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Risky hack could double access to ventilators

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Re: Risky hack could double access to ventilators

#121

Post by mistermann »

mellavora wrote: post #112
pbhjpbhj wrote: post #43

Have governments made orders (legal or purchase) for manufacture of ventilators by large scale companies? Presumably ventilators are a relatively niche product - what's in them that the World's industrial complexes can't ramp up production of within a couple of weeks? I imagine it's the pumps that's the limiting factor? Given humanity already has the working tested, established designs. Can't governments requisition…

I keep seeing people asking "Why can't we just quickly spin up technology X?" where this is here ventilators, otherwise vaccines, etc... without much awareness of how much specialization goes into almost every aspect of every job. Hell, even fast-food workers-- a skilled grill operator at McDonalds -- take time to train up. No, we cannot quickly undo the 20 years of systematic dismantling of our core infrastructure.…

> I keep seeing people asking "Why can't we just quickly spin up technology X?" where this is here ventilators, otherwise vaccines, etc...without much awareness of how much specialization goes into almost every aspect of every job. Hell, even fast-food workers-- a skilled grill operator at McDonalds -- take time to train up.

> No, we cannot quickly undo the 20 years of systematic dismantling of our core infrastructure. We are in for a very rude wake-up call.

Wait a minute. I was with you up until the end of "...take time to train up.", but I've lost the plot between there and "No, we cannot quickly undo the 20 years of systematic dismantling of our core infrastructure." To me, these seem like two extremely different issues, but it appears that you see them as being ~equivalent, or am I misunderstanding?

> And then, once we are awake, and are dealing with our new realization on the complexity of our economy, where every part depends on every other part functioning...

Agree, but I just wanted to add my $.02: Be careful when using "awake" - this is a very, very tricky word. To say it can be be deceptive is a major understatement.

> Then we realize that the economy is embedded in an even bigger system called "life on earth" which we have degraded and destroyed on a much larger scale than our economy.

I see your point, but again: for specific definitions of "degraded" and "destroyed", maybe. And even if so, does this have bearing on this particular issue? If not, it should not be part of the analysis. It confuses people, and this situation is confusing enough.

> If you think the weakness in our society which the virus uncovers are a big deal, you simply lack the full picture.

I assume you meant "...are not a big deal..."?

Re: Risky hack could double access to ventilators

#122

Post by bootlooped »

notabee wrote: post #118
earthtourist wrote: post #111

Earlier quoted context omitted.

That's been my question as well. Why doesn't spraying N95 masks with isopropyl alcohol work? 1. Spray mask with alcohol. 2. Place in the sun or under UV light. 3. Wait as many hours/days as possible before reuse. Seems better than re-using a highly contaminated mask day after day. I'm not an expert so I could easily be wrong though.

All of those break down the mask fibers or screw up the electrostatic qualities used to grab particles. There have been studies on it, but there's not really an ideal way that doesn't damage the filtering capacity over time.

From what I understand the virus breaks down with time at room temperature anyway, so you could possibly just get away with tossing them in a box for 10 days (or whatever time gets you 99+% virus breakdown). That would have minimal negative effect on the filter material and elastic straps.

Re: Risky hack could double access to ventilators

#123

Post by _ea1k »

Herodotus38 wrote: post #95

I encourage anyone wanting to help to try and finds ways of manufacturing the essentials of PPE that we need to limit spread, as that will have a much bigger impact. Every hospital and clinic in my area is running out of masks (both N95 and surgical), gowns, plastic goggles and starting to get into issues with disinfectants. Having double ventilator use is a nightmare scenario for various reasons. There are much bett…

I don't understand why so much of the talk is about ventilators. It seems like a massive increase in production of masks, gowns, and goggles would be easier to accomplish in the short term and also essential.

Re: Risky hack could double access to ventilators

#124

Post by gdubs »

theturingnerd wrote: post #19
bitexploder wrote: post #3

This is really neat. It seems a lot of the risk is how specific lung capacities and conditions interact with the ventilator and how much oxygen someone needs. My question to any MDs reading this: how often do you have to tweak ventilator volume for patients using one? What is the feedback loop? Blood oxygen levels?

(physician here) Vents can be quite tricky to get right; primarily because as disease progression continues on many things change. We are always trying to balance the deleterious effects of the intervention (in this case, the vent) with the goals of care. What most people don't know is that vents cause a lot of injuries on their own. (See ARDS). Hypoxemic respiratory failure is serious stuff, and it's almost always n…

I can't even figure out what my HVAC vents do, or how not to mess up my entire heating and cooling situation – so I leave them alone.

Utter respect for you and all the other medical professionals who are having to adapt and deal with this unfolding situation. Many thanks for what you do.

Re: Risky hack could double access to ventilators

#125

Post by dehrmann »

_n_b_ wrote: post #55
pbhjpbhj wrote: post #43

Have governments made orders (legal or purchase) for manufacture of ventilators by large scale companies? Presumably ventilators are a relatively niche product - what's in them that the World's industrial complexes can't ramp up production of within a couple of weeks? I imagine it's the pumps that's the limiting factor? Given humanity already has the working tested, established designs. Can't governments requisition…

I am not an expert on manufacturing biomedical devices, but I do know quite a bit about manufacturing safety-grade nuclear components. So take this with a grain of salt. However, from what I do know, fundamentally the requirements are pretty similar. There is likely nothing magical from a purely mechanical standpoint about making a ventilator. The part that is difficult is: * Have an adequate QA program for you and y…

> it took at least a year and a half to get the plant producing planes at an acceptable quality and quantity.

