
































5073-Article Text-16415-2-11-20201212


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Manufacturing Resilience during the Coronavirus 
Pandemic: On the investigation of Manufacturing 
Processes Agility  

Panagiotis Stavropoulos1*, Alexios Papacharalampopoulos1, Konstantinos Tzimanis1, Andreas Lianos1 

 
1 Laboratory for Manufacturinng Systems and Automation (LMS), Department of Mechanical Engineering and Aeronautics, University of 
Patras, 26504, Patras, Greece.  
 
*Corresponding Author: pstavr@lms.mech.upatras.gr 
 
Received: 06/09/2020 
Revised: 15/11/2020 
Accepted for publication: 04/12/2020 
Published: 18/12/2020 

Abstract 

The unprecedented events that worldwide population experienced during year 2020 due to the COVID-

19 pandemic, resulted in the formation of numerous challenges across the majority of aspects of every day 

life. Manufacturing industries and supply chain networks faced a unique decostruction during this period 

due to restrictions created by global or local lockdowns. Reduction of human resources availability and 

transportation restrictions linked with the extreme and rapid increase of demand for medical supplies led 

manufactring related activities to reach their limits. Moreover, the non flexible manufacturing methods 

that are employed for the production of this type of equipment as well as the delayed delivery of products 

that are used as raw material at the early production stages, resulted in market shortage of medical supplies 

while demand constantly growing. As a matter of fact, various production models and manufacturing 

processes had to be used at different phases, due to different levels of resilience. Automotive industry in 

particular tested corresponding processes’ agility by transforming production and speeding up the 

production of medical equipment with alternative ways. However, the formal identification of the problem 

as well as the quantified requirements of each manufacturing method have to be evaluated in order to 

extract meaningful results that identify the reasons why traditional manufacturing facilities faced such 

difficulties in the production of medical equipment and to propose a roadmap where Additive 

Manufacturing methods can be used for the immediate, local and low volume production of the desired 



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product, giving time to non flexible industries, such as Injection Molding, to initiate the mass production. 

To assess the presented methodology, a comparison between two different manufacturing methods for the 

production of a respiratory component has been used as case study. Finally, a hybrid manufacturing model 

is suggested.  

 

Keywords: Manufacturing Process; Agility; COVID-19; Medical Equipment; Manufacturing Network  

 

1 Introduction 

To understand how the manufacturing paradigms have been utilized during the years and how they can 

be applied systematically for crises like the COVID-19 pandemic, first, the modern business model has to 

be determined. The modern business model points out that individual businesses are not capable to 

compete each other alone, leading to the development of industrial alliances (Douglas, Cooper, 2000). In 

the meantime, the complexity of modern devices asks for cooperation between industries from different 

sectors while the guideline of European Union for Corporate Social Responsibility (CSR) leads industries 

to follow a social profile, by respecting the laws and the competition with other industries. The main goal 

is to follow the pulse of the society in order to going side by side with the customer needs and finally 

raising their profit (Corporate Social Responsibility & Responsible Business Conduct,2020), (Yildiz, 

2014). By following this directive, as well as the need for humanitarian engineering and in particular 

response to emergencies (Papacharalampopoulos et al, 2020),(Tayler,2016), industries have been been 

been organized to consortia in order provide the required products while supporting each other. In this 

critical period the networks of business relationships and the willingness of individuals to support their 

National Health System to fight the COVID-19 virus (Fauci et al,2020), led to the creation of Hubs that 

work as supply chains in order to produce equipment which is under market shortage (Carayannis, 

Zedtwitz,2005). Furthermore, it is highly desirable to address the concept of manufacturing resilience (Gu 

et al, 2015) through the manufacturing processes agility. 

The absence of medical equipment can be explained considering that the developed countries, mainly 

the Western world, imports this equipment from countries which are located far away where the labor cost 

is low. Despite the fact that the transportation cost is high, the excessive profits seem to counteract these 

costs. The high delivery time and the increased domestic demand for medical supplies, followed by the 

local lockdown, resulted in increased demand in countries with many cases, leading to worldwide 



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30 

shortages (Shokrani,2020). Decentralized production structures and AM Hubs tried to face this situation 

by adding flexibility to manufacturing processes in order to reflect local customer demand, by increasing 

the sustainability due to less distance that a product has to travel until the final destination, providing lower 

logistics, lower costs and shorter delivery time. From the beginning of this crisis it was evident that 

decentralized production structures have to be supported (Shokrani,2020). In addition, the investments in 

education, learning & teaching factories, as well as the Industrial Research and Development played a 

significant role in the fight against this disease; without R&D and commercialization of AM as well as the 

domestic and small scale production, the situation would be worse. On the other hand, hubs took advantage 

of commercial platforms in order to provide details and knowledge to inexperienced people and hobbyists 

that possess AM devices. To this end, everyone could learn how to produce the required equipment 

following the product specifactions. Furthermore, reverse engineering and 3D scanners deployed to copy 

the different designs of the various equipment. In some cases, such as CPAP devices, the complex design 

asks for innovative and flexible solutions from the industrial world in order to develop an exact copy of 

the part (Odena,Valls, 2020). In the meantime, chemical and pharmaceutical industry is really having a 

sprint in order to achieve some sort of attack to the virus with some sort of mechanism (Panoutsopoulos, 

2020). 

The several manufacturing processes is a result of the technological improvements of the modern world, 

leading to different methods for making the same product (Florusse, 1992). Based on the material and the 

production volume target the suitable manufacturing processes may vary. For every manufacturing process 

a different infrastructure is needed (Chryssolouris,2006). AM on the other side, is a non-conventional 

manufacturing process which is able to cover small production volume with small production rates. 

