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

#551

Post by mgsouth » Thu, Mar 19, 2020, 7:33 PM UTC

fma wrote: post #489

mgsouth wrote: post #372

Quote from a recent Scott Manley episode seems appropriate: We choose to do these things not because they are easy, but because we asked ourselves "how hard could it be?"[0] I'm pondering how long would it take GM to modify their ERP systems to handle an entirely new business line. Never mind that... how long would it take them to define the requirements for the plan to determine the framework for the project to expl…

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.

A quick search finds some articles stating they will do this, but nothing about results. But of course politicians and CEOs would never make empty promises...

Wikipedia says one Chinese manufacturer, Geely, sold 1.5 million vehicles last year [0]; that probably includes 700K Volvos [1] (they bought Volvo from Ford in 2010), so I'm guessing 600-700K domestic Chinese-produced vehicles. If they had successfully switched production, we'd be talking, what, 100s of thousands of devices a month? But not a word. If they were even making a few 10s of thousands a month I don't think we'd be having this conversation.

[0] https://en.wikipedia.org/wiki/Geely#Figures

[1] https://en.wikipedia.org/wiki/Volvo_Cars#Annual_sales_(all_m...

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

#552

Post by salawat » Thu, Mar 19, 2020, 7:36 PM UTC

adrr wrote: post #545

salawat wrote: post #203

Earlier quoted context omitted.

Woah there. Don't be so hasty to throw out the baby with the bathwater. Don't need another Thalidomide dropped on us just because things are looking a bit grim. It's one thing to ask "Do we really need to let this stand in our way right now?"; It's an entirely different kettle of fish to say "Screw it, if it kills the virus anything goes!"

So when given a choice to a 65 year old to die or take an unapproved drug. We should let them die. We are going to run out ventilators and will ration them. Our hospitals are already at capacity. Italy is at 8% mortality rate and climbing. We need to do anything to cut icu rate and spread. Virus is showing long term effects even in children. Known long terms issues is worse than hypothetical issues. Cautious thinking…

>So when given a choice to a 65 year old to die or take an unapproved drug.

Did not say that. Allow them to elect to take the drug, however, we still need to follow up, and keep track of the outcomes. Data is critical to avoid outcomes where we end up dropping bombs on houses to put out the housefire. Again, see Thalidomide.

>We are going to run out ventilators and will ration them.

Likely. I also believe that there should be a much greater tolerance allowed for expediting supply chains to make components for new ones; but data is also key. A fabrication method that results in immediate complications needs to have a quickly followed audit trail to ensure remedial action can take place quickly to minimize additional harm. That doesn't mean you can't compromise on some non or less critical tolerances while you're at it.

>Virus is showing long term effects even in children.

Noted, let's try not to add onto that by releasing something untested that causes severe side-effects as well.

>Known long terms issues is worse than hypothetical issues.

Difference: the known long term issues from the virus alone would happen with or without intervention in some portion of the population. Long term issues that arise as a complication via treatment would not happen except that weren't diligent enough.

Many of the GxP's are, in fact, written in blood. I'm fine with getting adventurous and experimenting, but we need to be tracking outcomes so interventions can take place at the first sign of trouble too.

It isn't easy. Quality never is. There is a damn good reason for you to put in the extra work to make it happen regardless.

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

#553

Post by FireBeyond » Thu, Mar 19, 2020, 8:02 PM UTC

naveen99 wrote: post #361

malandrew wrote: post #224

Earlier quoted context omitted.

It’s not that we’re bad at training medical personnel. It’s that the AMA acts as a cartel to limit the number of physicians train to keep income high. We just need to allow more people into medical schools and make more residencies available.

The number of hospitals and hospitals beds is also controlled by certificates of need.

Certificates of Need were something _hospitals_ themselves lobbied for. It's a case of "this is awesome when it protects me, and an aberration when I'm on the losing end".

Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.

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

#554

Post by dang » Thu, Mar 19, 2020, 8:14 PM UTC

thereare5lights wrote: post #546

dang wrote: post #525

Earlier quoted context omitted.

We detached this subthread from https://news.ycombinator.com/item?id=22623990 .

I've seen this a lot but never understood what that exactly means. What happens when you detach a subthread?

It becomes a top level comment instead of a child of its original parent. Does that make sense?

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

#555

Post by ethbro » Thu, Mar 19, 2020, 8:32 PM UTC

dillonmckay wrote: post #550

ethbro wrote: post #536

Earlier quoted context omitted.

https://www.cdc.gov/flu/pandemic-resources/national-strategy... What do you think the CDC does in the years there aren't pandemics?

I don’t know because most of those materials you linked to from the CDC are from 2005. I see more recent docs from HHS. So, what has the CDC been doing the last 15 years?

I'm going to leave Googling as an exercise for the reader. :)

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

#556

Post by 0xWTF » Thu, Mar 19, 2020, 8:35 PM UTC

ISL wrote: post #487

0xWTF wrote: post #222

Earlier quoted context omitted.

