Risky hack could double access to ventilators • Hacker News Board

Re: Risky hack could double access to ventilators

#151

Post by fifteenforty » Sat, Mar 21, 2020, 2:20 AM UTC

etrevino wrote: post #148

lee wrote: post #147

Earlier quoted context omitted.

I've got a really naive/dumb question for you. Could you use a CPAP machine as a poor man's ventilator? Would it be better than nothing? There's definitely a ton of CPAP machines out there.

A doctor asked me that-- a fact I found disturbing, because shouldn't he know-- so I did some research. And I found out that the machine would spread the virus everywhere with the outgassing (I'm not sure if that's the right term).

There are way too many different brands and types of CPAP machine for anyone to make any sort of sensible comment here. They aren’t all the same. Some of them do have a backup rate that could be used to mandatory mechanical ventilation, but that can’t be readily altered at the bedside in the models I have used. The use-case is radically different to the ICU.

Re: Risky hack could double access to ventilators

#152

Post by fifteenforty » Sat, Mar 21, 2020, 2:23 AM UTC

Mvandenbergh wrote: post #76

Interesting. This has been done before (after LV shooting) but has conventionally been considered as an intervention suitable for treating mass trauma. That's because people who are otherwise in good health are easier to ventilate than people with stiff, non-compliant lungs caused by inflammatory viral ARDS. Ventilating people with ARDS is hard. You have to use low, carefully considered tidal volumes and essentially…

As you say, we have many patients already in our ICUs who need ventilation, but aren’t /difficult/ to ventilate.

Perhaps they could get the split ventilators and the COVID-19 patients could get their own?

Re: Risky hack could double access to ventilators

#153

Post by gwright » Sat, Mar 21, 2020, 5:03 AM UTC

loeg wrote: post #23

Polylactic_acid wrote: post #10

Earlier quoted context omitted.

Seems likely. Italy is currently seeing a 13% increase per day while the US is now very close to a 50% increase per day. There are news reports showing beaches and bars in the US are still fully packed. It probably relates the US culture of disregarding expert advice and doing the opposite to "own the scientists"

The US federal government isn't actually doing much at the top level. Individual states are shutting down at variable times and rates. The beaches and bars are mostly in these slow-moving states.

That is because that is how our system of executive administration is designed. It is a federal system with the vast, vast majority of police powers (https://en.wikipedia.org/wiki/Police_power_(United_States_co... residing in the state, not federal authorities.

Re: Risky hack could double access to ventilators

#154

Post by gwright » Sat, Mar 21, 2020, 5:07 AM UTC

nerdponx wrote: post #141

sp332 wrote: post #105

Earlier quoted context omitted.

The growth rate is different in different countries. The USA is currently on a 35% slope. http://nrg.cs.ucl.ac.uk/mjh/covid19/

New York's growth rate is going to look terrifyingly high as testing capability ramps up significantly.

There has been a steady drumbeat of warnings to expect that spike, but unfortunately the statistical nuances of epidemiology will be lost on many.

Re: Risky hack could double access to ventilators

#155

Post by loeg » Sat, Mar 21, 2020, 6:55 AM UTC

gwright wrote: post #153

loeg wrote: post #23

Earlier quoted context omitted.

The US federal government isn't actually doing much at the top level. Individual states are shutting down at variable times and rates. The beaches and bars are mostly in these slow-moving states.

That is because that is how our system of executive administration is designed. It is a federal system with the vast, vast majority of police powers ( https://en.wikipedia.org/wiki/Police_power_(United_States_co... residing in the state, not federal authorities.

In ordinary times, yes, the US is a federal system of states with some level of individual state rights. But state power has somewhat eroded over time; federal supremacy is a thing; and there is plenty of precedent for the Fed stepping in during emergencies and war. (And war is a relevant point of comparison because even if this thing goes as well as possible at this point, it's likely going to kill more Americans than any foreign war and probably more than the civil war.)

No, the reason the top level federal government isn't doing much is because Trump is an incompetent idiot who doesn't have a second brain cell to rub against the first. The federal government has the funds and the coordinating agencies (FEMA, CDC, military and national guard) and could be buying masks, ventilators, tests; solving distribution problems; coordinating with states on social distancing and even lockdown/shelter-in-place policy. They did nothing during the early weeks when they knew it was a coming problem and it is not clear how much Pence is doing now.

Re: Risky hack could double access to ventilators

#156

Post by salawat » Sat, Mar 21, 2020, 7:27 AM UTC

pbhjpbhj wrote: post #138

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 see creation of a vaccine very differently to production of one of a range of existing ventilators. There are many companies using things like 6D CNC machines with high accuracy that can essentially spit out a part for which there's a definition (and we can 3D scan parts to micrometer accuracy with laser scanners); many electronics companies can make "any" circuit to some extent (I'm guessing ventilators use generi…

The problem isn't production.

It's mass automated production. Once you take the human out of the picture to get a machine to do the work you've now involved a programmer, CNC operator, roboticist. and an industrial engineer at a minimum just to get the rough task doable.

We could probably have a fully human operated production line up and going relatively quickly, but getting the machines all cut over and integrated so as to do it themselves is hard.

