reactors. And you produce these monoclonal antibodies, which are all exactly the same and mass produced . Those had a fairly low cost that can be much faster than vaccines. Now you may see monoclonals before the end of the year, and those most likely will go to healthcare professionals, those immediately on the frontline for protection, and also those that are most critically ill would get these monoclonal antibodies. Those will definitely be lifesavers. And I suspect that the first will be out quite a bit before the vaccine will be,

James Di Virgilio: 25:30

That’s like a triage solution, but not the best longterm. Is that a three ?

Dr. Peter Khoury: 25:35

Yeah. It’s not long term because eventually your body will remove those antibodies. So you’re talking a few weeks protection when you’re talking a vaccine, you’re talking usually a much longer term protection of years, if not the rest of your life, sometimes vaccines. If they elicit a longterm immune response, you only get them once. And that’s that you’re protected the rest of your life.

James Di Virgilio: 25:59

So the way out of this is seemingly to have a vaccine. That’s what people are saying.

Dr. Peter Khoury: 26:03

It is.

James Di Virgilio: 26:03

The world’s not going to truly relax into, we have a vaccine or this just maybe mysteriously disappears, which seems very unlikely at this point.

Dr. Peter Khoury: 26:10

Right? And even if it disappeared, there’s always the chance of it coming back. The same with SARS , the same with MERS. I mean, all of those could somehow reappear.

James Di Virgilio: 26:23

So we need to get a vaccine. We know that it takes a long time to actually manufacture a vaccine because it’s not that simple. It’s not like we have all the supply available in the world to produce a vaccine. We can’t just in a day, produce enough to give to the whole world. Right. So even when we get it right, it takes a while to actually produce enough to give out to all the people that need these vaccines. Here we are in the US in a country that has all of these resources. What if we’re not in the U S what if we’re in a developing country? What does it look like for them?

Dr. Peter Khoury: 26:49

Yeah. So in the US yeah, we’re fortunate. We have a lot of vaccine manufacturers, large manufacturers here, and in the time of pandemic borders closed down. And so if you don’t have vaccine manufacturing on your soil, it can be a real issue. That’s times where the, WHO, UNICEF the large manufacturers get together and say, we need to do something for the developing world. And they actually will donate vaccines that are used in those areas. I know of some manufacturing processes, and we actually in our building bring in some of these new types of manufacturing, just on a trial basis. And some of them are small enough that they literally could be put in a shipping container and take into areas where vaccine needs to be produced immediately. But then you run into problems with clean water and power and other things. But someone has taken the first step to develop a concept of manufacturing that now whether you can get a turn on solar power and you ship in water, where that, or you make the manufacturing process somehow different, I think eventually they’ll have something that is a vaccine in a box that you could ship to these countries that will produce low cost vaccine very quickly. The smartest thing right now is to stockpile vaccine. If you can, if you’re a country and you have the wealth to do it, and you don’t have vaccine manufacturing, if there’s a chance for like the release of smallpox , for something as a bio threat, you may want to stock pile some of that vaccine, because if it ever happened, you’re going to wish you had.

James Di Virgilio: 28:44

Right. I have something there. So herd immunity is talked about a lot, right? I’ve seen that we need maybe 50 to 60% of the population to have herd immunity. And it seems like there’s a lot of misconceptions starting with the UK, which that was their original strategy. Then they kind of shifted away from it. Now, maybe going to go back to selective release, to build herd immunity, assuming that this goes more of the route of HIV for a little bit, it takes longer than 18 months to get a vaccine, or are we able to build herd immunity without a vaccine? Or is this something where we would just continually have recurring outbreaks of the same significant level year after year?

Dr. Peter Khoury: 29:21

It depends on what the virus does. If the virus goes away, you’ll never develop herd immunity. Just the people that happened to come down with it . The same with SARS. I’m curious if someone had SARS, are they immune to this Corona virus? That’d be interesting. I’m sure someone’s looked at it because there may be some cross reactivity, the two, but eventually enough people would be infected and recovered that you’d reach that 50 or 60% mark. And then it’s again, a game of numbers where the virus no longer is transmitted rampantly through the population. And so exposure risk goes down dramatically. When you reach that. The other approach, when you do have vaccines or monoclonal antibodies, is you do ring vaccination, where you find an area where people are infected and around it, you vaccinate everyone in the area. And so it’s contained. And that actually has been shown to work very, very well. Now, if in Wu Han, they had identified and raise their hand very early and put something in place where they either stop the movement of people within that area, which is probably all they could do. Then it probably could have been restricted much, much more, or if there was a vaccine available, vaccinating everyone around the city and making sure people didn’t move out until they were over it.

James Di Virgilio: 30:49

Right. And that’s the key is stopping the transmission. If we have five people that are immune, got a vaccine there, then all of a sudden you have the one sick person, the virus can’t get passed on, which is obviously the goal. So let’s spend just a few minutes talking about something that maybe is been confused or is confusing. Are we flattening the curve, therefore reducing the total number of people that will get this, or are we just shifting the total number of people to get this to a lower monthly average? So basically same total are going to get it regardless, but we’re just spreading it out.

Dr. Peter Khoury: 31:19

See we never know again, because we don’t know if the virus will just dissipate and disappear. If it doesn’t then as you lower the curve, you’re maybe spreading it out. But when you spread it out like that, the vaccine comes out a year and a half later, then there’s a lot of people that still can be vaccinated that haven’t had it. And so there’s a much lower risk that they’re going to get it and then die, or have significant morbidity in mortality from the actual disease itself. So flattening the curve helps in two ways. One is if the virus stops circulating, more people were suffered the consequences of having the disease. The other is if it continues to circulate, you’re buying yourself time to get something that could, in a sense, truncate people getting sick, which would be the vaccine in this case,

James Di Virgilio: 32:14

Is there a consideration to extreme flattening of the curve, which we know will potentially lead to more people, not getting it in the short term, but with the other side, which is how much damage do you do to society. And there seems to be two effects. We have Spanish influenza where most cities did nothing, and they took the full brunt of that peak, heavy hits, 50 million die. And then you have what we’re doing now, which is the first world’s response to really do exactly what you just said. Is there a balance and consideration as a medical person, do you think of what do we do over here economically, if everyone loses their job for a year, or is there just, this is the way we have to do it in order to reduce these cases?

Dr. Peter Khoury: 32:51

That’s a real difficult one because as I look around me and I see the unemployment rates skyrocket 10%, 10% last night, I was listening to the news and I just couldn’t believe that it’s gone up so much and that’s just in the US let alone other countries. And I think it’s going to definitely cause a global bump, how quickly we recover from that. I think we’re pretty wrestling and the whole world will recover, but all of the ships are going down at the same time. So the question is, how much impact does it really have on the economy? If the whole globe is shrinking, if everyone’s economies being hit by the same thing. And that’s the part I don’t understand is it could be a lot worse if it were just the US and everyone else was still thriving. That probably would be even worse for us. But when everyone’s going through the same hurt, it’s still bad. There’s no doubt about it because production’s down. People just don’t feel like they’re productive, which is also a mindset thing. It’s, it’s not good for anyone. That’s a real tough question to ask, but there is a trade off there. There’s no doubt about it. And if there were a way to protect everyone and they could go to work, and we knew that they stopped shaking hands and everyone stayed exactly six feet away from each other, eventually the virus would go away.

James Di Virgilio: 34:20

And I think that’s, what’s interesting is we tend to look at these things in static environments, but the reality is every day we’re learning more. And , and even though we know that maybe there could be, like you said, a rebound in the fall, everything we’re learning every day helps to apply how we might return to normalcy. And I think one thing I’ve really learned is that we respond very well as humans. We’re not good predictors. We’re excellent responders. We’re very creative. We’re great problem solvers, but we have to have the problem in front of us, which we now have. And like you mentioned, I think the doomsday scenarios of us flattening the curve and no one doing anything for months is probably unrealistic because there will be some tactical solutions to get people back. Bill Gates, himself, I saw just said, I think a day or two ago that the global economic reaction to this will not be immediate recovery. This will take time, which I think he’s totally correct. And there’s also something else that I think has gotten lost in this, whether the government should have reacted faster or slower or whatever the case may be. Some things in life are beyond our grasp to understand right away, could China to something earlier. Absolutely, will that hopefully be a model for the world later? Yes, but we don’t have a clear solution forward. Like you mentioned, we hope that we’re thinking of the trade offs. If I choose this course of action, hopefully I won’t bankrupt the whole world, but if I don’t choose that course of action, how many more people get it right now? Can we handle every, all these questions? They’re very difficult to answer. And so I think day by day is the course to say, what’s the new data say, what are we doing? And ultimately, when it comes to a vaccination, is it helpful to have more testing at all? Or do we already have all that we need on the vaccination front to get all that research done? Testing is irrelevant to actually developing a vaccine.

