GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization • Hacker News Board

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

#471

Post by anthony_r » Thu, Mar 19, 2020, 2:52 PM UTC

vincentmarle wrote: post #461

chrononaut wrote: post #416

Earlier quoted context omitted.

The content quoted in the "The Star" makes it seems more to me that he's calling the _panic_ dumb, not the necessities required to fight the pandemic, which he acknowledges exists in his follow-on tweets, at least the ones "The Star" quoted. I also think the "coronavirus panic" is dumb, but I'm defining the "panic" when I say this as people buying 5 years of toilet paper, and unless there's more context that's what I…

There’s very good reason to panic early when dealing with an exponentially growing threat: https://youtu.be/e2Kga5HeAqk

Exactly. I don't understand why people are so avert to the word "panic". Extreme situations require extreme measures, which sure as hell look like "panic". If somebody is shooting at you - you're expected to panic and run and hide.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by jschwartzi » Thu, Mar 19, 2020, 2:52 PM UTC

ethbro wrote: post #175

kevingadd wrote: post #169

Earlier quoted context omitted.

Yes and no, some states are constantly on the border of being insolvent. California has a big 'rainy day fund' but this recession is projected to eat into a significant chunk of it. The way hospitals are funded and administered may make it tricky for a state to buy a bunch of ventilators with state funds and then donate them to a hospital... if you "lend" them then after the crisis the state owns a bunch of used vent…

So mothball them the same way the military does equipment. We don't have a shortage of land in this country.

Because the equipment requires very sensitive measurements on the order of tenths of cmH2O and tenth of a milliliter of air, a very small leak in any one of the seals can cause a significant inaccuracy in ventilation and especially in the alarms which govern whether the equipment isn’t overinflating your lungs. This isn’t like a car where you can just start it up periodically to keep seals lubricanted. You need to maintain them or to have a plan for how you’ll check them before putting them into service. And you need biomedical technicians who are trained to repair them and clean them. If you mothball the equipment there is a very real danger that without re-qualifying the equipment it will kill or injure patients.

The biggest effect GMs announcement seems to have had is convincing people that a car company that builds to PSI tolerances can build anything to the kind of tolerance needed to safely ventilate patients. I think this is a PR move and GM and Tesla will study the problem enough internally to determine they have no idea what they’re doing. Worst case we get ventilators from Tesla with the same manufacturing defects and quality issues which their cars have had. I personally would not feel safe on a Tesla or GM ventilator built without FDA oversight.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by TomMckenny » Thu, Mar 19, 2020, 2:52 PM UTC

riffraff wrote: post #190

TomMckenny wrote: post #183

Earlier quoted context omitted.

There are a couple possible re-thinkings. The disturbing one is where it is noticed that we are essentially sacrificing a bit of the economy to reduce fatalities. So next time it is decided that company valuations are worth the extra deaths[1] I submit that rethinking needs to be started early rather than late so the discussion isn't dominated by euphemisms for some very dark path. [1] As we know, social isolation is…

to be fair, you can adopt europe/wuhan-style total lockdown but you could also adopt developed-asia-style mass tracing. The latter seems to have been way more effective in containing the epidemic and less impactful on the economy. So, there was third option which saves both people and economy, but it's probably politically unfeasible.

The sole alternate to wuhan-style lock down is not utter incompetence.

You could have an administration spend the early days working on the problem and appointing an epidemiologist to spearhead it rather than assert it's "fake news" from political enemies, appointing a loyal politician to manage it and classifying early data.

For one, you could so easily just inform distributors ahead of announcements to address hording and delivery instead of leaving the elderly with no to get food.

Even merely a large government orders for masks at at the beginning would have had a huge impact.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

#474

Post by chasd00 » Thu, Mar 19, 2020, 2:53 PM UTC

jacquesm wrote: post #182

spectramax wrote: post #174

Earlier quoted context omitted.

I think the healthcare system and medical supply chain are two separate things. A universal healthcare system (for E.g. Sweden) still has a normal supply chain. The only difference is the profit motives are not present and the government can effectively pump money in without violating economic principles of supply/demand and pricing.

A commercialized health care system has lots of perverse incentives leading to price increases and profiteering. This sets the weakest fraction of the population up for losing all they've built up in the last 3 months of their life while barely impacting the strong. It also means that those hospitals don't care about overpaying for their supplies and medication (but not their workforce) because they get to pass those…

it may have been mentioned already but in the US healthcare prices are negotiable. It's strange because you can't go to a US grocery store and haggle over the price of cucumbers like you can in many other nations but you can do that with healthcare.

So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.