However, it is able to adapt in different applications without excessive preparation time and labor cost  

(Bikas, Stavropoulos, 2016). Numerous AM printing methods are available. They are categorized based 

on the printing mechanism and the printing material. The application, the user experience and the needed 

investment, are parameters that define which of the available machines is more suitable in every case 

(Bikas et al, 2016), (Stavropoulos, Foteinopoulos 2018). Currently, several models and studies have been 

developed in order to simulate the AM processes and predict the product quality (Stavropoulos, 

Foteinopoulos 2018), the Build Time (Komineas et al,2018) and the consumed energy (Peng, 2016) while 

optimum sets of process parameters are available for different materials and printers (Edwards, 2003), 

(Cantrell,2017). The above-mentioned work aims to make the AM processes predictable in terms of 



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31 

performance while the non-experienced users are able to create the desired product without being anxious 

for the selection of process parameters. 

Apart from the utilization of AM in automotive, aircraft, aerospace and consumer product industry,etc., 

AM has been applied also in medical industry in different fields such as dental use, prosthetic arms 

development (Mohd, 2018), integrated human tissues in prosthetic members etc (Partee, 2006). During 

COVID 19, AM has been involved in the production of Personal Protective Equipment (PPE), which is a 

number of parts that consist a set of medical protective equipment that can be used either multiple times 

or for one use and protect the population from getting in touch with diseased people and breath polluted 

air as well as in the production of breathing aids devices (Haleem, Javaid, 2020). 

Due to the lack of the literature and the novelty of the effect of COVID-19 in every aspect of everyday 

life as well as in manufacturing processes, this paper aims to investigate corporate responses and case 

studies that have been adopted during this pandemic crisis as well as to introduce an adaptive 

framework that can be used in order to face similar crisis, quantifying the response-related capabilities 

of manufacturing processes. The structure of the paper follows the investigation of the facts that took place 

during the pandemic crisis, in chronological order. In Section 2, the methodology of this work is mentioned 

while in Section 3, the phenomenology of the factors affecting the demand is presented. In Section 4, the 

Personal Protective Equipment for the hospital staff is documented along with the devices in market 

shortage during COVID-19 pandemic outbreak as well as the contribution of industrial world in the 

production of the aforementioned equipment is mentioned. The capabilities of the traditional 

manufacturing methods for the production of the abovementioned clothing and devices are described in a 

more systematic and quantified way in Section 5. In the same section, the presentation of the formation of 

Glocal hubs and their activities can be found. A roadmap is then sugested therein based on the KPIs of 

production that are relevant to manufacturing resilience and manufacturing processes agility. The 

relationship between the production rate and the required time for the production of a medical equipment 

with a flexible, a non-flexible manufacturing and a hybrid method in order to cover the local and global 

demand is mentioned in Section 6. 

2 Methodology 

This work aims to access the traditional manufacturing methods for the production of plastic/metal 

medical supplies in terms of flexibility/requirements and to understand what were the reasons that led to 



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32 

shortage of medical supplies and Personal Protective Equipment (PPE). To achieve that, different sources 

of information have been considered in order to gather the necessary material and understand the 

chronological sequence of events related to pandemic outbreak as well as to find out what kind of medical 

supplies and protective equipment are needed to face this crisis. Moreover, there were lot of articles, 

indicating the contribution of the industrial world to that effort. From all the industrial world, automotive 

industries stood out because they were organized quickly and they speeded up the production of medical 

supplies such as (breath aid devices, surgery masks etc.) that were given to local hospitals in order to face 

urgent cases. At the same time, individuals and hobbyist were also organized to create medical supplies 

with low production volume, but with less transportation cost and delivery time. Later on, many more 

industries begun the production of medical equipment, taking as granted the proper design of the final 

product. Having gathered and studied the aforementioned information, it is crucial to investigate the 

working principles of traditional manufacturing methods that were capable to undertake the production of 

such equipment and divide them according to their characteristics, on flexible and non-flexible 

manufacturing processes. This division determines how easily they can adopt to the production of different 

products and production volumes. To do that, data from literature was used and analyzed.  

The analysis of the obtained information and the better understanding of manufacturing hubs led us to 

define the Glocal Hub Manufacturing model that is capable to merge the high volume production of 

industrial world with the low volume production of individuals and restructured distribution networks in 

order to match the demand in medical supplies, locally and worldwide. The principles of this model and 

how exactly it works, can be seen on the related section (Section 5.1). To this end, it is evident that the 

developed hybrid manufacturing model needs to be agile and flexible to provide with the desired products 

under variable production volume and time.  The resilience of the hybrid manufacturing model can be 

defined as the ability to withstand and counteract disruptions and after a number of steps to recover to the 

normal conditions. This system can be flexible and one of the main features can be the workload 

reallocation that depends on the availability of raw material and machines (Xi et al, 2015). The next 

important feature of the proposed hybrid manufacturing model is the agility of the involved processes. 

Agility is the capability to respond effectively to the requirements of the existing market demand. As an 

example, to reduce the process cycle time and increase the productivity rate as well as to produce a 

different design of a product without excessive preparation time (Bessant et al, 2000). All these factors 

could be integrated into a methodology of assemblying the proper criteria and interpreting them them into 



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technical specifications (Figure 1). The matching of the various KPIs can be considered a continuation of 

previous works on KPIs interlink for decision making (Papacharalampopoulos et al, 2020).  

