The U.S. tried to build a new fleet of ventilators • Hacker News Board

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

#141

Post by cm2187 » Sun, Mar 29, 2020, 9:39 PM UTC

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…

If you repeat the same task 20 times a day you rapidly become an expert at it. If all the patients have exactly the same condition I would assume that the staff would quickly upskill to treat that condition.

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

#142

Post by Mediterraneo10 » Sun, Mar 29, 2020, 9:41 PM UTC

joe_the_user wrote: post #111

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…

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: H…

"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."

The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be a killer, etc.

Therefore, I would expect this to continue to be considered more of a peacetime inconvenience than a real war. A frequent response to this is, "But they could overwhelm the healthcare system so you or me couldn't be treated for our needs!" Well, if the bulk of the population is left inconvenienced and unemployed for too long, I can imagine some ugly scenarios where the population demands, broadly speaking, that those demographics simply be triaged out of treatment so that they don't overwhelm the healthcare system for everyone else. This is said to be already happening in Italy to a degree.

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

#143

Post by read_if_gay_ » Sun, Mar 29, 2020, 9:42 PM UTC

cm2187 wrote: post #141

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…

If you repeat the same task 20 times a day you rapidly become an expert at it. If all the patients have exactly the same condition I would assume that the staff would quickly upskill to treat that condition.

The subject matter is probably a bit more complex than “repeating the same task 20 times a day” even if it’s the same condition fundamentally.

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

#144

Post by jacquesm » Sun, Mar 29, 2020, 9:42 PM UTC

cm2187 wrote: post #141

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…

If you repeat the same task 20 times a day you rapidly become an expert at it. If all the patients have exactly the same condition I would assume that the staff would quickly upskill to treat that condition.

Typical for tech oriented people to look at it this way. Patients with the same condition are still meatware and each has the capacity to develop their own variation on a large number of themes all of which require adaptations in treatment regime and sometimes very rapid intervention lest you lose a patient.

Your assumption doesn't hold.

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

#145

Post by cm2187 » Sun, Mar 29, 2020, 9:42 PM UTC

Does anyone know the survival probability of a covid-19 patient once he requires the assistance of a ventilator? I have heard people mention it is fairly low but haven’t seen any figure on that.

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

#146

Post by omar_a1 » Sun, Mar 29, 2020, 9:43 PM UTC

cycrutchfield wrote: post #115

roenxi wrote: post #100

Earlier quoted context omitted.

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.

Obviously because being an ICU doctor isn't something hard like writing code. Fewer buttons on a ventilator! /s

But seriously, the amount of people on here trivializing modern medicine isn't helping matters.

Granted, neither is business-as-usual, but a 30-day "ventilator boot camp" for untrained professionals is going to kill far more people than it helps. And a poor allocation of resources during a time of scarcity.

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

#147

Post by jacquesm » Sun, Mar 29, 2020, 9:45 PM UTC

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…

You just asked a person qualified to give you their professional opinion and then you turned around and more or less completely undercut that professional opinion.

You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery. Just like you don't want a front-ender doing back-end or systems work you don't want your psychiatry residents to operate an ICU.

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

#148

Post by jacquesm » Sun, Mar 29, 2020, 9:45 PM UTC

SkyPuncher wrote: post #119

saurik wrote: post #103

Earlier quoted context omitted.

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.

That's a better idea, also, veterinarians tend to be much more all-round.

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

#149

Post by amelius » Sun, Mar 29, 2020, 9:47 PM UTC

ALittleLight wrote: post #74

cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing. Regarding whether doctors would want undertrained help - tha…

Also vets could help out if necessary, as they are trained to use ventilators.

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

#150

Post by empath75 » Sun, Mar 29, 2020, 9:47 PM UTC

Mediterraneo10 wrote: post #142

joe_the_user wrote: post #111

Earlier quoted context omitted.

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: H…

"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." The millions of people who would die in a worst-case scenario are mainly demographics that society is already used to neglecting: the elderly, the terminally ill, those with lifelong chronic illnesses where any infection could be…

That’s not true. Once you start getting into the tens of millions of deaths worldwide, that’s going to include a lot of young people and medical staff and people who will die of other treatable diseases or injuries because half of the doctors in the country are sick or otherwise occupied.