Interview with German Ventilator Manufacturer • Hacker News Board

Re: Interview with German Ventilator Manufacturer

#121

Post by InTheArena » Sat, Mar 28, 2020, 1:51 PM UTC

tyingq wrote: post #52

peteretep wrote: post #45

Earlier quoted context omitted.

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…

That doesn't surprise me culturally. I lived in Germany for a couple of years, and the deference to "rules that matter" was completely different than my US experience. Even for trivial stuff like waiting in line/queues. The Germans were much more literal in following the rules, versus my US and UK peers.

Have you ever gotten oN Or off a airplane on Germany? It is gage ring how un-orderly they are - much worse then any other place I have every been.

Re: Interview with German Ventilator Manufacturer

#122

Post by koheripbal » Sat, Mar 28, 2020, 1:55 PM UTC

InTheArena wrote: post #119

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."

By reporting, I suspect he means testing, as the actual reporting is working as expected. As for testing the United States did 120k tests yesterday and is accelerating. The CDC test failing really set things back. In terms of ICU beds, for once this is where the us health care system is in reasonable shape. iCU beds are very profitable and we spend way more then Europe on health care, so there is a abundance of them…

While it is true that testing in the US is lacking - that is true of many countries - particularly in more rural areas.

I've seen estimates everywhere between 90 to 99.9% of cases going untested.

Re: Interview with German Ventilator Manufacturer

#123

Post by InTheArena » Sat, Mar 28, 2020, 1:57 PM UTC

koheripbal wrote: post #122

InTheArena wrote: post #119

Earlier quoted context omitted.

By reporting, I suspect he means testing, as the actual reporting is working as expected. As for testing the United States did 120k tests yesterday and is accelerating. The CDC test failing really set things back. In terms of ICU beds, for once this is where the us health care system is in reasonable shape. iCU beds are very profitable and we spend way more then Europe on health care, so there is a abundance of them…

While it is true that testing in the US is lacking - that is true of many countries - particularly in more rural areas. I've seen estimates everywhere between 90 to 99.9% of cases going untested.

Yes, and honestly, testing makes it easier to constrain (at first) and see something much closer to the true CFR.

Re: Interview with German Ventilator Manufacturer

#124

Post by hef19898 » Sat, Mar 28, 2020, 2:01 PM UTC

pyb wrote: post #110

hef19898 wrote: post #102

Earlier quoted context omitted.

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.

I would just liscense it out for a certain amount of time. Fees can be paid for by the government. But I understand that Dräger might be concerned. No idea if that's the case so.

Bureaucracy can be a bitch.

Re: Interview with German Ventilator Manufacturer

#125

Post by mapgrep » Sat, Mar 28, 2020, 2:01 PM UTC

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

I am not an expert here but it seems dangerous to assume as you do that the baseline of “correct number of ventilators” is the UK number. They could be...

-Under provisioning for surges (not even Covid, even just a sudden emergency of another sort, a bad flu season, big accident, terror event, whatever)

-Going longer between maintenance intervals than is recommended

-Delaying ICU admission longer than is strictly recommended

-Relocating ICU equipment as needed more than other countries feel comfortable doing

-Using more reliable ICU equipment (does the German figure include any older and potentially less reliable gear in the former communist east?)

-Have less need among population for ICU

On the last point, Germany has accepted by far more refugees from MENA war zones than any other European country and I would not be surprised if this resulted in higher emergency medicine use.

Also a quick Google shows Germany is a bit older with 22% of the population over 65 vs 18% in UK.

None of this is to say Germany isn’t over provisioned but it is probably not 5X over provisioned, if it is.

Re: Interview with German Ventilator Manufacturer

#126

Post by hef19898 » Sat, Mar 28, 2020, 2:04 PM UTC

luckylion wrote: post #61

onetimemanytime wrote: post #26

Earlier quoted context omitted.

Nothing money or waivers cannot solve, as long as masks are being made and China allows export. I doubt Germany, USA, Italy etc care about chartering dozens of planes just for that.

I'm not so sure. We have an ongoing toilet paper crisis that is in it's third week now and the government is unable or unwilling to do anything about it, despite ensuring everyone that there's plenty of toilet paper somewhere in some storage of some company. If a somewhat trivial problem like coordinating a few trucks is beyond their ability, I have no hope for coordinating planes and import/export. You might say "bu…

My personal theory is, that the German entity tasked with procurement has no idea how international commerce works.

I saw a intriguing change in conversations I had over the last couple of days. First it was, like, no need, we got this. Just yesterday I found a call for an offer from the Armed Forces procurement department in my Inbox, while you now find direct contact details for these kind of things online. Not sure what happened, but there sure is a change in how authorities are approaching this.

Re: Interview with German Ventilator Manufacturer

#127

Post by wickedwiesel » Sat, Mar 28, 2020, 2:09 PM UTC

lone_post wrote: post #99

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 has the most ICU beds per capita among all countries. Germany is a close second. https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

Is that still true? These reported numbers for the US are very much outdated. Would love to see a source younger than a decade.

All seem to come from the same sources, a 2009 and a 2012 study. The Forbes article actually mentions an alternative source, an article from 2015 [2] which is actually looking at regional 2000-2009 data. You can also follow the links at Wikipedia [0].

For Germany, there are numbers from 2017: The German Office for Statistics is reported in 2019 28.031 ICU beds which is a rate of 33.7 per 100,000 inhabitants.

EDIT: This [3] WoPo article references data from 2016-2018: 93,000 ICU beds in total in the US. That's about 36 ICU beds per capita (aged 16 or older).

For comparison, Germany, based on the 28031 ICU beds and 70976000 inhabitants 16 or older [4] has 39,49 ICU beds per capita.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...

[1] https://www.sciencemediacenter.de/alle-angebote/fact-sheet/d...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351597/

[3] https://www.washingtonpost.com/business/2020/03/23/map-place...

[4] https://www-genesis.destatis.de/genesis//online?operation=ta...

Re: Interview with German Ventilator Manufacturer

#128

Post by dalai » Sat, Mar 28, 2020, 2:09 PM UTC

lone_post wrote: post #99

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 has the most ICU beds per capita among all countries. Germany is a close second. https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-co...

The number of beds per capita is one thing, how many are free or can be freed in the next few days/weeks is another. At least in Germany it was reported that a lot of them were in use and less than half were available for coronavirus patients.

Re: Interview with German Ventilator Manufacturer

#129

Post by liqu0rice » Sat, Mar 28, 2020, 2:09 PM UTC

eerltjhiou wrote: post #68

pintxo wrote: post #64

Earlier quoted context omitted.

Germany is at 80% though. So not that much difference.

80% versus 95% occupancy while having 5 times more beds can only be explained by Germany using ICU beds when they don't really need it (ie: as regular beds).

Or the UK is using regular beds where an ICU bed would be appropriate...

Re: Interview with German Ventilator Manufacturer

#130

Post by kyrra » Sat, Mar 28, 2020, 2:10 PM UTC

InTheArena wrote: post #119

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."

By reporting, I suspect he means testing, as the actual reporting is working as expected. As for testing the United States did 120k tests yesterday and is accelerating. The CDC test failing really set things back. In terms of ICU beds, for once this is where the us health care system is in reasonable shape. iCU beds are very profitable and we spend way more then Europe on health care, so there is a abundance of them…

By reporting, I believe they mean how many ventilators the US has. See my peer comment to yours that has data from 2010 and 2012, which is the newest the US seems to have.