 
Figure 1: Agility and Resilience in Manufacturing Processes, integrating definitions 

 
Source: [Fayezi et al, 2017],[Ahern, 2011] 

As it can be observed from this methodology, the present work can be seen as an adaptive framework 

which can be employed in similar crisis were shortage of an equipment exists.The presented methodology 

refers to this unique occasion of Covid-19 pandemic crisis. Each occasion is governed from different 

characteristics that have to be studied and evaluated in order to extract a reaction plan, through a roadmap. 

The technical specifications have been set so far, through adoption of criteria, either on/off, denoted in 

brown font color in Figure 1 bottom schematic, or as desired, annotated in yelow colour and the ones that 

are of priority (white ones). To achive extracting a roadmap, however, the comparison of different 

manufacturing methods must be conducted (end of section 5.1), providing with details regarding the 

characteristics of each method as well as their capabilities. For the assessment of this framework, a 

respiratory component is used. The comparison between two separate manufacturing methods (Injection 

Molding and Additive Manufacturing) in terms of production volume and cycle time, proves that a hybrid 

solution is required along-side with the restructured distribution network with the aid of Glocal Hubs in 

order to face this difficult situation. In brief, Additive Manufacturing can provide parts at small production 

rate and volume until the mass production manufacturing methods reach the desired production rates. 

3 Phenomenology of the factors affecting the demand-production equilibrium 



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The first confirmed cases of COVID-19 infections (due to virus SARS-CoV-2) appeared at the end of 

2019. After a few months, this situation evolved into a pandemic with millions of diseased people, because 

of the existing socio-economic globalization where citizens from different countries communicate, work 

side by side, products are exported/imported and people are travelling across the world to meet new 

civilization and cultures. The worldwide spread of the virus created an medical supply demand for which 

the medical suppliers were not prepared to cover, leaving hospital’s needs for equipment unmet. Errore. 

L'origine riferimento non è stata trovata.a represents the total confirmed cases over time while the 

Errore. L'origine riferimento non è stata trovata.b shows the number of deaths caused at the same 

time. 
Figure 2:(a) Number of cases, (b) Number of deaths 

 

  
(a) (b) 

Source: Covid-19 Coronavirus Pandemic,2020 

The moment that confirmed cases raised rapidly is the exact same moment that the number of deaths 

increased accordingly. To face that situation, the medical suppliers had to increase the production in order 

to match the hospital demands. At hospitals, the infected people with severe symptoms, such as pneumonia 

(Zu et al, 2020), were under medical care with special equipment such as breathing aid devices, air control 

valves, etc. and the hospital staff was obliged to use continuously the Personal Protective Equipment and 

replace it in short time intervals, in order to protect themselves and prevent the virus spread (Coronavirus 

disease (Covid-19) pandemic, 2020). Moreover, during this period the pre-arrenged medical meetings or 

surgeries were rescheduled in order to save medical supplies that can be used to fight the pandemic crisis, 



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leading to death people with sever diseaces such as cancer (Spinelli, Pelino, 2020). To this end, the 

necessity for medical supplies mass production was intense and unpredictable while in most cases the 

suppliers could not quantify demands. In order to produce at a higher productivity rate, production line 

adjustments/optimization required. However, the medical suppliers had to cover the worldwide high 

demand, making of utmost importance the contribution of individuals, research center and industries, in 

medical equipment production. The following plot represents the infected percentage of population over 

time. It has been produced based on the equation of the SIR model (Nesteruk, 2020) and illustrates a bad 

scenario where even up to 70% of the population is infected rapidly. The vertical axis represents the 

percentage of population that has been infected for a certain time period while on the horizontal axis the 

time period, measured on days, can be seen. The evolution of this situation has indicated that measures 

such as social distancing had to be applied in order to avoid the virus spread. The abrupt increase of 

diseased suggests the need for handling a lot of cases at the same time. The provision of personal protective 

and hospital equipment are prerequisites for the curing of diseased people and the reduction of new 

infected cases. This procedure lasts over a long time period, until the curve is flattened which means that 

the virus spread has been minimized (Haleem, Javaid, 2020)(Errore. L'origine riferimento non è stata 

trovata.). 

 
Figure 3: Infected percentage over time 

 

 
Source: Haleem, Javaid, 2020 

During the lockdown period, companies and industries were closed, the individuals were working from 

home while research centers were opened, following at the same time the protective measures. People 

with the necessary knowledge combined their forces to serve the national health system of their country, 



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producing the required protective equipment and breathing aid devices (Designs for Live-saving Breathing 

Aid to be Made Freely Available, 2020). Thus, with the aid of reverse engineering, the accurate design 

copies of several parts were available, while the final products were created by taking advantage of 

Additive Manufacturing techniques for plastic and metal printing. The domestic production and the small-

scale production from research centers could not meet the raising demand so there was need for 

transformations in the production line of big factories e.g. automotive industry etc. According to 

Chryssolouris (Chryssolouris, 2006), there are four classes of manufacturing parameters to be considered 

when making manufacturing decisions: cost, time quality and flexibility. These decisions, depend on the 

particular problem, specific objectives, goals and criteria (Errore. L'origine riferimento non è stata 

trovata.). 
Figure 4: The Manufacturing Tetrahedron 

 

 
Source: Chryssolouris, 2006 

Meanwhile, the situation had been getting worse. Therefore, the transformation of factories for medical 

supplies production had to be based on the flexibility of the production line, in order to create as soon as 

possible the first products to share to the hospitals. The products quality had to be fair enough to serve 

their cause while the productivity rate to be high to match the demand. The aim of the present work is to 

identify which of the existing manufacturing methods are enough flexible to deal with the 

sudden/unpredictable increase in demand, in medical supplies during COVID-19 outbreak. On the one 

hand AM has proven its potential, in small scale/domestic production, covering the local needs, while on 

the other hand, AM low productivity rates indicates that this manufacturing method is not capable to match 

the rising hospital demand, worldwide by producing in mass production medical supplies (Kose, 2020), 

(Baumers, 2015).  