I wonder if this would be longer or shorter today with how much of car assembly is automated. How many of the tools do one specific thing a human used to? How many are robots that can be reprogrammed? That, and cars and ventilators are completely different. I'd think a ventilator is closer to a dishwasher than a car (think appliance).

Re: Risky hack could double access to ventilators

#126

Post by mellavora »

mistermann wrote: post #121
mellavora wrote: post #112

Earlier quoted context omitted.

I keep seeing people asking "Why can't we just quickly spin up technology X?" where this is here ventilators, otherwise vaccines, etc... without much awareness of how much specialization goes into almost every aspect of every job. Hell, even fast-food workers-- a skilled grill operator at McDonalds -- take time to train up. No, we cannot quickly undo the 20 years of systematic dismantling of our core infrastructure.…

> I keep seeing people asking "Why can't we just quickly spin up technology X?" where this is here ventilators, otherwise vaccines, etc...without much awareness of how much specialization goes into almost every aspect of every job. Hell, even fast-food workers-- a skilled grill operator at McDonalds -- take time to train up. > No, we cannot quickly undo the 20 years of systematic dismantling of our core infrastructur…

Hey, thanks for the clarifications, and apologies to the community that I started ranting.

The equivalence between "takes time to train up" and "20 years of systematic dismantling" is that we have lost many of the experts we might otherwise depend on in a national emergency. For example, Trump dismantled the Pandemic Response Team. You can't easily replace that overnight. Longstanding cuts to CDC budgets, etc.

You are also correct that I was making a rather unexpected analogy between our current crisis and the environmental crisis. Yes, this would catch a reader off guard and cause the confusion you suggest.

Here it is again: The economy is a complex system. Each part basically assumes that the rest of the parts are there. Imagine Amazon without a postal deliver service, for example. Or your grocery store without a trucking industry.

Much of the global economy is now shut down. We will have to re-start it, which we will do, but it will be painful because of complex interdependencies between parts.

Here is the analogy: Life on earth is also a complex system. We have done our best to extract and destroy as much of it as possible. For example, insect populations are down by 80% in Western countries.

We take for granted that the natural environment is there, providing what it has always provided, without realizing how badly we have disrupted it.

Just as the US has taken good health for granted and dismantled things like the CDC, taken good roads for granted and not repaired them, taken good education for granted and demonized public school teachers (hello, Wisconsin!)....

Re: Risky hack could double access to ventilators

#127

Post by jefftk »

mrob wrote: post #65

Is negative pressure ventilation any use in treating Covid-19? Iron lungs are easier to build than positive pressure ventilators. I imagine many HN readers could build something like a Both respirator[0] in their garage over a weekend. Using negative pressure ventilation might be a better option than trying to attach multiple patients to a positive pressure ventilator. [0] https://en.wikipedia.org/wiki/Both_respirato…

I wouldn't expect this to work: the problem with covid isn't that the patient's muscles are unable to handle the breathing but that the usable lung capacity is too low, right?

But these are definitely worth looking into at least a little, since they're so much easier to make than a modern ICU ventilator.

Re: Risky hack could double access to ventilators

#128

Post by markmichalski »

djsumdog wrote: post #20
theturingnerd wrote: post #19

Earlier quoted context omitted.

(physician here) Vents can be quite tricky to get right; primarily because as disease progression continues on many things change. We are always trying to balance the deleterious effects of the intervention (in this case, the vent) with the goals of care. What most people don't know is that vents cause a lot of injuries on their own. (See ARDS). Hypoxemic respiratory failure is serious stuff, and it's almost always n…

What do you think are the risks of cross contamination in this setup (let's say, just for 2 people sharing one unit)? She mentions how, in a situation where you'd have to use this, they'd have the same infection. What if they have different secondary infections or different types of pneumonia? The example of the Vegas disaster is different because they were all gunshot victims; they were healthy, but wounded. I hope…

MD here. There is an inhalation and exhalation tube for each patient; the exhalation tubes would be in continuity using the described configuration. However, at least for part of the transmission route, viral particles would have to move against flow. So there is likely some cross-contamination.

All that being said in the situation where this is deployed I think it would be a risk most providers would take.

Re: Risky hack could double access to ventilators

#129

Post by markmichalski »

anonuser123456 wrote: post #109

People keep talking about ventilators. The only study I've seen w.r.t. ventilator success for COVID-19 treatment showed something like 3% survival for those mechanically ventilated. Do we have more data showing they even move the needle?

This isn't right--almost all with beds in the ICU right now are mechanically ventilated; >50% will survive.

Re: Risky hack could double access to ventilators

#130

Post by asah »

markmichalski wrote: post #129
anonuser123456 wrote: post #109

People keep talking about ventilators. The only study I've seen w.r.t. ventilator success for COVID-19 treatment showed something like 3% survival for those mechanically ventilated. Do we have more data showing they even move the needle?

This isn't right--almost all with beds in the ICU right now are mechanically ventilated; >50% will survive.

Wuhan study of COVID showed 31/32 died: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

non-COVID mortality is typically a coin-toss: https://www.google.com/search?q=mortality+rate+ventilators

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