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

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Post by thu2111 » Thu, Mar 19, 2020, 5:13 PM UTC

Mvandenbergh wrote: post #477

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.

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 t…

That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety.

Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps.

BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.

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

#532

Post by woofie11 » Thu, Mar 19, 2020, 5:14 PM UTC

mgerdts wrote: post #96

Manufacture of medical devices has specific regulation around Good Manufacturing Processes [1] (GMP, one of many GxPs). This requires a Quality Management System [2] (QMS) and very specific training for everyone involved. Pretty much any manufacturer that is not already manufacturing in accordance with 21 CFR Part 820 [3] and related regulations will have a ton of work to establish a suitable QMS. I'd like to think t…

I've designed medical devices. They're not rocket science. Yes, being tolerant of a single-point-of-failure is important, but not in this climate. Military should cut through fines. And as for lives, they just need to be more safe than not having a ventilator. You don't put a healthy patient on a ventilator.

I think if 10,000 come out which kill people, that's a problem, but it's not a particularly hard one to catch. If 10,000 come out where 1% kill people, that wouldn't pass any sort of bar in normal times, but these are not normal times. That's much better than not having them at all.

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

#533

Post by fma » Thu, Mar 19, 2020, 5:26 PM UTC

dougweltman wrote: post #521

fma wrote: post #489

Earlier quoted context omitted.

FWIW automanufacturers in China did this. So this isn't anything, or out of the realm of possibility (we do have more red tape in the US, i.e. see what happened w/ the Seattle Flu Study when people tried to be helpful). I don't have any English source for this. But Boris Johnson requested the same in England, too.

UK asks automakers to join efforts to scale up ventilator production: https://uk.reuters.com/article/uk-health-coronavirus-britain...

Yeah - I mean I didn't have an English source for the same initiative that in China.

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

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Post by snowwrestler » Thu, Mar 19, 2020, 5:34 PM UTC

MiroF wrote: post #444

adrianN wrote: post #427

Earlier quoted context omitted.

The medical system works pretty much like this. After studying medicine you have a long practical education where nobody trusts you.

Yes, but we also have the “fellowship bottleneck” and limited med school seating we use to keep doctor salaries artificially high. In addition to training new doctors, we should also just loosen restrictions for doctors to enter the US and use their medical expertise.

You don't need full MDs for respiratory therapy, or for many medical treatments. PAs and RNs can do a lot, and it's far easier and less expensive to attain those certifications than full MD.

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

#535

Post by magduf » Thu, Mar 19, 2020, 5:34 PM UTC

_pd19 wrote: post #526

magduf wrote: post #511

Earlier quoted context omitted.

You're forgetting the development of a vaccine. With enough time (10 years is way more than enough), a vaccine will be developed and deployed, and that capacity won't be needed because far fewer people will contract the disease and develop symptoms requiring hospitalization. The problem is, developing and testing a vaccine takes some time. How much time do we have before the global economy totally collapses?

> With enough time (10 years is way more than enough), a vaccine will be developed and deployed Based on what? It’s been more than 10 since SARS and we still don’t have a vaccine. I think you’re making a lot of assumptions about immunization when it is far, far too early to know. Also, the point is that we don’t want to be quarantined for 10 years, we want to build the capacity now.

They probably never developed a SARS vaccine because it didn't turn into a major worldwide pandemic. There's lots of diseases that don't have vaccines mainly because it's seen as not worth the effort or cost. SARS and MERS looked scary at first but never got this big.

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

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Post by ethbro » Thu, Mar 19, 2020, 5:39 PM UTC

dillonmckay wrote: post #413

ethbro wrote: post #404

Earlier quoted context omitted.

https://www.snopes.com/fact-check/us-coronavirus-test/ That's kind of like saying "I've got a motherboard, am missing an Intel CPU, but AMD has CPUs, so I'll just put one of those in there." Rolling out testing on the scale that was obviously needed even then is a non-trivial thing, requiring coordination of multiple parties, all in a climate of dubious information. So, yeah, I think it's understandable (a) to stick…

What pre-arranged plan?

https://www.cdc.gov/flu/pandemic-resources/national-strategy...