4 Paradigms of medical parts in high demand and the response of industry 



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Based on available evidence and medical surveys, the SARS-CoV-2, the virus that causes COVID-19, 

can be transmitted among the population either on close contact via hugs, handshakes and kisses or travel 

longer distances during talking, sneezing as well as coughing (Nesteruk, Igor, 2020). The ease of virus 

spread has led to more than 2.4 million confirmed cases (Covid-19 Coronavirus Pandemic,2020) since 

today upsetting the scientific community, making at the same time the use of Personal Protective 

Equipment (PPE) of utmost importance for people that are obliged to work nearby diseased people such 

as nurses, doctors, hospital cleaners as well as ambulance staff (Source: ). Due to the nature of the virus 

contagiousness, the equipment has to cover the whole body, mainly the free of clothes, skin. The table 

below ( 

Table 1) presents the safety clothing that it is considered as Personal Protective Equipment from World 

Health Organization (WHO) (Coronavirus disease (COVID-19) pandemic, 2020) , (Yao, 2020). 
 
Figure 5: (a), (b) Safety clothes and personal protective equipment (PPE) 
 

 

  
(a) (b) 

Source: Personal Protective Equipment (PPE),2020 

 

Table 1: Suggested equipment for human protection 

Protection Suggested equipment 
1.       Respiratory protection Face mask or surgical mask: N95, FFP2, FFP3 or equivalent 

2.       Body protection Gown/ apron: Long-sleeved water resistant 

3.       Hand Protection Safety gloves 

4.       Eye protection Goggles or face shields 
Source: Authors elaboration 
 



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Apart from the wearing equipment the COVID-19 pandemic outbreak has brought to surface the 

importance of equipment that is used in severe respiratory diseases. Meanwhile, the treatment in hospitals 

is based on the proper operation of assisting breathing devices. On the one hand the common breathing 

devices, without mechanical support, work on affected people without severe symptoms while on the other 

hand the Continuous Positive Airway Pressure (CPAP) is form of non-invasive mechanical ventilation, 

working as breathing aid, which applies mild air pressure on a continuous basis and keeps the airways 

continuously open in patients who are able to breathe on their own, but they need help keeping their airway 

unobstructed  (Ti, 2020). In addition, air control valves are responsible to control the oxygen that fills in 

the breath mask from an external respirator  (Ball, 2011). Without these valves the patient mask is not 

capable to work. In general, the aspirators/ventilators were in demand due to high numbers of intubation 

occurrences. These machines are generally expensive (Li, Xiao, 2020) (Elling, Politis, 1983), consist of 

many different materials and also require assembly further to processing, while the production rate is 

bounded, according to Stefan Dräger who is the head of a ventilator manufacturer (Top German ventilator 

company warns on global supply crunch, 2020). However, they can be reused once a patient exits intensive 

care. Regarding the consumables, however, they can be used only once, and they may need change every 

five days on average. Also, customized solutions often had to be taken into consideration, as often come 

across in the media from a number of sources like the Brussels (AFP) hospital. The main difference in 

addressing manufacturing of such equipment is that masks can be manufactured in a distributed, home-

made way, even though the demand is high (even 70% of the population may need them daily according 

to Errore. L'origine riferimento non è stata trovata. from NHS, while valves  (Figure 6b) require 

machine tools and the demand occurs at bursts and is a bit lower, involving only the intubated patients  

(Yao, 2020). The treatment also implied demand for continuous processes, like hospital-related gases, 

medicine, and disinfectants (Ti, 2020). Furthermore, it is worth noting that applying circular ecomomy 

policies in this particular case may be hard or even unacceptable due to the protocols existing, and due to 

the fact that the virus has not been previously met by medical experts or authorities (Chartier, 2014). 

 
Figure 6: Devices 
 



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(a) (b) 

Sources: (a) CPAP Device (Designs for Live-saving Breathing Aid to be Made Freely Available, 2020), (b) Air control valve 
(3D CAD File: Respirator-free reanimation Venturi's valve, 2020) 

4.1 Link to capabilities of existing lines 

Although many industries have contributed to this fight, automotive industries are studied due to the 

fact that they take advantage of cutting-edge technologies which are used from skillful operators, as well 

as, flexible and non-flexible manufacturing processes and it is worth to see how they reacted in order to 

cover the demand of medical equipment that faced shortages. Apart from actual products, many industries 

circulated the 3D desing of a medical equipment(respiratory components) to individuals, in order to create 

the desired part with the appopriate quaility and under the requested specifications. Car manufacturers and 

other industries accompanied by the traditional suppliers of medical equipment have been organized in 

order to address the spike in demand by speeding and scaling up the existing production. The World Health 

Organization (WHO) has published a list of COVID-19 critical items facing global shortage such as gloves 

and masks (Table 2). 
 

