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

#171

Post by SkyPuncher » Sun, Mar 29, 2020, 10:22 PM UTC

cadlin wrote: post #162

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…

Doctors that don't know how to properly operate a vent are currently a problem in the US. Not blaming them, as there doesn't seem to be any real alternative. Here's an /r/medicine discussion of it. https://www.reddit.com/r/medicine/comments/fr0x3m/how_do_you...

I don't think you can pick a single /r/medicine thread as evidence of a widespread problem. My wife and every other doctor to ever practice medicine can give you anecdotal examples of other doctors mismanaging patients.

Another thing to consider is this is a rapidly changing/progressing disease and there are no standards. The opinion of a recently graduated fellow has different biases than an experienced attending. They can both be correct while disagreeing on the specifics.

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

#172

Post by ahelwer » Sun, Mar 29, 2020, 10:24 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.

lol this whole thread reminds me of the first time I dated a medical resident, carrying myself with similar confidence seen here, and quickly realized (after pissing them off with intensely ignorant statements a few times) I knew absolutely goddam nothing about medicine and how the human body works.

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

#173

Post by mhb » Sun, Mar 29, 2020, 10:30 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.

Indeed. I was organizing some people to make face shields and was looking for a big room. When I talked to the city about using a school gym, one of the criteria was that everyone needed to have background checks. Because it would be in a school!

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

#174

Post by Erwin » Sun, Mar 29, 2020, 10:30 PM UTC

robomartin wrote: post #79

Lateral comment: I am starting to hate publishers who produce COVID-19 articles and post them behind a paywall or registration form.

Media are suffering at least in this country. Not much interest in buying ads these days.

If the newspapers get more people to pay for their stories, they will have to fire the journalist hard at work on the Corona stories.

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

#175

Post by db48x » Sun, Mar 29, 2020, 10:32 PM UTC

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…

They're really not very complicated; the requirements can be written out in a few pages. I'd say they're a bit more complicated than your fridge, but a lot less complicated than a car. Generally the primary barrier to entry for manufacturing medical devices is not their complexity but the onerous requirements of certification by the FDA. On the whole that's a good thing, since it means that properly certified medical devices are rarely built by fly-by-night organizations that disappear once they have your money.

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

#176

Post by lucretian » Sun, Mar 29, 2020, 10:36 PM UTC

cm2187 wrote: post #145

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.

it's not good.

in on study, 24/26 of pts with non-invasive mech ventilation and 31/32 of pts with invasive ventilation died.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

note that the study demographics were skewed to the more vulnerable cohorts (avg age = 56, range = 46-67, 62% male, 48% with a comorbidity).

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

#177

Post by mhb » Sun, Mar 29, 2020, 10:37 PM UTC

appleshore wrote: post #20

I always criticized the idea that “radical technology could exist but the competition buys it up” as a naive conspiracy theory. It’s pretty remarkable that the government paid for this but somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins, and void the contract.

Another line of inquiry to pursue would be why it took the government five years from canceling the Covidien contract to ordering ventilators from Philips.

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

#178

Post by SkyPuncher » Sun, Mar 29, 2020, 10:39 PM UTC

jacquesm wrote: post #147

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…

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 psych…

> Just like you don't want a front-ender doing back-end or systems

This is not the argument I'm making though. That implies the front dev has no oversight.

I'm making the argument that a frontend development can successfully complete features with the guidance/oversight of a backend dev. The results might not be ideal, but it can provide an acceptable outcome.

----

> You need the experience and you need the detailed instruction. That's why there are certification programs around the operating of complex healthcare machinery.

These programs are focused on developing individuals who can robustly and independently manage this complex machinery.

Should we also discredit airline pilots because laypeople have landed planes in emergencies? Or discredit sports professionals because many can kick a ball?

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

#179

Post by greedo » Sun, Mar 29, 2020, 10:45 PM UTC

joe_the_user wrote: post #160

Mediterraneo10 wrote: post #142

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." 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…

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. People imagining such triaging seem to think that a willingness to be appalling brutal means such brutality could be achi…

The death rate is in no ways comparable to the seasonal flu. It's quite higher:

https://ourworldindata.org/coronavirus#case-fatality-rate-of...

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

#180

Post by wildmusings » Sun, Mar 29, 2020, 10:48 PM UTC

romanows wrote: post #41

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…

I wonder how long it would take to teach someone to be more help than harm? After 30 intensive days of training, what would candidates lack?

Yes, people in this thread are letting the perfect be the enemy of the good. Everyone knows that doctors are overqualified for the vast majority of tasks they are responsible for. Normally, there's good reason for this, because you want a highly-trained eye to spot unusual and atypical cases.

But when you're dealing with a pandemic, you can do without. Do you really think that your typical doctor spent all that much time in med school or residency learning how to operate a particular kind of machinery? If we have the ventilators, we'll be able to find people to operate them.