What do you think the CDC does in the years there aren't pandemics?

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

#537

Post by ethbro » Thu, Mar 19, 2020, 5:42 PM UTC

rwmurrayVT wrote: post #443

ethbro wrote: post #162

Earlier quoted context omitted.

https://www.navsea.navy.mil/Home/Shipyards/Norfolk/Departmen...

'Their Optical Section performs optical alignment on shafting, masts, and other equipment.' That's me! Norfolk Naval Station is just one shipyard in the area. There are similar yards with all of the same equipment. BAE/Colanna/NASSCO/NNSY/Lyons/ECSR. It's the same story in San Diego, Pascagula, Jacksonville, Hawaii.

Cool!

That's the cleanest link I came across to illustrate the point. I think people forget how much end-to-end manufacturing capability the military retains (especially the Navy), even in these days of outsourced procurement pressure.

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

#538

Post by ethbro » Thu, Mar 19, 2020, 5:44 PM UTC

jschwartzi wrote: post #472

ethbro wrote: post #175

Earlier quoted context omitted.

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 ma…

Absolutely on requalification.

IYHO, would that be more or less time that manufacturing fully new units?

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

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Post by netsharc » Thu, Mar 19, 2020, 5:48 PM UTC

leereeves wrote: post #333

netsharc wrote: post #325

Earlier quoted context omitted.

I'm not blaming team B for not knowing about it immediately, I'm blaming them for their shrugging response even after it's terribly obvious what's happened. And you seem to say Team B is still utterly blameless, it's all Team A's fault.

Let's drop the analogy and discuss reality. What do you blame Trump for? From what I've read, the US response was hindered mostly by a faulty reagent in the CDC's test kits, which led to an inability to test patients for the virus.[1] How is a faulty reagent Trump's fault? And even with that hinderence, the course of the virus, the number of people hospitalized, and the government policies in the US seem to be procee…

Since my substantive but apparently "name-calling" reply got flagged, here it is with the offending parts corrected, for posterity's sake:

Can I blame him for picking John Bolton, who is well-known to have anger issues? As I said before, Bolton -- the best man for the job in Trump's eyes -- cut NSC/CDC funding, making the US blinder to threats.

Are you really that much of a Trump-defender? Now it's wholly CDC's fault, so Trump is still innocent?

I'd bother look up his many downplaying and ignorance of the issues, but is it worth it, if you're just going to deflect and still defend him?

As this man said [1], during the 2016 primaries:

> I would, however, add a casual observation: at this point Trump has been the front-runner for long enough that it’s very hard to imagine his supporters suddenly losing faith, because it would be too embarrassing.

> Bear in mind that embarrassment, and the desire to avoid it, are enormously important sources of motivation. [...]. Nobody likes looking like a chump, and most people will go to great lengths to convince themselves that they weren’t.

> Now think about someone who has been supporting Trump since the summer. For the Trump bubble to burst, many people like that would have to slap their foreheads and say, “Wow, he’s not a serious person! What was I thinking?”

[1] https://krugman.blogs.nytimes.com/2015/12/15/the-donald-and-....

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

#540

Post by Mvandenbergh » Thu, Mar 19, 2020, 5:51 PM UTC

thu2111 wrote: post #531

Mvandenbergh wrote: post #477

Earlier quoted context omitted.

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 t…

That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety. Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps. BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly…

CPAP machines generate continuous positive pressures though, they assist breathing. I know they have slow ramp capabilities for comfort reasons (start off at low positive pressure when you fall asleep and then increase) but I don't think they can swing pressure fast enough to enable inhalation and exhalation.

You need: -Gas blending (relatively trivial) -A source of pressure (CPAP has this) -A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this) -A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP) -A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others)

So I'm really not sure that you can do this with a modified CPAP machine.

BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.