Table 2: Critical items that face global shortage 

Category Critical Items identified by WHO Example of facilities that might be repurposed 
Protective 

Person 
Equipment 

(PPE) 

• Gloves, examination 
• Gloves, surgical 
• Goggles protective 
• Gown, protective 
• Face shield 
• Mask, particulate respirator 
• Mask, surgical 

• Textile factories 
• Garment plants 
• Yarn spinning mills 
• Electronic assembly plants 
• Injection molding facilities 
• Prototyping shops (3D printing)  



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Diagnostic 
Equipment 

• Lab screening test kit 
• Lab confirmation test kit 
• RT-PCR kit 
• Extraction kit 
• Cartridges for RT-PCR automatic systems 
• Swab and viral transport medium 

• Pharmaceutical preparations 
• Biopharmaceutical preparations 
• Pilot biotech plants 
• Clinical research laboratories 

Clinical 
care 

equipment 

• Pulse oximeter 
• Concentrator of gas 
• Nasal Oxygen cannula, with prongs 
• Ventilator patient, for adult, pediatric 
• CPAP with tubing and patient interfaces for 

adult and pediatric 
• Suction pump, mechanical 
• High-flow nasal cannula (HFNC) 

• Automotive production lines 
• Aerospace manufacturing plants 
• Specialized engineering service and testing 

facilities 
• Manufacturing technology and innovation 

centers 
• Vacuum cleaner assembly plants 
• Machine shops 

 
Source: Authors elaboration 
 
In modern manufacturing, production processes can be highly automated and specialized aiming to 

maximize the productivity rate. The approach of lean manufacturing tends to eliminate waste across the 

production line and improves productivity. Although a highly efficient and profitable production can be 

developed, it is extremely difficult to transform the production line to produce a new part. Several 

industries face difficulties to reach the desired level of quality and performance in short time after the 

initiation of a new production line. However, the attempts continued in order to tackle the further 

expansion of the disease by covering the needs in medical supplies, making possible to cure several cases 

by protecting the hospital staff, Most of the industries participating in the global effort mainly produce 

masks, respirators and head mounts for the face shields. The response of the automotive industry is 

analyzed indicatively below. During this period GROUP VAG was capable of producing face shields (350 

units per day), automated ventilators (13 prototypes) , reusable respirators (60 per day), and surgical masks 

(1000 per day) while PSA and FCA groups were producing respirators (200 per day), visors (30 per day) 

and masks accordingly. The experienced manufacturers and industrial consortiums not only transformed 

their production line to create the required equipment but also, by working side by side with the traditional 

medical suppliers achieved to share their knowledge in how to improve their production rates. In some 

cases, industries lent equipment, mainly 3D Printers, to research centers in order to manufacture simple 

equipment for the protection of local hospital staff (Table 3).  

 



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Table 3: Car manufacturers contributions (Mapping the auto manufacturers building PPE and medical equipment to battle 
COVID-19, 2020) 

Manufacturer Product Partner Details 
BMW Ventilator 

parts 
None Utilization of the 3D printers 

Ferrari Ventilator 
parts 

Siare 
Engineering 

Supercar maker is preparing to manufacture parts at its factory 

Fiat 
Chrysler 
 

Ventilator 
parts/ 
Masks 

Siare 
Engineering 
 

-Siare notes that carmakers have more component purchasing power than 
it does. 
-Aiming to distribute to emergency workers and first responders initially. 

Ford Ventilators GE Healthcare Rawsonville previously made oil pumps, battery packs, induction 
systems, ignition coils and fuel pumps 

General 
motors 

Ventilators Ventec life 
systems 

Kokomo previously made electronic and semiconductors components 

Jaguar  
Land Rover 

Masks N/A Its own design utilizing its 3D printing capabilities 

Linamar Ventilator 
parts 

O-Two Medical 
Technologies 

Partnership between Linamar, Magna and Martinrea to provide parts for 
ventilator designs 

Mahindra Ventilators Unnamed 
ventilator 
producer 

Manufacturing face shields and working on developing a low-cost 
ventilator design that will cost less than 7.500$ per unit 

Magna Ventilator 
parts 

O-Two Medical 
Technologies 

Partnership between Linamar, Magna and Martinrea to provide parts for 
ventilator designs 

Marelli 
Corporation 

Ventilator 
parts 

Siare 
Engineering 

Discussions are being held to confirm whether Italian manufacturers will 
build parts themselves or increase Siare’s capacity 

Martinrea Ventilator 
parts 

O-Two Medical 
Technologies 

Partnership between Linamar, Magna and Martinrea to provide parts for 
ventilator designs 

McLaren Ventilators Consortium Joined a UK consortium to develop an emergency ventilator for rapid 
deployment 

Mercedes F1 CPAP 
devices 

None Developed and building a CPAP machine which could reduce the need 
for medical ventilators by keeping the patients out of intensive care 

Nissan Ventilators Consortium Joined a UK consortium to develop an emergency ventilator for rapid 
deployment 

SEAT Ventilators Protofy XYZ 
and others 

The design uses 3D printed gears and a repurposed windscreen wiper 
motor from the SEAT Leon and is made on the Leon subframe assembly 

Tesla Ventilators Medtronic Aiming to develop its own design using many parts repurposed from 
Tesla cars 

Toyota Masks 
Filters 

None Preparing to 3D print face masks for emergency personnel and preparing 
to produce filters for respirator and ventilator use. 

Volkswagen Ventilator 
parts 

None The company is looking to utilize its 125 industrial 3D printers to build 
ventilator parts 

Source: Authors elaboration 
 
The contribution of Additive Manufacturing in that effort seems to be of utmost importance due to the 

flexibility of the process which gives the possibility to everyone possessing a 3D printing machine to 

create/develop a part, without manufacturing experience. The solution of Injection Molding follows as the 

process which is ideal to produce a significant volume of products in specific time. That process also 



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42 

involves the development of molds and the machine set up, assuming the existence of the machine in a 

facility.  