Look, thought experiment. You ever watch that show, "How It's Made"? They literally make entertainment out of watching the end result of the final outcome of integrating all of these stages of the fabrication process.

But if you have ever watched it, did it not strike you as interesting that they never seem to do an episode with regards to the production of the very industrial equipment automating the fabrication process?

They can't/won't because it is bloody hard, error prone, and freaking expensive. Once you've got it, you're gold, but it is by no means a short route getting there.

Re: Risky hack could double access to ventilators

#157

Post by salawat » Sat, Mar 21, 2020, 8:24 AM UTC

jariel wrote: post #52

Continuous wrote: post #48

This is ridiculous! Hacks are ok with web and app deployments where you are able to patch and fix to your heart's content and the damage is not life threatening. I have worked with the medical industry, the amount of formal validation and verification that goes through on software is insane compared to what we have in the "move fast and break things" world. Even if it is "temporary" and "desperate" I would stay away…

This is completely the wrong attitude. Different circumstances with different levels of risk, require the ability to adapt. Nobody is suggesting 'sharing ventilators' would be normal practice because in normal circumstances we want to make sure that equipment is 99.999% reliable. But as you imply, this requires extensive testing and regulation. Within these regulations are also significant safety margins that can be…

>Also - if you've worked in the medical industry, you know how vastly overpriced and bureaucratized everything is.

Quality guy here,though not in medical devices... Yet. Still trying to get up to speed on all the regulations; but I know enough to be able to vouch for some of the bureaucracy around the industry.

The risks in medicine being what they are, when launching into any novel space, there is simply no substitute for A) data and B) audit trail.

Your data varies from lot numbers of source material from suppliers (contamination happens), batch numbers of parts (and revision numbers of the process involved in making that batch) from manufacturers, to serial numbers matched up to individual patients in order to be able to implement some form of high-level statistical process control, and rapid intervention when things go wrong in order to figure out why, what you can do about it, and who else may be at risk. No one wants to be the one told "whoops, someone goofed, and that thing we put you on is trying to kill you," anymore than anyone in the chain from treatment inception, to installation wants to hear that they missed something, and even worse, get caught not knowing what to do about it.

That means paperwork, signalling mechanisms, and procedures involved with marshalling whatever response is to follow, which is not at all a trivial process to orchestrate, and while all of us wish there wasn't so much bullshit, there are plenty of examples where "falling asleep on the job" has led to catastrophic outcomes.

I can't necessarily say I that justifies the overriding though. The markups are ridiculous, but without access to the books, I can't really discount it either.

Re: Risky hack could double access to ventilators

#158

Post by gwright » Sat, Mar 21, 2020, 3:29 PM UTC

loeg wrote: post #155

gwright wrote: post #153

Earlier quoted context omitted.

That is because that is how our system of executive administration is designed. It is a federal system with the vast, vast majority of police powers ( https://en.wikipedia.org/wiki/Police_power_(United_States_co... residing in the state, not federal authorities.

In ordinary times, yes, the US is a federal system of states with some level of individual state rights. But state power has somewhat eroded over time; federal supremacy is a thing; and there is plenty of precedent for the Fed stepping in during emergencies and war. (And war is a relevant point of comparison because even if this thing goes as well as possible at this point , it's likely going to kill more Americans t…

As a matter of law the federal government controls the international borders and inter-state boarders. It is up to the state governments to limit movement within their borders. https://www.cdc.gov/quarantine/aboutlawsregulationsquarantin...

As it so happens, President trump has been limiting international travel starting all the way back in January.

Why do you think the federal government isn't "doing much" (https://www.usa.gov/coronavirus)?

And what exactly would you have it do that you don't think it is doing?

Re: Risky hack could double access to ventilators

#159

Post by koheripbal » Sat, Mar 21, 2020, 3:38 PM UTC

fifteenforty wrote: post #152

Mvandenbergh wrote: post #76

Interesting. This has been done before (after LV shooting) but has conventionally been considered as an intervention suitable for treating mass trauma. That's because people who are otherwise in good health are easier to ventilate than people with stiff, non-compliant lungs caused by inflammatory viral ARDS. Ventilating people with ARDS is hard. You have to use low, carefully considered tidal volumes and essentially…

As you say, we have many patients already in our ICUs who need ventilation, but aren’t /difficult/ to ventilate. Perhaps they could get the split ventilators and the COVID-19 patients could get their own?

Yes, but the demand projected for ventilators seems to exceed the entire existing supply, and obviously dwarf the uses for all other conditions combined.

Re: Risky hack could double access to ventilators

#160

Post by AntonStratiev » Sat, Mar 21, 2020, 3:56 PM UTC

asah wrote: post #130

markmichalski wrote: post #129

Earlier quoted context omitted.

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

We should be building palliative care centres across the country, not pop-up hospitals.

Pay everyone who contracts Coronavirus in the next 4 months and is refused ICU care, $100,000. If they die, the amount is divided between their surviving immediate family members or previously registered carer.

The current panic seems to be driven by the guilt of not being able to treat everyone. This payment should alleviate that guilt and allow us to continue with life.