Folks, military physician here, operating at the national level on the analysis that informs these projects. The recent post on HN about the MIT $100 ventilator is one of the things that got this rolling. Manufacturing is spinning up. What I really need is developers on this project: https://github.com/joshua-s/coronavirus-diary

There are a lot of software projects spinning up -- how do we know that this one is going to see active use? As an example for my concern -- I've had a consistently-updated pull-request[1] outstanding for the JHU data repository for more than a week. It is their prerogative not to pull, but it means my contribution is largely wasted. The coronavirus-diary project has one contributor, no issues, and no pull requests.…

OP here (and no, I'm not josh). We need the project to get from 1 to 2 to 10 to N. That 1 to 2 bit is hard. Please, push a bit.

JHU is bandwidth-constrained. Put your effort where it can have effect.

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

#557

Post by wwweston » Thu, Mar 19, 2020, 8:54 PM UTC

leereeves wrote: post #370

wwweston wrote: post #352

Earlier quoted context omitted.

> The only countries that appear to have handled it better are South Korea and Japan. How many better examples would it take before one concludes that it's possible to have done better and there is a responsibility to do so? I'd say one is adequate. > If I mixed up the charts for the US and other nations except those and Italy (which is much worse), you wouldn't be able to tell which is which. Take off the labels and…

This is daily data. The effectiveness of interventions doesn't change every day. You're just assigning meaning to random noise. I agree it's possible to do better and we should learn from other nations, but I think it's unrealistic to expect that USA be #1 in everything. Sometimes other nations will do better.

> This is daily data. The effectiveness of interventions doesn't change every day.

There's many endeavors in which the effectiveness of interventions can change daily, either with the conscientiousness of application, or in changing conditions that need response. On top of that, there's all kinds of systems where an intervention can introduce an oscillating contribution to the output.

I can't see any reason why viral containment responses wouldn't have potential interventions in any of those categories, and there are several good reasons why it's likely, perhaps chief among them that effectiveness of control in any system relies heavily on good data feedback.

> You're just assigning meaning to random noise.

First and foremost I'm describing distinctions between characteristics that show up in the plots you brought to the discussion. Those distinctions aren't speculation, they're there. Your attribution of them to "random noise" is at best just as much speculation as my attribution to intervention differences is. And considering how smooth some of those exponentials are there is almost certainly something functional rather than noisy going on behind them, whether it's something I've already mentioned related to containment efforts, or something else like differences in how continuity of social contact works in parts of the world represented by noisier graphs.

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

#558

Post by thereare5lights » Thu, Mar 19, 2020, 9:04 PM UTC

dang wrote: post #554

thereare5lights wrote: post #546

Earlier quoted context omitted.

I've seen this a lot but never understood what that exactly means. What happens when you detach a subthread?

It becomes a top level comment instead of a child of its original parent. Does that make sense?

yep

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

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Post by thu2111 » Thu, Mar 19, 2020, 9:22 PM UTC

tomatotomato37 wrote: post #542

thu2111 wrote: post #531

Earlier quoted context omitted.

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…

A CPAP is fixed pressure, what your thinking of is a APAP or the bilevel type of positive air-pressure machines. And there lies the problem with you're miniumum feature set; not all *PAPs are fully-featured machines. Maybe only 10% or so are suitable for ventilator duty, which means they too are supply-limited

I own two CPAP machines and yes they both implement bi-level/APAP features. CPAP is a bit of an ambiguous term these days; whilst there are technical differences between them, most people call all such devices CPAP machines. For instance,

https://www.usa.philips.com/healthcare/product/HCNOCTN447/dr...

It's advertised as "CPAP & Bi-Level therapy".

To be clear, I'm talking about the ones that implement bi-level pressure. The difference is (as far as I know) primarily a matter of software; perhaps older machines can be upgraded if pricing/selling upgrades is taken out of the equation?

I've had my machines for I think a couple of years now and they were all bi-level from the start. I'm not sure when that started becoming standard or where you got that 10% figure from, you may well be right. But there are 300,000+ sleep apnea patients being treated in the UK alone. If even only 10% of them use modern machines (seems low given how much better bi-level makes it), that's still 30,000 portable ventilators available to be requisitioned at short notice. Sleep apnea patients don't have a critical need for them.

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

#560

Post by thu2111 » Thu, Mar 19, 2020, 9:26 PM UTC

Mvandenbergh wrote: post #540

thu2111 wrote: post #531

Earlier quoted context omitted.

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 pressu…

CPAP machines technically can't but CPAP has become a generic term that also encompasses bi-level/APAP machines that can swing pressure fast enough to track inhalation/exhalation. Both mine do. They're not that old but they're not top-end either.

I don't know how many active machines are pre-APAP/BiPAP/A-Flex (there are different names for it). A comment below says 90% but this seems very high to me.

I wonder if it's possible some doctors don't realise the machines have this feature or it's importance? When I first was prescribed CPAP the machine did not come with bi-level flex enabled, it made it very hard to tolerate. I pushed through it for months but when I "cracked" the doctor-only DRM (i.e. looked up the cheat code on Google) and enabled A-Flex it instantly became way easier to handle the machine and my AHI scores were super low; big success. Doctor was quite happy with my altered configuration. I was just surprised such a basic thing hadn't been explained to me.

I suspect a lot of CPAP machines support bi-flex but it either isn't activated or could be added via a software update. I don't think you need extra components.

Oxygen valves come from here: https://learningenglish.voanews.com/a/volunteers-produce-3d-...