Motivation[edit | edit source]

Current situation[edit | edit source]

  • From WHO's Q&A on coronaviruses (COVID-19):
    • COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019.
    • The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell.
    • Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing.
    • Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
    • People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets. This is why it is important to stay more than 1 meter (3 feet) away from a person who is sick.
  • WHO's situation reports. (We'll update the next paragraph every now and then, specially if it changes the "what to do" picture.) : 142539 confirmed cases and 5393 deaths have been reported in the current outbreak of COVID-19 up to the end of 14 March 2020 by many countries.
  • (Link needed.) Some experts suggest real figures could be official figures multiplied by 2.5, because many cases are reported late or are not reported at all.

Update March 26th 2020 During the outbreak, updated reports are to be found here : WHO sitrep: 416.886 confirmed cases and 18.589 deaths have been reported in the current outbreak of COVID-19 up to the end of 26 March 2020 by many countries.

Possible futures[edit | edit source]

  • (Link needed.) Modelers suggest the number of cases is doubling every 2-3 weeks. At this pace, figures of up to one million cases or more for the end of 2020 have been mentioned. This would be the upper boundary of the current trend, if current interventions work less than well.
  • Other "worse cases" have been suggested.
  • Probably, the best practical way to avoid all those possible futures is to stop the current outbreak, and that's where most efforts should go. A small percentage of all efforts will be needed to do surveillance in order to know if/when/how the situation has changed, and to plan for such dire scenarios.

Open-source appropriate technology[edit | edit source]

International entities recognise innovative appropriate technology may play an important role. Besides, whatever is developed for this epidemic will be useful for others, now and in the future.

Yet to be updated: Dec 26th 2014:

  • Safer and faster personal protective equipment has been designed. Production, availability and cost will be known in (hopefully early) 2015. Not known if intelectual property would be an issue in creating appropriate-technology versions.
  • Excubator submission has been accepted but not yet assessed, and plans for Jan 2015 include further details in the design (including a hand-motioned ceiling fan with cloth filter), and stress-testing (wrap-up, see if there's air for enough time, plus temperature and humidity issues). If available to help, please contact LucasG (talk
  • WHO and AT for Ebola: Due to the urgency of the Ebola outbreak and the WHO’s scale up of international response in west Africa, WHO is providing technical information on appropriate available essential medical devices which are indispensable for treatment centres, community-based units and other preventive activities, in affected and neighbouring countries.
  • 2014 call for innovative technologies WHO is searching for innovative health technologies that can be used for infection prevention and control (IPC), diagnosis, and supportive care. 2014 call for innovative technologies.
  • USAID Fighting Ebola: A Grand Challenge for Development.

What we could do[edit | edit source]

Beware, reader[edit | edit source]

COVID-19 is life and death for many people. This page is bits on the internet. Please double-check every "fact", validate externally, and add generous doses of common sense and cautionary principle. Besides, please keep in mind that user lack of training (and stress and tiredness) are a given.

A generative process[edit | edit source]

Pharmaceutical companies start developing many products, and only some of them become commercial products. Likewise, many OSAT ideas will prove to be useless or worse. So maybe there's need for some light, open, perfectible process. The following steps are suggested:

  • Ask what's needed. Look at (anonymised or at least respectful) videos of caregivers giving care, people burying the dead, etc. Comb news and conversations for facts: what do people do, who to, how often?
    • Just as a made-up example: cleaning vomit, an average of 10 times a day for an average of 7 days. Adding all that up would give us an approximation of the per-patient workload.
    • Example: Spanish tv
    • Rehydration seems to make a big difference (link needed: rehydration makes a difference, slow rehydration is not very practical with moonsuits because it takes very long). How long does it take to spoon-feed a gallon of water a day?
  • Look at obvious and not so obvious ideas. Get creative:
    • Look at what doesn't work and reverse some features. This is how the "excubator" concept came about: current "ebolanaut" suits are too hot, expensive and very cumbersome to use (difficult to get in and out, use only for 40 minutes to 2 hours (links needed)).
    • Look at resources on the ground: what do locals know that the internets don't?
    • Develop other people's ideas. (That's why we make them free: free to build on top of.)
    • Challenge your own thinking: what is it that you assume, and could you take a different route?
  • Develop and document prototypes:
    • Build it, do some role-playing, shoot (anonymised or at least respectful) video.
    • Share with experts in science, care, building.
    • Improve the prototype.
    • Repeat.
  • Ask for external validation:
    • Somebody may eventually do careful small tests.
    • But before that, what do experts in science, care, building and maintenance think of your best efforts?
    • Could scientists do a formal assessment so that users will decide by themselves, taking that data as one more element? See CDC simple t-shirt mask (thought to have some use for a flu pandemic).
  • Include training (in building and using the devices) as a deliverable:
    • Video or (preferably wordless) documentation. Could be done simply: builder to builder, user to user.
    • Subtitling and translation. Experience with amara.
    • Overdubbing.