5 Capability & Agility of Manufacturing Processes and Manufacturing Resilience  

5.1 Quantifying the Processes capabilities 

The centralized mass production for medical supplies made from plastic takes advantage of the forming 
processes. In the industrial scale it is crucial to produce with high productivity rate, low cost, and fair 
product quality. Moreover, the production has to be flexible enough to produce a variety of products 
without wasting time and money to change the equipment every time that a new design comes to the 
production (Chryssolouris, 2006). In  

Figure 7 the recommended manufacturing processes for several materials can be seen, considering also 
the production volume and the melting temperature of the machined material. The estimated production 
volume for medical supplies like face shields, face masks etc. is identified between  10!	and 10". 
Therefore, the forming processes seems to be the preferable for that kind of production. The diagram has 
also been reformed to an axes form, showing the two criteria independtly. 

 
 
 
Figure 7: Manufacturing processes vs material 

 
(a)                                          (b) 

Sources: (a) Original form of the diagram (Chryssolouris, 2006), (b) reformulated form of the diagram 

According to Chryssolouris (Chryssolouris, 2006), forming processes are divided into casting and 

melting processes. The casting process involves the effect of gravity during the filling of the mold while 

the melting process takes advantage of applied pressure to process viscous polymers, at high temperatures, 

forcing the material to flow under the effect of gravity. For plastic material, the molding process correlates 

with melting processes, which takes place with the aid of a mold, similarly to casting process in metals. A 

wide range of molding processes can be found, namely; compression molding, transfer molding, injection 

molding, extrusion, reaction injection molding, rotational molding, calendering, and melt spinning. The 



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43 

characteristics of the forming processes are included on the table below (Table 4). In this study it is 

important to have bear in mind that non-dedicated for medical supplies factories have to be transformed 

in production lines with high production rate, fair quality to protect the medical staff and assist the diseased 

people as well as low labour cost. Assuming that the transformation is possibly to happen on industries 

with facilities to create the mould and then proceed to the injection molding for the production, the cost 

can be maintained on low levels for tooling, while the transformation period can be significant small. 
 
Table 4: Forming process characteristics  

 Cost Production Rate Quality Flexibility 
Forming Processes High Tooling/Low 

Labor cost 
High Medium to Low Low 

Sources: Chryssolouris, 2006 
 
The above-mentioned characteristics there are available for every process explaining the reason why 

industries decide to run the production with the aid of certain processes based on four main indicators: 

a. Material selection 

b. Manufacturing of complex designs. 

c. Time for the preparation of the process (molds, machine process parameters, etc.) 

d. Production Rate 

e. Ramp up rate 

The meaning of the first three terms can be easily extracted. The material term refers to the choice that 

engineers have made to be used for a certain product based on its properties. The material choice is the 

first step for the development of a product and manufacturing process selection. Figure 8 shows preferable 

processes for the manufacturing of products based on their raw material.  If the circumstances lead to 

change the raw material, then, all the production process has to change as well as the design of the product. 

So, there is a strong relationship between the product design and the raw material choice, explaining why 

the design is the second step of the process selection. The product design guides the manufacturing 

process. Complex parts spend too much time in manufacturing processes (one dedicated machine or more 

machines based on the manufacturing phases) while simple designs need significantly less time. Moreover, 

the part design defines the required equipment to run the process. As an example, for injection molding 

process male or female molds are required.  



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The complexity of molds design (Italian engineers support the fight against the COVID-19 virus by 3D 

printing valves to medical equipment, 2020) and manufacturing is considered as extra time added to the 

final production time. Up to this point it can be extracted that on the one hand, for small production 

volumes and for immediate initiation of production, processes that require complementary equipment to 

run should be avoided, while, on the other hand, the extra time spent at the early stages of production 

(mold manufacturing/design) is covered due to the increased production rates that a process, such as 

injection molding, can offer.  

Production rate refers to the number of units produced over time. The production rate can be expressed, 

when the production run smoothly, and the machines are optimized. At an earlier stage, the production 

has been tested in several scenarios, in order to examine if there are issues that can lead to faulty products. 

So, three stages can be pointed; a) pilot production when the first parts come out of the production and 

both the machines and the parts are under inspection to ensure, that the products follow the product 

requirements and the machines are in good condition; b) the low volume phase where the production line 

work at  50% of its potentials in order to control the production in terms of energy consumption, cost as 

well as the wear of machines; c) the high volume phase where the product quality, production volume, 

energy consumption etc. are optimized and they remain constant over time (Ball, 2011). The last term 

ramp up expresses the rate with a production can address all the knowledge obtained during the low 

volume production in order to move to high volume production or from pilot production to low volume 

production. If the ramp up is low, then the production needs much time to alter from the one level to the 

other. The ramp up time as well as the different production phases can be seen below.  

 
Figure 8: Production phases 

  
 Sources: Ball, 2011 



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Figure 9 aims to present how the five main process selection indicators affect each process. The scale 

1(low)-5(high) defines the variety of different materials that can be processed on each process, the 

capability and agiility of processing complex designs, the required time for the preparation of each process 

and finally which one of the available processes can offer higher and lower production and ramp up rate. 