Dr. Peter Khoury: 35:51

I think testing is very important. There’s no doubt about it, but how much of it can be done concomitantly with administering it to people that are at high risk, let’s say so that’s when you get into that whole risk benefit again. So the very first people in the phase one and two, should they be the emergency room workers cause you now, Hey, if it works, that’s great for them. If it doesn’t work, maybe a few will have some issues, but there’s a chance that it’s going to work because some of these are pretty tried and true methods. It’s a real trade off. And it all comes down to that risk and benefit. People tend to like pointing their fingers at the FDA, but the FDA has a job of keeping people safe. And when you’re administering in our country, over 300 million doses of this, they give a vaccine to every person in the country. That’s a lot of people, that’s a lot of lives that you’re taking responsibility for, but there is an urgency to , so again, there it’s that whole risk benefit.

James Di Virgilio: 36:55

Right? And I tend to be someone who thinks central governing organizations are slow and inefficient in general. Because again, it’s hard for us to prescriptively know what’s going on, but in times like these there’s things that I think are being done well, which the FDA has greatly relaxed the hurdles that exist to create a vaccine. So no matter how you feel about the FDA, if you’re more like me, the things I’d like to see it be a little more expedited in times it’s happening now. And in fact, I think it’s safe to say, if we just got rid of the FDA right now, it sounds like the vaccination time wouldn’t be any faster than 18 months at this point in time. Or if it was, it wouldn’t be significantly more, right ? So we can take that off the table. The FDA is not going to materially affect the speed with which we’re creating a vaccine for COVID-19, which is a good thing to get out there. All right . This has been a wonderful wide ranging expert discussion on vaccinations. Certainly we applaud Ology for doing something that’s brand new, which is really neat, right? This DNA vaccination. We look forward to hearing more about this as we go on to conclude the podcast. Is there anything that we haven’t talked about yet that you feel is something you’d like to discuss?

Dr. Peter Khoury: 37:57

I feel like I’m the most fortunate CEO in the world. I lead a company that is still privately held and with a large majority of our shareholders that are current or past employees. So many of them are really dedicated individuals. It really see the value that we bring to the market, not just bottom line profits. It allows us to truly support programs where we can combine the measurement of profitability and potential life saved to what Gates foundation does when we decide I’m bringing in new work. So I mentioned that we do work with the government and we do a lot of commercial work with everything from small laboratories to large multinationals. But we also do work for NGLs is like the Gates foundation and others. That really is not all that profitable. And I know that these doses are going to developing world countries and whatever, but my team who, as I said, are everyone that joined their company is given options for shares. The first day they joined, because I believe that if they’re invested in the company, that they will always do the right thing, they’ll always raise their hand when there’s an issue. And they’ll make sure that we have the best quality and we’re the safest. And they’re the ones that agreed that they don’t mind taking a little less money if we’re helping to save lives in doing so. So I’m still proud of them in taking that mindset on it. It’s a lot of the younger, what I’d call millennials, the younger crowd that really likes that. And when we bring in new programs, we have to sit everyone down and explain to them exactly what it is and how it’s used and what the diseases and how many people died , because they want to understand exactly how they’re helping the world and God bless them for doing it.

James Di Virgilio: 39:58

Yeah. Love your neighbor as yourself. Right. And there’s a lot of that going on now, there’s one silver lining to something like COVID-19, it does bring the world together and makes you recognize there’s really no such thing as race or gender difference or things like that. Because at the end of the day, we’re a human race and we’re all people and this virus doesn’t care. It doesn’t at all about the fact that you’re a different color from someone else that does care that you are human. And like you mentioned, we can care for our neighbors. We can care for those that have less resources than we have. And we should use that if we have the ability to assist. And the culture at your company obviously is doing that from day one, which will I’m sure leads you to better results in the long run. Anyway.

Dr. Peter Khoury: 40:34

It, will I’m sure. Thank you.

James Di Virgilio: 40:36

Dr. Peter Khoury. Thank you so much for joining us. This has been absolutely fantastic. We’ve certainly enjoyed visiting with you and for Radio Cade. I’m James Di Virgilio.

Outro: 40:45

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida. This podcast episodes host was James Di Virgilio and Ellie Thom coordinates, inventor interviews, podcasts are recorded at Heartwood Soundstage, and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinist, Jacob Lawson.

Moving COVID-19 patients from one ICU to another is possible thanks to transportation ventilators.  In the second of two episodes on ventilators, James Di Virgilio talks to Dr. Richard Melker, Professor Emeritus of Anesthesiology at the University of Florida College of Medicine. He holds over 25 issued U.S. patents including several for emergency medical devices in use throughout the world,  and by the US Special Forces. 

TRANSCRIPT:

Intro: 0:00

Welcome to a special two-part edition of Radio Cade . We’ll be discussing COVID-19 and ventilators. In part one, we visit with Dr. Sem Lampotang. And in part two, we visit with Dr. Richard Melker. We hope you enjoy the program. Inventors and their inventions. Welcome to Radio Cade a podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade , who invented Gatorade in 1965. My name is Richard Miles. We’ll introduce you to inventors and the things that motivate them, we’ll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

James Di Virgilio: 0:54

Welcome to a special episode of Radio Cade. I’m your host, James Di Virgilio. Today we’re going to be covering mechanical ventilation and its effect on the COVID-19 crisis. Mechanical ventilation is a life-saving therapy that is used extensively and modern intensive care units. The origins of modern mechanical ventilation can be traced back five centuries ago to the seminal work of Andreas Vasilis really the founder of modern human anatomy. Joining the program now is Dr. Richard Melker. We just had him on the show very recently. He is the professor emeritus at the Department of Anesthesiology at the UF College of Medicine. We touched on ventilators last time you were with us Dr. Melker, COVID-19 had not taken off yet like it is now. We want to talk with you about ventilators. I know you have a story about how you got interested in them. Welcome to the show. And tell us a little bit about that story.

