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Interview with German Ventilator Manufacturer

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Re: Interview with German Ventilator Manufacturer

#101

Post by Zenst »

lazyjones wrote: post #94
freeflight wrote: post #87

Earlier quoted context omitted.

> why on earth is Germany running five times more beds that it generally needs? I feel like that question is asked the wrong way around because you are assuming England has "exactly enough", that's how you end up with Germany supposedly "running five times more beds than it needs". But there's good reason to believe England has not enough ICU beds, even outside of a pandemic, the result of years of austerity cuts to…

> he UK right now sits at 11 deaths per 1m population, Germany at 5, and that's with Germany having tens of thousands of more cases [3]. The UK has done around 110k tests, Germany more than 400k. Don't confuse positive test results with actual infections. If the UK tested more, it'd very likely have more "cases".

Very very true of many countries, the level of testing and how they record deaths has been done at the discretion of individual countries and in many ways, makes comparing data not as clear-cut as you would think. THough if you don't know that, you end up comparing, what are hard numbers that you take as golden and end up down many wrong turns.

With that, who really thinks Russia has so few cases compared to the rest of the countries?

Even deaths, which you would of thought would be pretty clear cut, some countries will not count deaths with underlying conditions when many do. Then you have those who died at home and nobody knows about it.

I do know one thing, I feel for the postal workers in months ahead as there job will become a lot more morbid seeing who's letterbox is rammed and with that, possible dead people inside that nobody knows and for those postal workers - they will be the ones raising the alarms.

Re: Interview with German Ventilator Manufacturer

#102

Post by hef19898 »

pyb wrote: post #6

"I spoke with Daimler over the weekend. They would also like to help. But it’s unfortunately not so simple..." It would be interesting to hear more precisely why. We've heard more than a few well-respected industrialists essentially saying "Scaling up ventilator production ? How hard could it be?" Edit. Of course I am not suggesting that car assembly lines are suitable to build ventilator parts. That's clearly not wh…

A friend of mine is coordinating Airbus effort to build ventilators. I know Airbus manufacturing base, and theoretically possible. Getting a design together that works, and can get certified for medical use, is the difficult part as far as I understood. But they are in contact with various universities and so on.

One big issue can be IP. Dräger put a lot of money behind that. Just opensourcing the design and specs would kill the company. But why not negotiate liscense agreements or sub-contracting production out. Could be a solution. Just shows how everybody is still trying to adopt to the new reality.

Re: Interview with German Ventilator Manufacturer

#103

Post by pmyteh »

elyobo wrote: post #80
thu2111 wrote: post #78

Earlier quoted context omitted.

Insufficient by what measure? You're comparing against - it appears - the second highest spender in the world. There have been no cuts in NHS service. Sometimes I think I need to assign this to a keyboard macro because it's such a frequently repeated myth. The NHS has more funding now than it's ever had, it has been explicitly protected from budget reductions when every other government department has seen massive re…

I can't find stats to back this up either way; funding seems to have grown in real terms over time, but I can't see real funding per capita which is probably the more relevant factor.

It has grown in real terms, but not as fast as either demand or costs. Healthcare inflation is very high, and greatly outpaces the CPI index that we use for 'real-terms' comparisons. Basically, the same funding in 'real-terms' doesn't buy you the same level of care as last year in any country.

Plus Britain is getting somewhat older, and somewhat sicker (partly because of medical advances meaning that previously-fatal conditions are now chronic and need ongoing treatment). And we can treat more now, so there is more demand.

Bluntly, the proportion of GDP which needs to be allocated to healthcare to maintain a good quality service is rising unsustainably in all countries. The NHS is beating CPI inflation (and in doing so doing way better than other parts of government: local government has seen >25% real terms cuts, which has trashed the social care system amongst other things) but not nearly enough to keep up.

Re: Interview with German Ventilator Manufacturer

#104

Post by Zenst »

peteretep wrote: post #93
nicoburns wrote: post #58

Earlier quoted context omitted.

Note that the UK spends a lot less (per capita) on healthcare than Germany: (£2,989 vs £4,432 in 2017), and that funding for healthcare has generally be considered to be insufficient over at least the last 10 years in the UK, leading to cuts in service. This may account for at least some of the difference. Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

> Note that the UK spends a lot less (per capita) on healthcare than Germany: (£2,989 vs £4,432 in 2017) If Germany have provisioned 5 times more ICU beds than they generally need, I can see why their costs might be higher

Maybe that they count them as beds and have more that can cater for ICU than others.

However, let's not forget historical factors and was case of many countries having armies in Germany for legacy war reasons and that may well of seen the mentalities to have a higher number of such beds than most places.

Re: Interview with German Ventilator Manufacturer

#105

Post by freeflight »

lazyjones wrote: post #94
freeflight wrote: post #87

Earlier quoted context omitted.

> why on earth is Germany running five times more beds that it generally needs? I feel like that question is asked the wrong way around because you are assuming England has "exactly enough", that's how you end up with Germany supposedly "running five times more beds than it needs". But there's good reason to believe England has not enough ICU beds, even outside of a pandemic, the result of years of austerity cuts to…

> he UK right now sits at 11 deaths per 1m population, Germany at 5, and that's with Germany having tens of thousands of more cases [3]. The UK has done around 110k tests, Germany more than 400k. Don't confuse positive test results with actual infections. If the UK tested more, it'd very likely have more "cases".

> Don't confuse positive test results with actual infections.