To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by Mvandenbergh » Thu, Mar 19, 2020, 2:53 PM UTC

mhb wrote: post #445

greedo wrote: post #411

Earlier quoted context omitted.

This is incorrect on many levels. A ventilator always requires intubation. Sometimes that's through the mouth, sometimes through the nasal passage (both cases are referred to as endotracheal), and rarely through a tracheostomy. Ventilators do have some monitoring capability, but require consistent attention from respiratory therapists. The chances of infection (VAP), pneumothorax etc are serious without careful monit…

A ventilator always requires intubation Can you elaborate? This ventilator documentation[0] says for invasive and noninvasive ventilation [0] https://www.usa.philips.com/healthcare/product/HCNOCTN98/res...

Many vents can also operate in BiPAP or CPAP modes or as pure demand O2 supplies for people who can still breathe. That can be done with a mask.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by jschwartzi » Thu, Mar 19, 2020, 2:57 PM UTC

beefield wrote: post #348

omar_a1 wrote: post #296

Earlier quoted context omitted.

I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy. Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause…

I am getting frustrated by the comments that miss the big picture. There are likely going to be lots of people that are going to die without ventilator. Now, who with any common sense and decency[1] cares if 30% of them are dying because the device was not used properly/broke/whatever if the only other available option is that 100% of them die? [1] Sigh... I know, I know. American lawyers and legal system.

The thing you’re missing is these new RTs wold not just be treating COVID-19 patients. There are tons of people who will need ventilator therapy because they were injured or sick and they would have gotten injured or sick anyway. These are people who can be saved with proper treatment or injured by improper treatment. Barotrauma and lack of tidal volume have implications beyond simply alive or dead. We need people but we must make sure they can actually provide adequate treatment.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by Mvandenbergh » Thu, Mar 19, 2020, 2:59 PM UTC

NohatCoder wrote: post #258

malandrew wrote: post #235

Earlier quoted context omitted.

Because they are not the bottleneck. Intensivists that can operate the vents are the bottleneck https://sccm.org/Blog/March-2020/United-States-Resource-Avai...

That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly. Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.

Setting up a ventilator for treating ARDS (caused by the viral infection and inflammatory response) is at the much harder end of respiratory therapy unfortunately. This is also one reason why just building the simplest possible ventilator simply isn't possible / useful here. Yes you could basically build a 1960s design en-masse but at the moment 50% of people on modern vents are surviving so this is no panacea.

The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by jschwartzi » Thu, Mar 19, 2020, 3:01 PM UTC

beefield wrote: post #350

abeld wrote: post #338

Earlier quoted context omitted.

The type of ventillators required by the most serious cases are much more complicated: as I understand it, it involves push a tube down to the lungs, and the machine breathing instead of the patient, i.e. it has to carefully monitor and regulate the pressure etc. Already the "push tube down to the lungs" part is quite a challenge: avoiding damage to the vocal cords, or to the lungs, etc.

Should we then not be damn sure that there are shitloads of the simpler ventilators so that the complicated ones can be fully reserved for the serious cases?

In the hospital they’re all complicated cases. The simpler vents are for home care use. The hospital doesn’t typically do noninvasive ventilation because it’s meant for patients who are awake and outside of a hospital setting.

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

#479

Post by supdatecron » Thu, Mar 19, 2020, 3:03 PM UTC

omar_a1 wrote: post #296

NohatCoder wrote: post #258

Earlier quoted context omitted.

That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly. Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.

I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy. Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause…

I'm sure the hospital nurses can learn via on-the-job training in a day. This is an emergent situation. No one is suggesting pulling a random person off the street to do it

Re: GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization

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Post by throwaway5752 » Thu, Mar 19, 2020, 3:05 PM UTC

I don't want to disappoint anyone, but they are stating "we stand ready to do this" but the tacit follow up is "when we are asked to".

The president has stated he is not ready to ask them

"He's casting doubt over whether he will actually implement a move to invoke the Defense Production Act -- that he signed on Wednesday and that gives him authority to order industry to work towards homeland defense and national goals. In this case, it could speed the production of badly needed ventilators, masks and other supplies for hospital workers" - https://www.cnn.com/2020/03/19/politics/donald-trump-leaders...

FEMA and the Army Corp of Engineers have said the same thing. For some reason they are not being mobilized while CA, WA, NY/CT/NJ are dealing with a crisis and have asked for that help, formally and officially. Meanwhile, ICE is fully deployed and arresting people in hospitals, then concentrating them together without adequate separation.

GM and Tesla (and Ford, and all other domestic manufacturers that have done so) should be saluted for volunteering to help. But there is a slow-walking of the response and something very, very rotten is going on in some areas at a coordination level in the US.