Dr. Richard Melker: 1:49

Well, thank you. Yeah, I think using a chronological order will allow people to understand how we got to the sophisticated ventilators we have today, and also as to why we don’t have enough of them. So I went to medical school and graduated in 1974 and did my residency in pediatrics at a hospital in Los Angeles called Harbor General Hospital. It’s now called Harbor UCLA Medical Center, but most people would never recognize the name of the hospital, but the hospital had another name called Rampart General. And Rampart General was a hospital used in a TV show called The Emergency. And back in the days, when I was doing my residency at Harvard General Hospital, they were filming this show and using my hospital as where the patients were taken by ambulance. And I was doing my residency and realize that when the paramedics came in, they really had no understanding about children. So I went to the chairman of my department and I said, you know, Los Angeles County has one of the best EMS systems in the United States. It was one of 12 systems that was a paramedic system at the time. And I said, if I can spend some time with them, I would like to write some material that they could use for training paramedics on how to care for children. And my chairman was all for it. So every Friday at 12 o’clock, I would leave the hospital and I would go to ride with the paramedics for the rest of the day. And the fire station that they were using on television was actually the fire station that I worked out of with the paramedics. And by the time I completed my residency and was ready to move to Florida, I had written a textbook some information on how paramedics should care for children. And so I had filled a gap that one wouldn’t think needed to be filled, but it was very clear that it was because this information was shared around the United States. So I came to the University of Florida in 1977, and I did a fellowship. And during that fellowship, which means I was already a licensed physician and I spent two additional years doing pediatric cardiology and critical care medicine. And I was fortunate enough at the University of Florida to work in the critical care division with some of the most brilliant faculty who were developers of some of the original ventilators that were used, both for adults and for children. And when I completed that fellowship, obviously I knew a lot more about ventilators. And when I started and I became the medical director of the Alachua County EMS system, and I started riding on the ambulance with the crews, or I would carry a radio and I would meet them at the scene of an accident or whatever the medical issue was. And what I realized was that on the way to the hospital, they were ventilating patients. And I’ll describe ventilation in a moment. I’ll define it for you. They were ventilating in patients with what was called the demand valve. And basically many of your listeners would be familiar with a lot of demand valves like scuba gear. When you want to take a breath, you breathe in and the valve gives you as much air compressed air as you need. And when you’re filling your lungs with air, then you exhale. And the valve closes so that it’s not wasting gas. And you’re only using the gas when you need it. Another example of a demand valve is a fireman where these face masks, which have a demand valve built into them so that they can go into a fire and their faces are covered and they’re breathing air from a cylinder. And so they’re not breathing in all the toxic fumes and everything. So anyway, the demand valve that was used for all these other applications had been modified so that you could use it to ventilate a patient. So what are you trying to do when you have a patient who’s not breathing on their own or breathing inadequately? What you’re trying to do is to push gas into their lungs. And in order to do that, you have to use a pressure higher than the ambient pressure. So you push the button on the demand valve and it forces oxygen into their lungs. And when they exhale outcomes the carbon dioxide, that’s building up in their blood. So when you ventilate somebody, you give them oxygen under pressure. And then they usually passively the lung recoils and outcomes, the carbon dioxide. So that’s what a ventilator does. And a ventilator is different than a respirator. And the terminology right now is getting very confused. Respirators are devices that the user is breathing normally, and either it filters the air or serve some other purpose, but it’s driven by the normal breathing pattern of the patient who’s using it. So when you and I are breathing like, while we’re talking, now I take a breath in and the pressure inside my chest is lower than the sea level pressure that we’re at. And therefore a gas goes into my lungs and that requires muscles, the respiratory muscles for that gas to get into my lungs. The gas comes out when you stop breathing in because the chest wall and the muscles recoil and the gas comes out. So a respirator is a device where the user is breathing in and out. Now a ventilator is a device that does exactly the opposite if using positive pressure forces gas into the lungs of the patient, and then they exhale. So some people say you inhale and you exhale. And other people use the older terminology where you’re really then is inspiration. But unfortunately when you breathe out, it’s expiration. So you’re expiring. And with what’s going on now, and other terms we went to inhalation and exhalation because of the poor connotation of the word expired . So I’m now at the University of Florida. And I I’m looking at these devices that the paramedics are using. And I was fortunate to have many colleagues, like I said earlier, who had a lot of background in the development of ventilators. As a matter of fact, some of our faculty helped develop the baby bird, which in early 1960s was the first ventilator designed specifically for neonates and these people at the time were in the military. And they developed the baby bird with a scientist and aviator by the name of Forest Bird. So anyway, one of my colleagues, a respiratory physiologist , and I went into the laboratory and studied how this demand valve that they were using on the ambulances works . And what we found is that when you push the button, it would drive gas into the stomach because the resistance to the gas was lower into the stomach than it wasn’t to the lungs. And another problem with it is that it had a peak pressure because everybody was afraid of over pressurizing the lungs. So as you push the button and the pressure went up, the flow of gas would go down. And so it became very apparent that what was needed in what’s called the prehospital arena or the military theater was a ventilator that worked just like the ventilators that we were using in the hospitals. And so with a number of colleagues and I, we developed and actually produce a number of portable ventilators, which is generically called transport ventilators. And so we spent the next couple of years writing papers and doing the research and looking at different transport ventilators. And we liked to believe that we helped advance the development of more and more sophisticated transport ventilators.

James Di Virgilio: 11:03

So with regards to transport ventilators, we can look at this like other ventilators your innovation story from start to finish, you said was several years, correct?

Dr. Richard Melker: 11:13

Correct.

James Di Virgilio: 11:14

Okay. Where we are now with regards to ventilation, let’s bridge these stories, and we just talked with Dr. Lampotang and he was saying that the FDA of course, is relaxing some restrictions that exist, that I’m sure you were facing fully when creating your transport ventilator to allow for these new designs to come into play. So in the arena of ventilation, the question everyone is asking is why don’t we have enough ventilators. They’re academic studies that are from the early two thousands that suggest that in a surge situation, we won’t have enough of them. Hospitals could not possibly afford to have all the $50,000 ventilators, but they could have cheaper solutions on hand in the event that this happens. So why do think we haven’t done that? And should we have even done that in the first place? Maybe we should have waited until we had an event. What are the answers, I guess, to these medical innovation questions when it comes to crisis predictable crisis maybe? Not really sure.

Dr. Richard Melker: 12:07

So, as you’ve mentioned, the ventilators that are being used in the hospitals to care for these patients are extremely sophisticated. The permutations and combinations of settings on these ventilators are mind boggling. And these are extremely expensive devices because they have electronics in them. And they have a lot of other features and they’re made in relatively small numbers as we have unfortunately become aware of. And so when we started working on transport ventilators, we actually had companies come to us that were contracted with the military to develop ventilators for use in the battlefield scenario. And I know of ventilators that some of those companies made for the military exclusively, which I am sure in the right patients would be more than adequate to ventilate them in the hospital. Now, one of the interesting things that we’re learning and most of this information is coming from Italy because unfortunately they were severely hit by the virus and undermanned to care for the tremendous number of patients that they saw. But the lung injury that we’re seeing with the COVID-19 virus is very different than the lung injuries that we normally use these highly sophisticated ventilators for, and I’m not doing clinical research anymore, but it would seem to me that because this lung injury is different and it doesn’t require some of the high pressures and sophisticated techniques that are used in the intensive care units, that some of these ventilators would actually be excellent ventilators for the properly chosen patients. As a matter of fact, the doctors in Italy assumed that the lung injury was similar to what they had normally encountered during their practice. And they initially set up the ventilators so that they could treat these patients. And they found that the patients were doing very poorly. So some very good scientists who were also clinicians did some studies using CT scanning and showed that when they set up the ventilator to ventilate these patients with the normal settings that they were using, they were over inflating the lungs. And what happens when you’re over inflate , the lungs, your heart can’t push blood through your lungs. And so one of the major findings that the Italians found and obviously is now well known everywhere. They’re treating patients with COVID-19 is that you don’t have to what they call positive end expiratory pressure. In other words, you don’t need a lot of pressure to keep the lung from collapsing. And as a matter of fact had deleterious effects on the patients.

James Di Virgilio: 15:04

Very interesting. I don’t think I’ve seen even a single article yet that has talked about that in detail with regards to that, which to me immediately raises another question. In my professional life, I’m an investor. And all my years of studying have led me to believe that predicting things as humans is often a fool’s errand, we think we know the solution to something we say here’s variable, A and variable B, variable C will be this, which then creates something called a three body problem. For those of you listeners who enjoy things like that, where you really don’t know what the third variable is going to be. So oftentimes in my life, I’ve found that reacting quickly tends to be the best way to handle something. What you’re saying is interesting. Here’s a different situation. Although we could have predicted a surge event, maybe we would have spent a lot of money building ventilators that wouldn’t necessarily work , or in your case, we actually already have ventilators that you were saying solve this problem. Now the question is producing them. So with your ventilator specifically, is it difficult to get the parts to make your ventilator? Now, if you had to mass produce your ventilator, could it be done or is there not enough supply of those parts?