I don't, I'm mostly going by deaths/1M pop, and afaik even if the UK tested more, that number wouldn't change and still be more than double that of Germany.

So Germany must do something right that the UK doesn't.

Maybe it's the extra ICU beds, maybe it's the rapid testing, most likely it's a combination of both of those in addition to the better funding?

Re: Interview with German Ventilator Manufacturer

#106

Post by yalogin »

thu2111 wrote: post #54
yalogin wrote: post #35

I hear GM and now Daimler are all offering to help. How easy are these to manufacture? Also setting up the manufacturing plant takes time doesn’t it? All these companies make it seem like it’s trivial to create the infrastructure needed to manufacture them in bulk. Or does auto manufacturers somehow have the equipment to do this already? Is that the case?

Cars are many orders of magnitude more complex than ventilators so it's not unimaginable. A ventilator is basically a motor/small turbine connected to a few sensors and air filters, all linked together with some fairly sophisticated software. The software can obviously be 'manufactured' at infinite speed. That leaves an assembly of pipes, valves and flow sensors - but only a few. Especially if you customise the machi…

Should still months to create the setup right? I see that it’s stated than not having any but it doesn’t serve the immediate need.

Re: Interview with German Ventilator Manufacturer

#107

Post by usrusr »

peteretep wrote: post #45
sabertoothed wrote: post #41

Some key statements: "Dräger: In Europe, the number of intensive-care beds per capita is very unequally distributed. In Italy, it is three times lower than here. In England, five times lower. The challenge in England will be greater than in Spain. And the situation in the U.S. is very alarming. The reporting system there is also underdeveloped."

I’ve wondered about this for a little while. Why does Germany have five times as many ICU beds than England? Until now, I’ve never heard a suggestion that England had fewer ICU beds than it needed generally, and assuming England and Germany use beds at the same general capacity, why on earth is Germany running five times more beds that it generally needs? (please don’t answer “for a case like this” unless you have so…

NHS hospitals have a completely different set of incentives than German hospitals that exist at a boundary between market capitalism and something entirely different. Terminal ICU patients are the health care equivalent of a billable hours fountain.

It's definitely not a deliberate "for a case like this" precaution but an emergent outcome of the specifics of how hospital funding is done and had been decried as a problem to be solved by should of the usual suspects.

Re: Interview with German Ventilator Manufacturer

#108

Post by kyrra »

sabertoothed wrote: post #41

Some key statements: "Dräger: In Europe, the number of intensive-care beds per capita is very unequally distributed. In Italy, it is three times lower than here. In England, five times lower. The challenge in England will be greater than in Spain. And the situation in the U.S. is very alarming. The reporting system there is also underdeveloped."

The US last got data in 2010 I believe. I believe this is the paper many people site today:

https://www.cambridge.org/core/journals/disaster-medicine-an...

> The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2–23.1), ranging from 11.9 to 77.6

Edit: WSJ opinion linked to a NIH study from 2012.

https://www.wsj.com/articles/americas-intensive-care-dividen...

> A 2012 review [1] in the journal Current Opinion in Critical Care found that the U.S. has 20 to 31.7 ICU beds per 100,000 people compared to 13.5 in Canada, 7.9 in Japan and between 3.5 and 7.4 in the U.K. Differences in how countries define “ICU” account for some of the disparity, the article notes, and the U.S. needs more ICU beds because it has a higher incidence of chronic conditions like heart disease.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/?mod=ar...

Re: Interview with German Ventilator Manufacturer

#109

Post by lazyjones »

freeflight wrote: post #105
lazyjones wrote: post #94

Earlier quoted context omitted.

> he UK right now sits at 11 deaths per 1m population, Germany at 5, and that's with Germany having tens of thousands of more cases [3]. The UK has done around 110k tests, Germany more than 400k. Don't confuse positive test results with actual infections. If the UK tested more, it'd very likely have more "cases".

> Don't confuse positive test results with actual infections. I don't, I'm mostly going by deaths/1M pop, and afaik even if the UK tested more, that number wouldn't change and still be more than double that of Germany. So Germany must do something right that the UK doesn't. Maybe it's the extra ICU beds, maybe it's the rapid testing, most likely it's a combination of both of those in addition to the better funding?

> So Germany must do something right that the UK doesn't.

... or wrong. Italy e.g. tests dead people for Coronavirus, Germany might conclude in many cases that people with prior issues died from those issues. I know Austria is very reluctant about this.

Re: Interview with German Ventilator Manufacturer

#110

Post by pyb »

hef19898 wrote: post #102
pyb wrote: post #6

"I spoke with Daimler over the weekend. They would also like to help. But it’s unfortunately not so simple..." It would be interesting to hear more precisely why. We've heard more than a few well-respected industrialists essentially saying "Scaling up ventilator production ? How hard could it be?" Edit. Of course I am not suggesting that car assembly lines are suitable to build ventilator parts. That's clearly not wh…

A friend of mine is coordinating Airbus effort to build ventilators. I know Airbus manufacturing base, and theoretically possible. Getting a design together that works, and can get certified for medical use, is the difficult part as far as I understood. But they are in contact with various universities and so on. One big issue can be IP. Dräger put a lot of money behind that. Just opensourcing the design and specs wo…

I am also concerned that Draeger refusing to share crucial IP might be an unspoken bottleneck. Of course, if that's the case, the right solution is for the government to acquire said IP for a large amount of money, but it may fail to happen for purely bureaucratic reasons.
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