Even this process can be improved and streamlined. Please do.

Areas in need of useful ideas[edit | edit source]

It can be argued that there are 3 main overarching goals when facing a disruptive epidemic such as this:

  • (Prevent.) If Ebola is duplicating every 2-3 weeks (needs updated link), then containment would work if we reduce current contagions by 50% or more. The figure 70% has been suggested (link needed). Update Dec 26th 2014: Unless the epidemic fires up elsewhere, the current phase seems to be one of putting off each local fire, with contact tracing being one big priority.
  • (Treat.) There's need to care for the sick:
    • This is usually done with commercially provided and officially approved medications; this takes trials which in turn take time, care and resources.
    • There is information about some medications being counter-productive (say, anti-inflamatory drugs that facilitate bleeding), so stopping them only needs having good information and making it available to users of the information.
    • Rehydration (particularly done early) seems to be important, and it takes time at the bedside. WHO report says: High-quality supportive care is thought to have contributed to the larger number of survivors. However, two limitations compromised the quality of bedside care: staff were too few in number; and the duration of time spent providing care at the bedside was too little, due to dehydration and over-heating of clinicians wearing personal protective equipment. Update Dec 26th 2014: In some specialised centers, case-fatality rate has been as low as 26%. Oral Rehydration Solution seems not to be very acceptable due to the large quantities needed and also its bad taste. Maybe mix with local or global flavors? Slow gastrointestinal drip?
  • (Cope.) There's also need to keep all the other essential activities of societies running:
    • This includes keeping caregivers fed, take care of the orphans and PSTD'ed, etc.
    • Disruption is hurting affected countries in many other ways: hospitals see that healthcare workers and patients flee, the economy takes a blow, even agriculture is affected. (Links needed.)
    • One useful framework to look at "needs" might be SCIM, which has been adapted for severe pandemic flu. CDC has done extensive work on community response to influenza pandemics. None of this has been tested for our current concern, so the "beware, reader" comment above applies in full force!

It is suggested that all other activities are secondary to these main ones: funding, helping hands, education, etc - would all be means to the end of reducing contagions, caring for the ill and keeping vital stuff working. Of course, you may be in a position where you can help in funding, people or education -- just see how your work helps further one or more of the 3 shared goals.

Update Dec 26th 2014: Further reflections:

  • The prevent-treat-cope model could use one extra dimension: location. Example: treat - at home, in community, in specialised centers.
  • Focus on Needs of People on the Ground. Not only on Systems as told by Administrators from a Distance.
  • Anthropology is a body of knowledge. For most of us, what matters is that we "listen first". But also, could the simplistic model (prevent-treat-cope x location) be useful in cross-cultural conversations?

Some examples[edit | edit source]

  • Tippy tap, an inexpensive and simple to build device for safe hand-washing, has apparently already been used in Ebola care centers, as shown on this article's heading's picture.
  • The notion of an "excubator" (inverse incubator) is being explored. It would be a tall box with a plastic window and gloves coming out. Internal handles and maybe wheels make it easy to port the device from bedside to bedside. A marsupial bag, fed from within through a one-way slot, could be added. An external slide might help with supplies not in the bag, that would be dropped from behind by an assistant. The box would be made of cardboard (can be burned later) or plastic (can be spraywashed).
  • The excubator has been morphed into "bedside wall" and "michelin suit" (oversized suit with foam bricks so that air passes through and the suit is more tolerable). (Link to individual project pages.)
  • Temperature: swamp coolers as used for burning man (works in dry climates only), http://www.sleepbreeze.com (for humid climates), solar-powered without battery (hot when sunny).
  • Pads to soak patient fluids: menstrual pad technology might help.
  • Teams (includes families, caregivers, suppliers, organisers) need: transport, communications, etc.

What else?[edit | edit source]

  • Simple masks are bound to be out of stock. I have been looking at this article for a Dust Mask but we need the following things: cheap filters that could be as close to N95-compliant (testing fabric combinations might be nice), and different sizes.
  • Handwashing stations! We need them everywhere. Some areas are low on water, so they need to be efficient.

Related pages[edit | edit source]