Dr. Richard Melker: 16:10

So there’s several answers to your question. Number one, there are a couple of companies that have mass produced ventilators for the military, and I’ve not kept up with them. In other words, when they were developing those ventilators and wanted to know what features had to be in those ventilators for use by the military, that’s where we were involved. But I’ve actually met with the president of the company a couple of years ago at a special forces meeting. And they were selling ventilators like crazy to the military. And I personally believe that those ventilators have features in them that would make them more than adequate to care for many of the patients with COVID-19. So I don’t know how many of those ventilators the military has stockpiled, but you asked the second question, which is equally as important. So, these sophisticated ventilators, and even these less sophisticated transport ventilators or field ventilators have lots of parts of them. And we can tell every company in the United States to start making ventilators, but there are only a certain number of the key parts for those ventilators. And so right now, and I’ve spoken to several people. In other words, there are chat rooms and a lot of different ways that I keep up with my colleagues who are still doing research on ventilators and parts has become a real problem. So, I’ll just give you one little anecdote. When I was at the University of Florida doing my fellowship, we wanted to transport patients from other facilities to our facility. And there was a brilliant respiratory therapist by the name of Paul Blanche. And he went and built a ventilator. And because it was a one off, it did not have to go through FDA certification. We’ll just skip that whole story. And he built a couple of Blanchlater. And when the helicopters service came into being at the University of Florida, we would transport patients from other facilities to our facility using the Blanchlater. Now the Blanchlater’s a little box, you know , size of a shoe box. The ventilators that they using in the hospitals weigh several hundred pounds and they’re huge. And by now you’ve probably seen plenty of pictures of them. So the Blanchlater at our hospital was what we use to move patients from the operating room to the intensive care unit or from the intensive care unit. So you have an MRI done because you can’t bring an MRI machine up to the ICU or from the ICU to a CT scan. So, our hospital had a Blanchlater, a couple of them for these unique transport situations. Well, it turns out that Paul’s little ventilator was so good that he formed a company with a gentleman who had been involved in ventilator companies for his whole career. And they started manufacturing this ventilator and went through FDA approvals and everything. And they were selling and are selling a considerable number of these ventilators every year. But they’ve got an order from the government for 10 times that. So, from one day where you’ve got all your parts and everything to build ventilators at the rate that your company is building them to suddenly have to make 10 times or a hundred times that number of ventilators, where are the parts going to come from? Where are the components going to come from? And that has turned out to be part of the issue. So I don’t personally believe telling general motors to make ventilators is going to solve our problem because they have no inventory. What we need to do is have the companies that are making the ventilators maximize, you know, maybe go to three shifts a day, do whatever they have to do to make more ventilators, but it’s getting the components into the companies to assemble into a ventilator. So, you asked the key question , are we going to continue to make $20,000 ventilators, which after this is over, hopefully are gonna sit in storage somewhere, or are we better off looking at some of these other ventilators that are not quite as sophisticated, but require less parts? FDA clearances is a lot simpler. And I don’t really know the answer . When I heard about the ventilator shortage, I just started scratching my head and calling up my colleagues who still are either working with her consult with the companies that make the ventilators. And they said, the problem is parts. The problem isn’t that there aren’t people to make ventilators. The problem that they have identified is that everybody needs parts at the same time. And because these are expensive products and you’re only turnover a few ventilators a year in a hospital. Normally, in other words, over the past, I would say decade or two people have used ventilators a lot longer than they used to so that they don’t have to buy this capital equipment, which is so expensive. So, the one thing that I see missing, or that I haven’t heard about is who are the people looking at the alternatives to $25 – $30,000 ventilators, because I’m sure knowing friends of mine and colleagues who build ventilators, that they don’t have to be that sophisticated and understanding the underlying lung disease created by this virus who had made me believe that you don’t need quite that level of sophistication.

James Di Virgilio: 22:24

Well , I think you’re definitely articulating that correctly. Dr. Lampotang was telling us that his ventilator could probably get 60% of the capacity, the ability of , of the $50,000 ventilator. And it costs him $300 to make it. It’s also rather disposable, right? The parts are a hundred total dollars plus other stuff. So hospitals could just throw a part of it away and spend a hundred bucks to get another one. So you don’t have to worry about issues when it comes to the ventilator cleanliness or transmission of disease, interesting stuff. But I think that raises the next question that you’re touching on, which is complicated and it has to do with supply and demand. So why 15 years ago, did we not produce a lot of ventilators? Well, one, you still had the same supply and demand issue. You didn’t have enough supply to make enough of these $50,000 ventilators. And to what you said is also true hospitals, can’t simply outlay lots of capital to buy ventilators because for every ventilator they buy, that’s something else they can’t buy. They have to steward their funds correctly. And only in the event of a surge, would you need even enough of these ventilators? And like we just talked about, you may not even need the Cadillac ventilator. So now what are we to do? If there’s no supply for the ventilators that we know how to make, what happens next, incomes, someone like Dr. Lampotang, in comes someone like you and your story noticing a need, and then fixing that problem, creativity, innovation come in, they take the place of going on, but sort of this rigid structure. Hey GM, Hey 3N, Hey, go make these things seems great. Sounds good. But it’s not really even possible as you are mentioning. And I think the good news is, as you’ve said, continually, especially from a medical perspective, there are other solutions and these other solutions not only work in the U.S. but they can help people across the world that don’t have the same resources we have to hopefully effectively treat their patients. And the transport piece. I want to touch on that because this is interesting, right? We know in New York city, we’ve got an issue. We have all these patients in ICU’s and in hospitals. And if we have to get them from one hospital to the other one, and they’re on ventilation, how do you get them there? In comes the transport device you’re mentioning, if we have enough of these transport devices, Dr. Melker, are we then able to help efficiently spread out our COVID-19 cases to get use of ICU beds and other maybe even States that aren’t being utilized. Is that a realistic transportation alternative?

Dr. Richard Melker: 24:40

The answer is clearly, yes. The provisor is can the companies that make those ventilators gear up quickly enough to dramatically increase the number of those ventilators that are available, or are they having the same part problems that we are a lot of our components aren’t even made in the United States anymore. And we all know the story about why that’s happening. Let me give you a little anecdote, which always brought this to my attention right after 9/11, I was starting to work with a company up in Bowling Green, Kentucky to make a detector for a drug that we use for anesthesia. And the original application of that detector was to detect nerve agents. So it was used by the military and developed by a brilliant scientist. And he formed his own company because he couldn’t get anybody to fund it. So he built his own company. I mean, that’s what you call entrepreneurship. So anyway, he was making these detectives for nerve agents for the military. After 9/11, he got called up by the military and was told every component that you need to make these 24 hours a day, seven days a week. So we can have them in the subway systems. We can have them anywhere where nerve agents might be used to kill Americans. You have priority for everything you need. And what he did was put together a list of the components and the companies that were making the components. He went to three shifts and within two months he was shipping a hundred to a thousand times as many of these detectors systems. And they’re still running today in the New York subway system and all over the United States. So that’s what the system is geared to do during a warfare situation. The government can tell people who have components that are needed to protect the American people, that they must supply those components for the good of the country.

James Di Virgilio: 27:09

Indeed. And we saw that invoked multiple times this week, really by the president with regards to the dope act, right? And vote on 3N and whether or not you think it’s good for the president to be able to have such a power or not something you’re saying remains true, which again comes down to that wall of supply and demand. And in your story, there were enough supplies to be able to ramp up in the ventilator story if there’s not enough supplies, the beauty of entrepreneurship and human innovation is, creativity allows us to tweak things or find alternative ways to do it, to get maybe almost all the way there, and sometimes even improve the situation that we are in which I think is just an interesting story of people, right? And that comes down to whether you think as a society, we should predict ahead of time, what’s going to happen, stockpile things, or you think, Hey, we can very quickly respond to what’s happening, tactically. And that’s the most efficient way to do it. Those are obviously debates for a different style podcast , but I want to ask you a medical question. Obviously, you think about things. You are the director of EMS, you’ve run departments, hospitals. When this starts happening, COVID-19 comes on board, they’re meeting, they’re getting together. They have disaster plans . What if we have overflow, how much overflow do we have? Where can we send people in the event of a shortage? These are the types of exercises that are being done by hospitals across the country, correct?

Dr. Richard Melker: 28:26

Correct

James Di Virgilio: 28:28

And then in the event of an actual shortage, do you feel like the hospitals would be able to work with let’s like, let’s take Gainesville here with private practices and say, well, you’ve got a certain bed because you’re an into an ICU and Shand’s has doubled the surge capacity. Or do we feel that we still even utilizing all of the available rooms , space, buildings we have would not be able to handle a surge. Are we that deficient when it comes to facing something like COVID, or is there a way to plan to be able to expand our capacity?

Dr. Richard Melker: 28:55

So the United States has had repeated warnings that this was going to happen. We had SARS, and then we had the middle East respiratory syndrome and epidemiologists, and the military have been telling our governments. This is just a matter of time. We lucked out with SARS. Ebola was kind of a different story. It killed people so fast that you had a ventilator the next day, but particularly the Coronaviruses. And remember, we’re not even talking about an attempt intentionally to harm the American people with a biological weapon. This was just a mutation that occurred in a virus, which every year people would get upper respiratory infections with. But it mutated this time into a virus that we have absolutely no natural defenses for. So if you read what epidemiologists have written, the United States has not paid enough attention to this. And I know everyone wants to believe that we have the best healthcare system in the world, and that could be a debate for a show by itself. But we got caught with our pants down. We were very slow to react. We did not, and still today have not on a national level, done all the things that we have to do to minimize the loss of life. And I think there are people in the administration now who are going people aren’t listening to us. We, you and I are sitting in the state of Florida and our governor, our governor did not issue look orders, and still, it appears somebody has to twist his arm to get him to do anything. Now, I don’t want to get into the political reasons for that, but when you have an epidemic like this, where days matter and accumulate down the line in deaths, every governor in the United States on the first day should have issued proclamations that people need to stay at home, social distancing, everything else. And the proof of it is that where that was done in the United States, we’re going to have far fewer deaths than in areas of the United States, where the governors waited and to say on national television, that you didn’t know that there could be asymptomatic carriers of this disease after everything that all of us see every day in the news is beyond my comprehension.