To this end, it can be said that this scale is a comparative means for the examined parameters. e.g. the 

ramp up rate for additive manufacturing processes can be equal to joining process and higher of removing 

process. This happens due to the process variables that are involved on the process; for removing 

processes, factors such as cutting fluid temperature and flow, cutting tool failures, workpiece placement 

on the table, process parameters selection etc. seems to reduce the ramp up rate, while in AM processes, 

less factors are involved such as process parameters selection and filament replacement after certain time 

intervals, leading to higher ramp up rate. A utility function derived from these five criteria could be 

defined, however, the current framework ought to take the five constituents separately into consideration, 

in terms of a five-dimension vector (or more formally like an array). This five-fold metric could be called 

as extended manufacturing process agility metric. 

 
Figure 9: Process selection procedure (each component has a unique scale) utilizing extended process agility 

 



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Source: Authors elaboration 

5.2 Considering Glocal Hubs Manufacturing as a manufacturing model for enhanced resilience 

The Glocal Hub Manufacturing Model is defined as numerous locally placed manufacturing subsystems 

that act together in a unified network to cover a demand that appears at a global level (Trappey, 2007). 

The Glocal Hub Manufacturing system shares similarities with the hub-and-spoke system the airlines use 

to better cover the travelling demands from minor origins and destinations and at the same time remain 

cost efficient (Cook, 2014). With an opposite mentality, the initial approach to cover a large part demand 

was to subcontract the overall need to a single supplier and after the production of the total batches is 

completed, the orders are divided and shipped to the locations in need accordingly. When time response 

is critical and demand spikes can occur, this singular supplier system indicates high risks of bottlenecking 

and failure. The three main causes were identified to be: 

i). The singular supplier’s production stops and requires additional troubleshooting actions 

and time to restart. 

ii). The utilization and setup of additional manufacturing equipment for parallel 

production is cost intensive. 

iii). The global shipping network is overloaded. 

Implementing the Glocal Hub Manufacturing model for mass production compensates for the above 

risks of the singular supplier model. The large number of local manufactures, near the hub in the high 

supply need, secure that in the scenario of failure of a production line of one or more suppliers, the 



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remaining functioning ones can intensify their production rates to supplement the failure or at least 

partially cover the supply demand. The ability to utilize additional equipment in a short time is process 

dependent. As an example, in the case of the respirators which faced excessive demand during COVID-

19 pandemic, Additive Manufacturing machines were more efficient and flexible to set up the process and 

inititate the small scale production than Injection Molding machines. Finally, the organized Glocal Hubs 

cotributed to shorter traveling distance between the supply and demand which performed better in the case 

of a shipping network malfunction. The current circumstances regarding the COVID-19 outbreak created 

an absurd spike on the demand of medical devices (Haleem, 2020). The identified medical components 

can be divided into two main categories; a) the ones that can be manufactured exclusively by a specific 

manufacturing process and b) those that with simple desing modifications can be manufactured via 

alternative ones (Figure 10, Figure 11).  

 

Figure 10: Examples of additive manufactured 

  

(a) (b) 

Sources: (a) Additive Manufactured valve for emergency masks to assist patients suffering from 
respiratory failure (Ferrari continues its efforts to fight the Covid-19 pandemic, 2020) ,[b] similar valve 
for oxygen respirator were an urge, the right one (Italian engineers support the fight against the COVID-
19 virus by 3D printing valves to medical equipment, 2020) 

 

 

Figure 11: Face mask mold, injection molding for mass production 



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Source: Edition 2020, 2020       

When it comes to mass production of medical equipment, the production is centralized, and the 

supplying distribution is realized via the shipping network. That is, the uneven equipment demands across 

the globe, combined by the bottleneck of the supply network between Asia and Europe resulted in crucial 

deficiencies of medical equipment. A profound solution was given to this issue by the Additive 

Manufacturing community, from individuals with both professional and desktop equipment. The medical 

components that were on shortage and that had part features that where AM manufacturable (Bikas, 

Lianos, 2019) were rapidly reverse engineered and manufactured in large numbers from users that acted 

as suppliers with access to AM equipment. The demand was thus covered via the localized manufacturing 

hub model. The small batch of approximately 12 pieces per print was counteracted by the number of the 

available equipment spread across European countries. Only Greece has an active 3D Printing community 

for plastic manufacturing that is estimated to be of more than 2000 individuals with at least one AM 

machine each. 

To understand the better suitability of AM in the case of the COVID-19 pandemic the medical 

equipment demand and supply chain must be investigated.  

i). The first point was that the overall demand increased in a short period of time.  

ii). The second aspect was that the overall large number of medical equipment produced were to be 

distributed in smaller numbers among the hospital units that were facing shortage. This step in the 

supply chain was bottlenecked from the shipping networks that were also facing profound numbers in 

regional and international level.  

The AM supply chain was in the contrary locally identified and evenly spread due to the low cost of the 

AM plastic equipment. This made the shipping more efficient as the hospitals were supplied by close-by 

AM suppliers. This alternative way was also not dependent on a singular standalone large supplier but on 



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49 

a coherent network of the AM community of small but numerous professional and amateur individuals. 

This resulted to the satisfaction of the demand spike more efficiently with AM compared to the Injection 

Molding supply. The idea behind the decision making for the most suitable process is to provide; a) rapid 

response from the initial demand spike to the first manufactured part and b) high production rates to cover 

the global demand in time. The parameter of time is the most critical parameter in that decision making 

framework.  

