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

#561

Post by MiroF » Thu, Mar 19, 2020, 9:40 PM UTC

wahern wrote: post #547

MiroF wrote: post #444

Earlier quoted context omitted.

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.

When choosing a primary physician at one of the San Francisco Kaiser Permanente campuses, I noticed that a substantial number of doctors had overseas medical training. Which was fine by me--I'm an enthusiastic Kaiser member and support their cost management strategies--but I found it interesting. Kaiser also recently opened their own medical school: https://en.wikipedia.org/wiki/Kaiser_Permanente_Bernard_J._T... So t…

> So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.

Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)

We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.

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

#562

Post by MiroF » Thu, Mar 19, 2020, 9:40 PM UTC

snowwrestler wrote: post #534

MiroF wrote: post #444

Earlier quoted context omitted.

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.

For sure and we should also expand the jobs that PAs and RNs are allowed to do.

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

#563

Post by 76543210 » Thu, Mar 19, 2020, 10:20 PM UTC

stephencanon wrote: post #490

76543210 wrote: post #394

Earlier quoted context omitted.

Just an idea (that would never happen)- Why not make it like Engineering? You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer g…

How do you think medical education works? Because it's basically exactly this.

No. there is an extra 4+ years of classes.

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

#564

Post by 0xWTF » Thu, Mar 19, 2020, 11:05 PM UTC

egwor wrote: post #267

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

What help do you need? - testers? - docs? - code reviews?

Need more developers:

* security engineer

* iOS engineer

* Android developer

* Dart engineers

* Flutter developers

* Engineers with health industry experience

* backend infrastructure

* backend security

Goal: 1-2 months to MVP deployment. Maybe sooner if people pile on.

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

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Post by hokkos » Thu, Mar 19, 2020, 11:30 PM UTC

Alex3917 wrote: post #496

blackrock wrote: post #415

Earlier quoted context omitted.

How did they know to order more supplies in December? China reported the new novel strain of the coronavirus to the WHO on December 31. [1] If correct, then this means they were monitoring the news, and reacted immediately, and on the very same day of the fresh report. [1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6905e1.htm

It's been widely known outside of China that this a novel SARS-like disease was spreading since December 20th, they just didn't confirm that it was novel until the 31st.

I can't find any article on google dated before december 30 about "pneumonia china".

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

#566

Post by MiroF » Fri, Mar 20, 2020, 2:10 AM UTC

colinmhayes wrote: post #498

MiroF wrote: post #444

Earlier quoted context omitted.

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.

Doctors wouldn't let either of those things happen because it would lower their salary. The AMA is a powerful lobbying association, no way any law that lowers doctor salary would pass.

Lobbying power can be confronted by other considerable lobbying interests. Large healthcare conglomerates would seem to have considerable interest in reducing labor costs.

A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.

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

#567

Post by lsc » Fri, Mar 20, 2020, 2:14 AM UTC

codexjourneys wrote: post #396

lsc wrote: post #209

Yeah, I'm personally not too concerned with the "stuff" end of things. This is America; in spite of rhetoric to the contrary, we remain a manufacturing powerhouse. Apply enough money and we'll get whatever "stuff" we need on pretty short order. I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that…

The problem is threefold. We need: 1. ventilators 2. PPE 3. healthcare personnel (respiratory therapists). In the short term we should train existing doctors, physician assistants, and nurse practitioners in respiratory therapy ASAP. But without PPE they put themselves at risk, and without ventilators the patient may die anyway. We need all three, and there's a worldwide shortage. That is the bottleneck.

I'm not questioning the need. I'm just saying that it seems to me a lot more realistic that we'll be able to short-term ramp-up production of 1 and 2 than it is to think we'll be able to adequately ramp up 3.

The stories I hear from medical people I know (and this is just anecdotal) is that they are only given serious PPE when they know there is an infection, but it's less clear if that's just standard policy or if that is due to limited supply.

I do agree that if PPE isn't used early and often here, we're going to be short medical personnel, and I think getting those back online is probably going to take longer than throwing money at manufacturers to build more PAPRs.

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

#568

Post by lsc » Fri, Mar 20, 2020, 2:16 AM UTC

grey-area wrote: post #421

lsc wrote: post #209

Yeah, I'm personally not too concerned with the "stuff" end of things. This is America; in spite of rhetoric to the contrary, we remain a manufacturing powerhouse. Apply enough money and we'll get whatever "stuff" we need on pretty short order. I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that…

My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed. By the time they are imposed, it will…

I agree with you... last week.

I mean, sure, we should lock down now, but my feeling is that it's mostly too late for the urban areas.

The rural areas might have a chance... they need to lock down hard right now. But... from talking to rural family... I'm not sure that's culturally possible.

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

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Post by jariel » Fri, Mar 20, 2020, 8:27 AM UTC

rstupek wrote: post #482

jariel wrote: post #134

I still can't believe that most large companies were not offering everything they could several weeks ago. All Army/Navy/Air Force medical personnel should already be deployed to the field with makeshift drive-in testing spots. The Army is good at creating controlled zones. They can direct traffic while someone takes a swab. All other military personnel should be working with hospitals to do 'anything non-medically r…

The military is legally prohibited from operating on US soil (kind of something the framers didn't feel comfortable with). Perhaps you mean the National Guard, which is controlled by the governor of each state?

I mean deploy them without weapons, or possibly uniforms if necessary. If that's still illegal, they put many of them on 'leave without pay' if they were with a different federal agency wherein they operate without rank or difference to their military status i.e. 'bodies for work'. They can be filtered into roles given qualifications.

Uniforms are not necessary and they would have no real legal authority, the legality could be enforced by local law enforcement if necessary.

Don't need guns, uniforms or much training or authority to divert traffic, take peoples names, guide them in parking lots while they wait for test results.

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

#570

Post by Mvandenbergh » Fri, Mar 20, 2020, 10:59 AM UTC

thu2111 wrote: post #560

Mvandenbergh wrote: post #540

Earlier quoted context omitted.

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…

Very interesting, thanks. If that is the case then it may indeed simply be a software thing. Specifically for treating ARDS you need:

-High PEEP (obviously any CPAP machine can do this)

-Low plateau pressure (probably possible, that's just software)

-Low tidal volume and high breathing rate. Breathing rate is just a cycling variable so should be software only issue. Managing low tidal volume will require the machines to have a flow sensor. Do you know if any of your machines do? If so, then this is likely fixable with only software.

My interpretation of that article is it must refer to the patient valve as those are one-time use (as they in contact with contaminated patient exhalations) rather than O2 inlet valves which are not disposable. Patients are breathing high-ish O2 but obviously not HP pure O2 so 3d printed is fine for that.

3D printing is useful for cases like that where due to logistics there is a temporary shortfall in local supply. I suspect that 3 months from now we are unlikely to be using those measures as global production and distribution of ventilator consumables ramp up.