James Di Virgilio: 31:50

Well, you raise a lot of the current points that are going on right now. Obviously, why did we not prepare for this? Why are we slow to react to it? You can study the Spanish flu, right? Influenza of 1918 to see that very much the same things happened. We have cities like St. Louis that instituted social distancing, and actually largely avoided a lot of the significant deaths that other cities at the time like New York didn’t do. And then we have this one, which is different. The benefit of COVID is it’s a lot less deadly for people without underlying conditions that are young, very, very deadly for those underlying conditions. How do we respond? What do we do? But here is something, and for me, I should full disclosure I’m a very small government person. I believe in people taking care of what they can reacting locally reacting quickly. But I think you have to look at what the government spends money on and say, what’s important. You know, we’ve spent $1.5 trillion on a fighter jet program that is basically still defunct, 1.5 trillion. And I don’t even agree with the idea of stockpiling things for the future because we can’t predict the future. But at the very least, if you’re going to take taxpayer dollars and spend it, you would think spending it on the health and welfare of your citizens would be a potentially important thing to do. And here we are, like you said, in this quagmire, because it’s a rope, right? If we pull too far in one of the rope, we’re going to lose the economy, we’re going to have a depression. You’re going to have difficult things. And if you pull too far, the other way, too many people are going to die and we’re stuck with this very difficult, complicated problem to solve. And now the question is looking forward, what do we do? And I think what’s interesting about today’s discussion with you and Dr. Lampotang is obviously people, real people, you and I, and others that have real expertise that can help are able to find solutions to these problems. If we can empower them to solve them right now. And what you said is true right? Every day, we wait to react to what we now know is real, is a day that we’re wasting. And I think that maybe is the saddest narrative out of all of this is there’s a lot of voices out there, but unless we’re able to react to something quickly and less and less cooler heads can prevail to address the problems, what are we left with? What do we do? Where do we go? So in your opinion, are we at a critical risk right now with hospital capacity? If we get surged, are we to the point to where we wouldn’t have alternatives or solutions to be able to treat people, is it as bad as some people say it is?

Dr. Richard Melker: 34:05

So I would say that in Gainesville, I can only speak about Shands, but Shands is prepared. In other words, we’ve had enough time in Gainesville to know what works and what doesn’t work. So for instance, whoever was the first person who said, you know, we have all those anesthesia machines that have a ventilator in them. We can jury rig the anesthesia machine and turn it into a ventilator. Okay. Well, if you have 26 ORs , you just got 26 ventilators. Okay? And I’m not going to talk much about the issue of sharing one ventilator with more than one person, because that’s a quagmire, it’s been tried, they tried it in Italy, they’re trying it here. And as you know, the news reports, what they’re told and by and large, most reporters, even reporters who focus on the healthcare field are not going to have the level of sophistication to know which of these things are gonna work and which ones aren’t, but I’m scratching my head a lot and going well, that wasn’t a good decision. But if we talk about North central Florida, I can tell you because I get the emails every day that Shands is prepared. I think South Florida, with the elderly population and so many people living in high rises, where the only way they can get up and down is in an elevator, which is just an incubator for the virus. I think South Florida is in huge trouble. And I believe that the time that we’ve lost is going to translate into a huge number of deaths. I mean, it’s a horrible thing to say, and it’s a horrible thing to even believe. But I was trying to put all of this into something that I could write for lay people to understand. And I think I’m correct. And if I’m wrong, somebody is going to let me know. But despite the fact that we have the first amendment and we have the freedom of speech, if you yell fire in a movie theater and there isn’t a fire and somebody gets injured, that’s not covered. However, if there really is a fire in a movie theater and you run out and don’t tell anybody else, don’t pull the fire alarm, don’t, you know, there’s a fire, you have no liability. And so, you know, I’m thinking, well, what are we going to do to these governors who didn’t respond appropriately to the threats , but you really can’t because the fires occurring and they didn’t do anything about it. So when I was thinking of some way to put this into terms that people would understand, because there are so many people now who are fearful of the government, they’re fearful of the information they’re getting. They’re getting mixed signals every single day. In one news conference, you can cut different people. Different speakers can contradict the person who spoke just before them. How are the American people going to understand the seriousness of this and the fact that not only can they die, but if they’re young and relatively healthy, they can be responsible for the deaths of many, many people and never know it to me. It’s just frustration. You wake up every morning and you go, Oh my God, we’re just not doing it right. We are not taking this seriously. We are so behind the eight ball. And there are a million reasons why, and I think some of them are legitimate. And I think a lot of them aren’t legitimate, but that doesn’t matter. The simple fact is we have to a very large extent, created this scenario.

James Di Virgilio: 37:59

A lot of things were said there that I think are echoing. What a lot of other experts are saying. I want to ask you this. What do you make of having to deal with limited information, right? Because on one hand you take information. We have the data I’m looking right now at NYC Health’s, daily data summary on Coronavirus deaths and in New York city. Right now we have 26 people that have died with no underlying health conditions. We have 1400 that have died with underlying health conditions. If people look at the data and they say, well, I have no underlying health conditions. I’m safe. I should be out there developing herd immunity while the at risk patients should be isolated or staying away. What do you say to that solution? Or is that nonsense? And it doesn’t matter what happens to economies or work life, we have to do this to save lives. Like what’s the scale? What I’m not hearing people tell me is what’s the scale? What percentage are we looking at? If we isolate a certain part of the population versus everyone, 20%, 30%, 50%, what’s the prudent course of action. I think I would hope right, most Americans want to do what’s best for everyone. I want to do what’s best for my neighbor. And what’s best for the world around me. How do we know what the right course of action is given maybe some of the difficulty of interpreting the data, what’s the right move in your opinion?

Dr. Richard Melker: 39:11

Okay. First of all, you’re asking the question that is the most difficult to answer. And the one that keeps me awake at night, but let’s look at what happened in China and whether we believe they’re true statistics, or we don’t believe their statistics. And we think they should have notified the world sooner, which I believe they should have. What they did to control deaths was taunting . If you look at other countries and we haven’t talked about testing, and I think the biggest single failure of the United States healthcare system has been the screw up of telling people, anybody can get a test anytime they want over two months ago and today, not even being able to do surveillance so we know how to answer the question that you just asked. But if you look at the countries and they’re not all dictatorship , so they’re not all totalitarian South Korea because they tested and identified very quickly those patients with the virus and quarantined them they have kept their death rate extremely low. Okay. Now, what did it take to do that? What rights in the South Koreans give up to do that? Not nearly as much as what we’re going to give up, having not done it. Singapore is a very interesting country as anybody who’s ever studied, their governmental system would know about, Singapore has also managed to have much better control over the spread of the virus. Now the Philippines pick out a slightly different take on it. They’re just going to shoot you. So we’re not going there, but we do have examples of countries that have reacted quickly. And in my opinion, appropriately, and the key to everything was testing. Knowing who had the virus and who did now, what do you do once you have that information is the question you’re answering. And I don’t know the answer, but for a very short period of time in England, they decided that they were going to go with the herd immunity we’re dealing with this and they very quickly gave that up and they’re in big trouble now. So I think the big problem with the herd immunity solution is that not only are we going to wipe out the elderly population and I can see a lot of younger people going well, that’s Medicare, that’s all the things that I didn’t want to pay for anyway. But the reality is that younger people are dying as well. And I don’t think people appreciate the fact that what we call elderly today. Isn’t that elderly. I was thinking the last couple of days, because I’m in my seventies now. But if I died 10 years ago from whatever, cause what technology I developed after that that’s being used like crazy now we’d never had been developed. And so I don’t know the answer to your question, but I just, in my gut have this feeling that the herd immunity solution isn’t going to work. It sounds like a good idea. Now there’s a piece of news that came out today, which obviously your listeners won’t hear today, but it’s very interesting information from Scripps Institute in California. And what they did is they got an individual who had the original SARS Coronavirus back in 2002. And they took the blood from that person. And they found that that person still could have immunity to Coronavirus and that the antibodies in the blood of that person actually worked against the new novel virus. Now, if that pans out, that means we may have, because the antibodies are so similar and we now have the capacity to replicate antibodies very quickly. We have the potential maybe of getting to a vaccination very quickly. Now, I’m sure there are a lot of differences between using an antibody that’s already developed versus most vaccines are either killed or attenuated bacteria or viruses or organism that you’re trying to develop immunity against. But it’s really exciting to me that somebody who had the original SARS still has immunity 18 years later. That’s a pretty good vaccine.

