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The U.S. tried to build a new fleet of ventilators

nytimes.com

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Re: The U.S. tried to build a new fleet of ventilators

#111

Post by joe_the_user »

SkyPuncher wrote: post #97
oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

The question in a lot of ways is how many exponential doublings do we have to have before this situation switches in peoples' minds from a peace-time inconvenience to essentially real war.

Right now, the death rate still isn't higher than a flu epidemic but just the number of known infections promises a lot worse and the potential doublings after that are terrifying.

It seems like there's an endless dialogue of:

A: How would you accomplish X? B: I wouldn't, X is not what I do.

But we need to give the final answer: A: I didn't ask whether you can do X. I'm telling you, "do X or many people die, you are all we have at this point. Think outside the box".

Re: The U.S. tried to build a new fleet of ventilators

#112

Post by No1 »

SkyPuncher wrote: post #97
oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

> Given how medicine works, the chances of actually seeing this in action are low.

This has already been happening in Lombardy according to an account I read about two weeks ago.

Re: The U.S. tried to build a new fleet of ventilators

#113

Post by SkyPuncher »

lukevp wrote: post #7

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft e…

My wife is a doctor (I am not). I've been following COVID closely and discussing with her/peers. I'm not an expert (but feel I have an above average understanding, thanks to my wife)

> I see a lot of DIY posts that are probably not 100% the same thing but are they even close?

I have yet to see (though I haven't looked extensively) a DIY ventilator that has the fine tune control many doctors are suggesting are required for COVID patients.

My understanding is most of the DIY vents are comparable to emergency or transport vents. They'll keep a patient breathing for minutes/hours until they can be transferred to a proper ventilator. After a short period of time, you really need to transfer a patient to a proper ventilator to continue to support life.

Two big challenges with COVID patients in particular:

* They require ventilation for DAYS or even weeks. Over durations of that long, you really need precise control over a vent. A tech analogy is using floating point numbers for finance. Over a small number of transactions, a floating point number may be sufficient. Over time, though, the inaccuracies of floating point numbers will become apparent.

* Many COVID patients needing ventilation also have Acute Respiratory Distress Syndrome (ARDS). The simple explanation is their lungs are functioning so poorly that you can't simply stuff oxygen into them and hope it works. You need to be extremely particular with how you control breathing.

* Bonus, related to point two, many doctors are reporting using pretty crazy ventilation settings as a baseline. They're basically overclocking a CPU/GPU by default then hoping they can keep overclocking as CPU/GPU load increases (not fully accurate, but it's an analogy).

Re: The U.S. tried to build a new fleet of ventilators

#114

Post by SkyPuncher »

No1 wrote: post #112
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

> Given how medicine works, the chances of actually seeing this in action are low. This has already been happening in Lombardy according to an account I read about two weeks ago.

Sorry, I should have been more specific.

Given how American medicine works, I see challenges with this approach.

Re: The U.S. tried to build a new fleet of ventilators

#115

Post by cycrutchfield »

roenxi wrote: post #100
cycrutchfield wrote: post #85

Earlier quoted context omitted.

Ah yes, you surely know better than the trained professionals about how to best run an ICU. Just because you can call yourself a software engineer with little more than a high school diploma doesn’t mean that the same rules apply for doctors.

Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker. Medicine has traditionally had a problem with a large number of very clever people who are…

> If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker.

Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.

Re: The U.S. tried to build a new fleet of ventilators

#116

Post by joe_the_user »

AlexCoventry wrote: post #106
joe_the_user wrote: post #104

Earlier quoted context omitted.

If only there were a nation, so far unaffected by the virus, with a large number of skilled medical professionals willing to travel to other countries and help. I'm sure if such a place existed, the US would be negotiating right now to get a supply of such medical professionals. And certainly wouldn't be sabotaging that country's ability to aid other countries /s. https://en.wikipedia.org/wiki/Healthcare_in_Cuba

Where can I read more about those sabotage attempts?

"US pressures countries to reject Cuban aid during coronavirus pandemic"

https://morningstaronline.co.uk/article/w/us-pressures-count...

Re: The U.S. tried to build a new fleet of ventilators

#117

Post by amanaplanacanal »

throwawaynerdy wrote: post #53
blunte wrote: post #10

Earlier quoted context omitted.

This story, if accurate, is simply an illustration of how low-regulation capitalism works. "Working as intended." Profit is the only motive, and thus as long as the company/investors profit, then it is a success. The fact that national or global human well-being suffered is irrelevant (so long as we accept that capitalism (as currently implemented) is the right way). Now, there's a strong likelihood that the governme…

Government patents and the heavily regulated medical cartels = capitalism? Not to be a Communist when I say "not real capitalism", but it seems there's no pro capitalism political party in the US.

The Republicans certainly give lip service to it but both parties seem more corporatist than anything else.

Re: The U.S. tried to build a new fleet of ventilators

#118

Post by baybal2 »

SkyPuncher wrote: post #97
oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

> I don't think we really need to create more skilled medical professionals,

USA has 5 million medical professionals, almost as much medics per capita as Cuba.

Re: The U.S. tried to build a new fleet of ventilators

#119

Post by SkyPuncher »

saurik wrote: post #103
SkyPuncher wrote: post #97

Earlier quoted context omitted.

> It’s much harder to ramp up production of medical professionals. I have a mixed opinion on this. In particular, I don't think we really need to create more skilled medical professionals, we just need to change the way they work. Most of doctors have exposure to the basics of intubating and ventilation through medical school. Those without direct critical care experience would likely be absolutely terrible at it. Ho…

I now don't remember where I saw this, nor can I find it... but I swear I had seen something in the past week or two comparing how much retraining different medical professions needed to quickly get useful for staffing ventilator technology, and veterinarians came out on top; so like, people are (unless I dreamth this?!) looking into reusing people.

Veterinarians make sense. The ones that do surgery already know how to run vents on animals. Humans are a form of animal, after all.

Re: The U.S. tried to build a new fleet of ventilators

#120

Post by joe_the_user »

cycrutchfield wrote: post #108
joe_the_user wrote: post #99

Earlier quoted context omitted.

It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory. Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited. It…

Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.

In a huge medical emergency, when people essentially desperately pleading for a ramp-up of the effectiveness of medical personnel, it's kind of mind-boggling that the only answer you're giving is sneering at how little the layman knows (and yeah, that seems like a standard answer doctor in the US are going give).

And, yeah, maybe I know little of what exactly ICU processes are but it seems indeed implausible that there are no intermediate levels of skills that are the slightest bit helpful, just about physical task can aided by a "third hand" etc.

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