These two system characteristics are contradicting for a singular manufacturing process. As the mass 

production capacity and pace increase, the agility of the system decreases, whereas a highly agile system 

is not capable of mass production. To abide to both specifications a hybrid system it seems to be more 

functional. The first subsystem can manufacture rapidly and produce initial batches to feed the demand 

(AM). This buys time for the second system to reach high production levels and cover the overall demand 

(Injection Molding) 

6 Workflow adaptation for the production of respiratory components 

To investigate further the mechanism behind this unprecedented supply chain, the respiratory 

component was chosen as a case study (Figure 10). The Additive Manufacturing(AM) and Injection 

Molding(IM) productions are to be compared for the manufacturing performance. All the different process 

steps and their relative durations were identified for a new supplier to initiate production (Table 5). 

 
Table 5 AM and IM process steps comparison 

Steps Injection Molding Additive Manufacturing 
1 Part design for injection molding manufacturability Part design for AM manufacturability 
2 Mold design and manufacturing Optimizing the process parameters  
3 Optimizing the process parameters  Part manufacturing 
4 Part manufacturing  

Source: Authors elaboration 
 

In Figure 12, it can be seen that the AM response time for the initial part manufacturing is much shorter 

than the one for injection molding. This is due to the fact that the process steps from part design to the 

actual part manufacturing are fewer and shorter. The aforementioned quantities for the required time and 

production rate are an indicative average. The actual numbers are case dependent and can vary. That is, 

once the upstream steps are realized, the capacity and production of injection molding is far superior 

compared to AM.  



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Figure 12: (a) Compared process steps, (b) Comparing Injection Molding and 3D Printing: Preparation Time in IM concerns 

design of the mold, while in 3DP it concerns design of the part. based on authors estimation and literature  

  
(a) (b) 

Source: Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with 
suspected or confirmed COVID-19, 2020 

From Figure 12 the utility function that measures the success of the decision making for the appropriate 

manufacturing method can be obtained. It is noted that the utility function, being a means to measure the 

success of a decision that is affected from different factors (Pavan, Todeschini,2009), due to the 

complexity of this application, remains to be an array of the aforementioned different aspects. Finally, the 

roadmap for the Covid-19 pandemic crisis, considering all the intermediate actions and steps that were 

necessary in order to confront this situation, can be seen below in Figure 13. In order for this framework 

to be taken into consideration, one has to take into account that there are two arbitrary assumptions under 

which it has been formed; 

i). The question on the decrease of the demand (annotated in grey colour) should be not done 

after every step, as it has been considered unlikely to exit an emergency situation in short time 

ii). The production shift should be designed early enough (the second grey box) 

 

 

 

 

 

 

 
Figure 13: Roadmap for COVID-19 case 



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Source: Authors elaboration 

7 Conclusion 

The ongoing unpredictable socia-financial situation due to COVID-19 pandemic required special 

treatment in all different fields of everyday life. The industrial world reacted with its own means, taking 

advantage of the whole inventory of manufacturing processes, in order to cover the demand of medical 

supplies in a limited time space. The R&D and the commercialization of AM printers, followed by the 

development of local Hubs, created a network of individuals and traditional manufacturers that were 

capable to produce low production volume until the non flexible production lines managed to raise the 

mass production upto the desired levels. The industrial world, organized in consortiums, has provided 

technologies and infrastructures to face that situtations. The Corporate Social Responsibility (CSR) ideal 

created the pillars and guide the industrial world to this effort. The expansion of this pandemic was tackled 

by combining all the available resources and manufacturing processes. To this end, this paper proposed 

the development of a decision making framework that depends on the parameters that governs every time 

the situations.  

In this work,  the process time, the production volume, the flexibility in terms of processing different 

materials and the ramp up rate, were the main factors that were used as indicators for the process selection. 

By investigating the capabilities of each manufactuirng process, a hybrid manufacturing solutions was 



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52 

proposed. At the beginning of this effort, Glocal hubs were capable to produce, in very short time, low 

production volume in order to offer it to local hospitals. During this time, the industrial world was trying 

to adopt and transform the production lines in order to maximize the production of medical supplies, 

matching the demand. The combination of the aforementioned solutions with the aid of AM and IM 

processes, managed to provide enough equipment to cover the global needs for medical supplies in less 

time than applying each solution individually. However, this call to action was based on the individual 

companies’ internal decision making policies and agenda, thus, a coherent and legislated framework is 

needed to secure the response in similar future crisis across the world. 

As future research, the source of this shortage has to be studied in depth as well as to quantify how the 

individuals, the small enterprises and the industries managed to reach the desired production levels to 

counteract this shortage. Moreover, the way that Glocal Hubs were organized can be expanded and 

analyzed as a means to face similar crisis in the future. The modern means of communication, the 

automation technologies and the commercialization of AM seem capable to support similar reactions in 

the future. In Europe and in the Western world in general, the educational programs can adopt lessons that 

familiarize the young people and the individuals with modern technologies such as Additive 

Manufacturing, 3D design with Computer Aided Design (CAD) software, e-commerce, etc. that are 

fundamental for the requirements and the standrads of the modern world and they were crucial to overcome 

this difficult situation. If people understand and analyze what causes this unprecedented shortage of 

medical supplies, everyone will be better prepared to face a similar situation in the future, not only for 

medical supplies but for every kind of equipment. In terms of future technical developments, the 

manufacturing processes, regadless of the mechanism, ought to be improved in terms of flexibility, ramp-

up time and production rate, so that manufacturing succeeds in safekeeping population through meeting 

demand for emergencies. 

Acknowledgements 

This work is under the framework of EU Project AVANGARD. This project has received funding from 

the European Union’s Horizon 2020 research and innovation program under grant agreement No 869986. 

The dissemination of results herein reflects only the authors’ view and the Commission is not responsible 

for any use that may be made of the information it contains.      
 



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