James Di Virgilio: 43:58

Yeah, I’d say so. Right? And this is SARS II something that I think has gotten lost from this.

Dr. Richard Melker: 44:03

Yeah. I don’t think people realize that the original name was SARS COVID II. We’ve seen this picture.

James Di Virgilio: 44:10

Right. We got a glimpse and it didn’t, as you mentioned get transmitted as far

Dr. Richard Melker: 44:13

And the messenger came and we shot.

James Di Virgilio: 44:16

We did. And I think what’s interesting is the conclusion for me is the data, right? If you talk about innovation, you talk about entrepreneurship. You talk about moving humanity forward. That always has to come from good data. You can’t improve something unless you understand how something works and why it works and why maybe it could work better. And I think that’s the big problem that we have as you said, is without the data, the thesis of, Hey, let’s let the younger people go out. It looks like healthy, young people aren’t dying. Let’s send them out into the world. Could be a good one the thesis of keeping everyone apart from each other could be the best one. The real problem is like you said, what do you do when you don’t know? And that’s where I think you see this middling response. And certainly it’s something we actively could have done much, much better was to figure out who has it, who doesn’t have it give clear messaging to those that have it to stay away. We dropped the ball on that. Something you mentioned, we’ll be on our next episode, we are going to talk all about vaccines and vaccinations, which is obviously the big solution to this problem as far as mitigating the top end risk. And obviously Dr. Melker, thank you for joining us today. Great discussion on a wide range of topics. We appreciate your efforts in the field of medicine, as well as in the field of ventilators. We know that your expertise has been very helpful and hopefully will continue to help those as we go through this. Thank you for joining us on the program today. It’s been fantastic.

Dr. Richard Melker: 45:31

I enjoyed it also, and I hope that we move forward more quickly to resolve these issues. Thank you again.

James Di Virgilio: 45:39

For Radio Cade, I’m James Di Virgilio.

Outro: 45:42

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida . This podcast episodes host was James Di Virgilio and Ellie Thom coordinates, inventor interviews, podcasts are recorded at Hardwood Soundstage, and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinist, Jacob Lawson.

Building ventilators to help COVID-19 patients could be much easier than we think.  Dr. Sem Lampotang is a Professor of Anesthesiology and the Director of the Center for Safety, Simulation and Advanced Learning Technologies at the University of Florida.  Based on a design Lampotang helped create 30 years ago,  simple "crisis" ventilators can be built with parts from Home Depot, Ace or Lowe's hardware stores for less than $300.   The "open-architecture" design can be downloaded anywhere and allows anyone to use locally-available parts if traditional parts can not be sourced.  Doctors and engineers in Mauritius, Lampotang's native country, have already produced ventilators using his design.   

Moving COVID-19 patients from one ICU to another is possible thanks to transportation ventilators.  In the second of two episodes on ventilators, James Di Virgilio talks to Dr. Richard Melker, Professor Emeritus of Anesthesiology at the University of Florida College of Medicine. He holds over 25 issued U.S. patents including several for emergency medical devices in use throughout the world,  and by the US Special Forces. 

Building ventilators to help COVID-19 patients could be much easier than we think.  Dr. Sem Lampotang is a Professor of Anesthesiology and the Director of the Center for Safety, Simulation and Advanced Learning Technologies at the University of Florida.  Based on a design Lampotang helped create 30 years ago,  simple “crisis” ventilators can be built with parts from Home Depot, Ace or Lowe’s hardware stores for less than $300.   The “open-architecture” design can be downloaded anywhere and allows anyone to use locally-available parts if traditional parts can not be sourced.  Doctors and engineers in Mauritius, Lampotang’s native country, have already produced ventilators using his design.   

TRANSCRIPT:

Intro: 0:00

Welcome to a special two-part edition of Radio Cade . We’ll be discussing COVID-19 and ventilators. In part one, we visit with Dr. Sem Lampotang and in part two, we visit with Dr. Richard Melker. We hope you enjoy the program. Inventors and their inventions. Welcome to Radio Cade a podcast from the Cade Museum for Creativity and Invention in Gainesville, Florida. The museum is named after James Robert Cade , who invented Gatorade in 1965. My name is Richard Miles. We’ll introduce you to inventors and the things that motivate them, we’ll learn about their personal stories, how their inventions work and how their ideas get from the laboratory to the marketplace.

James Di Virgilio: 0:53

Welcome to a special episode of Radio Cade . I’m your host, James Di Virgilio. Today we’re going to be covering mechanical ventilation and its effect on the COVID-19 crisis. Mechanical ventilation is a lifesaving therapy that is used extensively and modern intensive care units. The origins of modern mechanical ventilation can be traced back five centuries ago to the seminal work of Andreas Vasilis, really the founder of modern human anatomy. My guest today is Dr. Sem Lampotang. He is the Joachim S. Gravenstein professor of anesthesiology at UF Health and the Director of the Center for Safety Simulation and Advanced Learning Technologies. Dr. Lampotang, welcome to the show.

Dr. Sem Lampotang: 1:33

Thank you.

James Di Virgilio: 1:35

Now your background is extensive. You have a PhD in engineering. You spent a lot of time dealing with patient safety, especially on the anesthesiology side, but today you’ve been working extensively on a mechanical ventilator. That is interesting for a lot of reasons. Tell us a bit about how this project came to be.

Dr. Sem Lampotang: 1:54

If you go way back, like 30 years ago, what we are building today, I actually designed 30 years ago together with two respiratory therapists, Michael Bonner and Paul Blanche at the University of Florida and our design was actually commercialized and used on patients in the United States by a Swiss company. The ventilator was called Hamilton Max. And what we’re building today is essentially the Hamilton’s Max, but we’ve paused from hardware stores. The reason we decided to use hardware store parts from my work 3 decades ago, with ventilated companies , we still have insider information being a good way about what’s going on. So three, four weeks ago, before everybody else knew, we already knew that there would be no parts traditionally use to build ventilators. That’s a problem GM is facing right now as they’re trying to build ventilators. So when we were approached to design one to address that expected shortfall of ventilators, if we truly need a million, then the design style that we have , how do you build it? If your traditional supply chain is no longer available. And that’s when the idea of going to home Depot and ACE and Lowes came into being.

James Di Virgilio: 3:05

And your ventilator itself is an interesting concept. You are open sourcing it. What essentially means you put the design out there into the public arena. And anyone is able to take a look at this and improve it as necessary. We often see this done in the internet and things like that. How often is something open sourced in the medical community?

Dr. Sem Lampotang: 3:25

It is quite common today with the COVID-19. So there are a lot of open source ventilator projects going on. So we were among the first day , a lot of open source efforts, spontaneously sprang up around the country. And also I think in the UK, I don’t know whether it was common before that, but I can tell you now, currently in this crisis, it’s quite common.

James Di Virgilio: 3:47

No, I’ve seen a lot of studies back in the mid two thousands that had suggested that we did not have enough ventilators in the case of a surge event, which COVID-19 certainly is a surge event. However, those same studies argued that the $40,000- $50,000 ventilators that exist in the ICU would not be appropriate to basically hold on reserve based upon daily usage. But instead they suggested a combination of something more like you were creating or something that could be utilized. Why is it that those academic studies just went unheated that in reality, we really didn’t attempt to address maybe a middle ground, a less intensive ventilator. Why do you think it is that that’s been the case?

Dr. Sem Lampotang: 4:28

Well, it’s a lot of it is mission Creek. And also a lot of it is there’s a tendency to treat to the highest need. So when you order a ventilator, you want to make sure it will need those patients who have really, really dire needs. So that’s a tendency. It’s just like, why do we not drive small cars? Why do we drive bigger cars? Because we can. And so if hospitals also want to make sure they can treat the sickest patient, so they usually order the Cadillacs instead of the base models.

James Di Virgilio: 5:01

That’s one reason, right? And obviously it would be cost inefficient to stockpile, a lot of $50,000 ventilators that may not get used, but there is this other side we’re in now where we know that a virus could happen, that causes this situation and you and I, before the show, we’re talking about something, that’s very interesting. So your design has been working now for a week straight. Your ventilator has been working as you wanted it to for one week straight, right? But you were telling me that’s not enough yet. And why is that?

Dr. Sem Lampotang: 5:30

The reason is not enough at the one week nonstop running, it’s going an endurance testing is the data from Italy. And China indicates that worst case scenario, a patient needs ventilatory support, meaning they need to be on a ventilator for up to three weeks nonstop. So, currently all I can say with confidence is that this ventilator will run for a week nonstop because I have not run it for another two weeks, but my dilemma and my ethical dilemma as an engineer, a professional engineer is, if let’s say in a week from now, when I’m two weeks into endurance testing, and by the way, there’s more than one ventilator . So I have three ventilators undergoing endurance testing right now, but even two weeks from now, two weeks of endurance testing, but I’ve not completed my three weeks. And the doctors are being faced with a stock choice of you have the ventilator you don’t then do we start building and giving them to the doctors and say, trust us, even though we have not finished the testing, because the proper engineering practice is to finish the testing costs and then deliver. One of the benefits of working at the University of Florida, is it has a lot of faculty with expertise. So I talk to an ethicist when I was faced with that dilemma, I called an ethicist who I know, and I said, this is my dilemma. And it was very helpful because he told me, in his opinion, if in a week from now, we have not finished, but the need is there. You have defensible ethical ground to release, even though your testing is not finished, because at least you did some.

James Di Virgilio: 7:05

Right. And what’s the alternative? Patient X,Y, Z, you have no ventilator at all. We’re going to have to now make a triage decision to let someone else on this ventilator. And you don’t get one versus your solution, which is, this may not work for three weeks, but also it may work for three weeks.

Dr. Sem Lampotang: 7:19

Correct. But at that point would know it’s been working for two weeks. So that’s why then ethically each its a bit more defensible because we did as much as we could until the virus overtook our testing, right?

James Di Virgilio: 7:32

Creating an emergency situation where then innovation in this case allows for at least an opportunity as you’re mentioning to improve it. Now, the FDA gets talked about a lot in crisis like these, are they helpful? Are they harmful? As far as what the FDA has been doing? Again, you mentioned before the show, they’ve been relaxing, some restrictions we’ve seen this in the news. Do we feel like we’re in a spot where, what you said would be possible where the FDA would allow an emergent situation, people to have to try some of these ventilators that have been obviously operating for a while, or do we think that they wouldn’t be allowed into the system in an event like that?

Dr. Sem Lampotang: 8:06

The FDA has been flexible, my understanding, but this is third hand. I have no way to know whether it’s true or not. They have been approving devices that are specific to the in crisis already. So some devices have already been approved under the what’s called the EUA (Emergency Use Authorization), which has a reduced set of requirements. And the FDA has been also flexible in this sense. So they’ve relaxed the rules. And now if our ventilator becomes approved, we intend to file in a week from now. So around April 10th, if we’re approved, the approval is only while the crisis lasts. The moment of the COVID-19 is no longer a pandemic, our approval from FDA would lapse immediately. So I thought that was also very creative from the FDA. And so they’ve been flexible and it’s also helped us to do due diligence on our testing because by following the FDA standards, we can make sure, A: whether they are relevant to this situation and B: how to meet them and then give ourselves an added measure of confidence that we are producing a safe design.

James Di Virgilio: 9:17

Now let’s talk about your design in general. So it seems like ventilators range from as cheap as $5,000 to as expensive as $50,000. One of the issues with the Cadillac ventilators, as you mentioned, is that you have staffing concerns as well, only so many people are trained to operate those. I’m imagining that your ventilator does not require extensive training to have someone operated. Is that correct?

Dr. Sem Lampotang: 9:40

That is correct. There’s only three settings. So it will not be complicated. One setting is we call it, title volume. How much gas do you want to flow into the patient’s lungs with each breath, a small breath, or a big breath or something in between the second one is what we call the breathing frequency. How often do you want this patient to breathe? 10 times a minute, 15, 20, 25, 30. And then the next one is how long, how much longer is exhalation compared to the inhalation? And it’s a ratio. So it is one to two, one to one or one to three. And that’s it. That’s the ventilator.

James Di Virgilio: 10:20

And so it’s much simpler. To give me a difference someone who knows really nothing about ventilators, how much less effective would this be in a serious case someone’s in the ICU, they have a serious case. Would your ventilator be able to get 60%, 80% of the way towards the Cadillac one? Or is there a big, big gap between what both of them do?

Dr. Sem Lampotang: 10:38

I think it would get to 60% and I’m guessing and what it would not do, you may have heard this term when reading about ventilators , it’s called weaning . Just like you wean a baby from breast milk, to something else. So weaning means if a patient has been on the ventilator a long time, they may become dependent and now you have to slowly wean them from the ventilator. So our ventilator will not have weaning capabilities. That’s what the big Cadillac ventilators have. So instead of forcing the lung each time into the patient, because they can’t breathe, then they start saying, okay, I’m going to wait a bit lets see whether the patient can take a breath on his own or her own . And then if they can the gradually step back and let the patient do more and more spontaneous breaths until finally the patient is breathing on their own. And then they get removed off the ventilator. We don’t have that capability.

James Di Virgilio: 11:35

Okay. And that’s probably needed in the most serious cases, right? So in a mid level case, yours would be able to be sufficient. But if you get a really serious one, maybe not so much, and that allows then the hospital to get some flexibility with how they’re treating patients. It gives them scalability with who gets what.

Dr. Sem Lampotang: 11:50

Right. So our ventilator is a crisis ventilator to be clear. So it’s really a survival. We’re not trying to win people. We’re trying to prevent them from dying because there’s no ventilator.

James Di Virgilio: 12:03

And how difficult was it to build something like this? I know you’re using like Lowe’s and home Depot and normal parts that I could go and purchase right now to do this. How difficult was it to create this design? Because you did it so quickly.

Dr. Sem Lampotang: 12:16

The design was a paper design until our lead engineer, David Lizdas in our lab, did they run on a Saturday, which was five days into the project because we were doing a lot of paper designs, lining up things. And then he ran to Home Depot and acquired a lot of parts and then went back to his garage and put something together. And then he FaceTimed me. I look at it, I asked him to do some adjustments, and then I was satisfied at work. And we put it up on the web immediately. Like an hour later, it was on the web. And when we put it on the web, a lot of people saw it. And then we were able to convince a colleague of mine who was initially a bit skeptical. And that’s Dr. Gimme , he’s an anesthesiologist who is retired, but also an electrical engineer. And again, that’s an open source concept. He’s also a ham radio operator. So he brought in all his ham radio buddies, and they’ve been tremendously helpful with the electronics and the software. And one of them was actually the ham operator person is a genius from Bangalore, India. So he’s been tremendously helpful. And now we’re happy that our design is helping him start creating ventilators in India for each country.

James Di Virgilio: 13:30

And that’s something to think about in life, I like to think about doing unto others as you would have them do unto you. And how do we love our neighbors? And obviously in the U.S. we’re a very wealthy country. We’re fortunate to be able to have the medical resources we have at the top end. And if you’re looking at a lot of developing countries, they don’t have a lot of those Cadillac ventilators. They don’t have a lot of ventilators at all. Your solution, as you just mentioned, is something that can be downloaded on the internet with the open source. Someone can take that. They can build that. They can use that. How expensive is it for someone to build your ventilator? I see this on the internet and I live in India. What does it cost me to build one of these ventilators?

Dr. Sem Lampotang: 14:07

So I mentioned earlier, our design, it’s actually a very specific meaning. It’s called open architecture. Open architecture means speed site design that people can alter, because we don’t know that the part from Home Depot we use in Gainesville, he’s available in India, or for that matter in New York, a gentleman in New York is worried about his state. He’s building one. He went to Home Depot. He couldn’t find some of the parts . So then the idea is, as long as we specify the pod , very clearly, then you should be able to find a substitute. And that’s what happened actually in Mauritius yesterday, Mauritius is where I was born and grew up in the Indian ocean. And they already have a ventilator built with the parts that were available locally. And one of the other ways that this ventilator was designed, it was designed on the assumption that transportation would come to a grind that would be no transportation because of the pandemic . And I was reminded of that because I was texting the engineer and Mauritius building. He said, we don’t have Arduinos , which is the computer running our ventilator. I said, well, you can order it readily on Amazon or Alibaba. And he goes there are no flights come in. The Island is on lockdown for two weeks. And that was exactly how we designed it, that we designed A: that traditional parts would not be available and B: transportation would be disrupted. So then he did what he’s supposed to do. He went and looked for a local equivalent that was available, substituted it. And then today he uploaded a video on our website and you can see the ventilator from Mauritius on it.

James Di Virgilio: 15:44

That’s an amazing story. You’ve talked during your creation story about how many people, how many innovators and creative people it takes to have this idea, the power of what you just mentioned of opening your idea to others so that it can be quickly and nimbly changed and altered depending on the environment, the foresight that you had to recognize that if this surge event does happen, people aren’t going to be able to acquire things in the normal means. You just mentioned. So the person you just spoke of, what did it cost them to build this ventilator? Is this $2000 or $3,000 venture? Is it a $30 venture? What does it cost to get one of these up and running?

Dr. Sem Lampotang: 16:16

I don’t know. I look at their design, they need a teflon. So I just talked to my lead engineer this morning. So that’s long is a piece of instrument that simulates among all the patients . And that’s how you’re able to test that your ventilator is built to spec, but they don’t have it in Mauritius and probably in India. So I just put something and it’s being uploaded to the web so that everybody can say, okay, we’re going to do not on these ventilator. We’re going to home build a Tessalon so that we can test that our ventilator is built to specifications.

James Di Virgilio: 16:49

Okay. And the cost here in Gainesville, when you’re making one of these, what does it cost you to do it here?

Dr. Sem Lampotang: 16:54

It’s less than $300. And actually our thinking now has evolved as we’re getting ready to go through the FDA, so that we don’t have to meet all of FDA’s requirement for contamination, from one patient to the patient that uses the ventilator next, the disposable pod is $98 from home Depot total. So the idea is off the patient has used it for up to three weeks, rather than probably to we sterilize it and need the FDA requirements what designed , pushed the realization. We would just throw the whole thing away and bring another one in, because that’s $98. That’s like an expensive meal, right?

James Di Virgilio: 17:30

Right. No, it’s remarkable. We anchor this show on the $30,000 to $50,000 ventilator. You had mentioned, you get just a guess somewhere around 60% of the operational capacity, and you’re doing it for 300 or so dollars here in the U.S. that’s remarkable. And that is the productivity of creation, innovation, especially during a crisis time. It’s something that makes innovation. I think so powerful. Obviously what you’re doing is so impactful, not just here but abroad. I mean, imagining that these countries can now give themselves access to a possibly functioning solution during a crisis like this or something that is affordable, that is not going to bankrupt them. That is why the usable is amazing. And of course, this is not the first time this has happened right? Throughout human history. This is the response to crisis is when people are allowed to be able to think creatively and put their solutions together. And what you’re doing is simply remarkable. And to me, it’s just further proof of the power of people working together, working together quickly and producing something that again is just to me , incredible to think of the costs that you’re producing this unit for given to the functionality that it has so far. Just really remarkable.

Dr. Sem Lampotang: 18:35

I want to clarify though , the whole team behind us, and also I would be remiss if I didn’t mention the University of Florida. So for example, in open source, you probably understand that the University of Florida has a lot of intellectual property, like Gatorade that funds the university. So generally the university owns everything. The faculty member like me designs. So I have a very good working relationship with the Office of Technology Licensing of the University of Florida because I have multiple patents. So very early I involved Office of Technology. I said, are you okay with this being open source? Because it goes against everything belongs to UF. So UF was also very supportive, they said, run with it. We need this. We are not going to worry because if we had said, oh, if you partner with us, UF has to have X percent of whatever this project would not happen. And I think my technology manager at UF [inaudible] was very supportive, particularly at it. And he said, yes, you have authorization to run with it. Even though what you’re doing is technically against the university’s rules, that they own everything that a faculty member designs.

James Di Virgilio: 19:47

And so that’s a further example of flexibility. You mentioned the FDA, you mentioned UF, they’re sort of relaxing the rules in a crisis, which is allowing for this innovation. And obviously here being at the Cade, and we’re very familiar with, with what happens when universities are obviously working closely with inventors and employees, and a question that comes to mind, Dr. Lampotang is, why do this? Why wouldn’t you heard about this crisis set aside what you’re normally working on and do this? I’m certainly assuming it was not to make money, but rather to save lives. But what was your motivation to put aside everything else? And to begin working on this?

Dr. Sem Lampotang: 20:21

Many things, first of all, like I told you, building a ventilator is not a challenge for me because I built one, I was a graduate student at UF, so that was none of that can I do it? I knew I could do it. And then when, you know, you can do it and you know, there’s going to be a shortfall , depending on what news outlet you read. We have either 40, 60, or 80 thousand ventilators in the U.S. and the projected need is 1 million. And it almost seems that my path, my journey through life, brought me to this where I was like, you really need to do this because you know how to do this. And you can just stand on the sidelines. And the other thing is on a personal note, I’m a prostate cancer survivor. So I have been in a close shave, and luckily I believe I’m cured. So it is also, when you get a second chance at life, you sort of also say, why was I given that second chance? And you try to get some meaning, to that second chance you were given.

James Di Virgilio: 21:17

That’s, that’s powerful. And obviously I think myself on behalf of everyone, listening to this podcast is thankful for people like you that have the expertise to create these things, to save lives. And like you mentioned, I heard you say before, hopefully this is not something that’s even needed, right? Hopefully we don’t reach that level of surge. But if we do, obviously those and others working around the world to find these solutions is what allows us to save lives. And that’s rather remarkable. One last question here, it’s been a great discussion so far, this gets asked more than all the other questions. So we have to ask it looking back. Is there something we could have done to have been more prepared for this situation, with regards to ventilators specifically? Should we have been stockpiling them? Should we have been developing what you’re developing now 10 years ago? Or was this something that we had to go through to then ramp up our efforts to create these ventilators?

Dr. Sem Lampotang: 22:09

Yeah, that’s a difficult question. My approach to this is we are where we are . There’s no point in looking back because that is not helpful at this juncture. I would say yes, we could have been better prepared, but we are where we are and we have a shortfall. The thing that’s been uplifting easily, the outpouring of support from all over the U.S. and the world and people volunteering to build and to build them out of their own funds and take it to the local hospitals. Now, the main thing we need to do is clear the regulatory hurdles, but there’s one more twist to this that I want to make sure people understand if it comes to where those ventilators are needed and the FDA approval is not recieved. Some hospitals are going to basically have a consent form that will tell the patient. This is a ventilator that has not been fully tested. Some testing has occurred, but it was not completed. Do you want to go on this ventilator? Do you consent to be put on that ventilator? And that’s false under compassionate use. And it’s a relief to know that because to get FDA clearance takes time, and that’s the alternative path. If really our development effort and our FDA regulatory effort gets overtaken by events , that’s the fall back position. And then one last thing from my part is when this crisis is over, there are a lot of under developed countries who lack ventilators, perennially, and the whole design. This design being open source would be continued to be used and maybe improved so that low resource countries can build their own ventilators and safely.

James Di Virgilio: 23:56

And thank you so much for the time that you’ve given us and for the message you just put out there, right? I think that’s the goal. Definitely moving forward. As you said, I agree. We can look back into history and take lessons to learn, to improve the future. And what you just said, right there is certainly improving the future. How can we give ventilator access to people across the world? Because I’m sure this won’t be the last virus or surge event we deal with that deals with the respiratory system. And certainly the work that you have done thus far in the work of others than something being open source consistently able to be looked at and improved and tweaked and tested and changed very quickly because of its open source nature will allow for the fastest adaptation of getting to the best result. And I applaud you for your time for your efforts, for what you and your team have done through the University of Florida, through all of your colleagues, putting time aside to do this. It certainly is again, the power I think of individuals getting together and creating solutions to very complicated and difficult problems. I’ve enjoyed our discussion today, Dr. Lampotang, thank you so much for being with us.

Dr. Sem Lampotang: 24:53

Same here . Thank you so much. Stay well

James Di Virgilio: 24:55

For Radio Cade, I’m James Di Virgilio.

Outro: 24:58

Radio Cade is produced by the Cade Museum for Creativity and Invention located in Gainesville, Florida. This podcast episodes host was James Di Virgilio and Ellie Thom coordinates, inventor interviews, podcasts are recorded at Hardwood Soundstage, and edited and mixed by Bob McPeak. The Radio Cade theme song was produced and performed by Tracy Collins and features violinist, Jacob Lawson.