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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

#181

Post by joe_the_user »

greedo wrote: post #179
joe_the_user wrote: post #160

Earlier quoted context omitted.

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...

Indeed,

If you read my parent post in context, I hope it's clear that I mean currently in Italy, people are not dying at a rate higher than the seasonal flu BUT this has a big potential change if the infection rate were to shoot up (we know this is prevented by extreme quarantine measures, enforced by the army).

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

#182

Post by greedo »

bamboozled wrote: post #94
ALittleLight wrote: post #74

Earlier quoted context omitted.

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…

You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of. Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chanc…

It's not the age of the pilot or doctor, but the experience. In WW2, some pilots were considered combat capable after 150 hours of flight time, basically 6 months. They died. Eventually the flight programs ended up taking 1.5-2 years on average to crank out a new pilot. A pilot that also died quickly.

Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad pilots only kill themselves, they don't kill patient after patient through malpractice.

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

#183

Post by URSpider94 »

cycrutchfield wrote: post #48
romanows wrote: post #41

Earlier quoted context omitted.

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?

About 4 years of medical school, and around 4 more years of residency training.

Doctors don’t run ventilators. Respiratory therapists do. A respiratory therapy degree is a 2-year associates degree that includes basic training on physiology and biology. I’m betting that someone with an undergraduate degree in biology could learn the role in a few months of intensive training.

Doctors would still be responsible for reviewing the care protocol and making decisions on treatment, but one doctor could oversee many respiratory therapists, each caring for many patients.

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

#184

Post by greedo »

joe_the_user wrote: post #181
greedo wrote: post #179

Earlier quoted context omitted.

The death rate is in no ways comparable to the seasonal flu. It's quite higher: https://ourworldindata.org/coronavirus#case-fatality-rate-of...

Indeed, If you read my parent post in context, I hope it's clear that I mean currently in Italy, people are not dying at a rate higher than the seasonal flu BUT this has a big potential change if the infection rate were to shoot up (we know this is prevented by extreme quarantine measures, enforced by the army).

Your point still isn't clear or accurate. The worldwide CFR is over 4%. In Italy, it's currently at over 11%. The flu is nowhere near that level of risk. It's normally around 0.1% depending on demographic. Are you saying that the seasonal flu in Italy normally kills 11% of those who become infected? If that's the case, the facts don't bear that out.

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

#185

Post by thepangolino »

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…

I don’t think there’s going to be a mindset change in the population. The absolute worst estimates are between 0.5 and 1 percent of the population dying.

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

#186

Post by ALittleLight »

alxlaz wrote: post #123
ALittleLight wrote: post #74

Earlier quoted context omitted.

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…

I'm not an MD but I've had contact, on-and-off, with mission-critical equipment in the energy sector (according to my university I'm an EE but I was cleverly disguised) and then I've worked in the medical equipment industry for a few years. I would be very, very surprised if the parent comment(s) weren't correct. Training, no matter how intensive, is no substitute for education. Getting nurses, doctors from other spe…

I fully expect that a person who has only thirty days training will be worse than a professional and their relative incompetence will kill people. I don't understand how that is an argument against the plan to train volunteers though.

I'm reading that hospitals may be overwhelmed. I understand that to mean there will be more people requiring intensive care than capacity to give intensive care. If the choice is between the hospital sending people who need ventilators off to die and sending them to someone with thirty days of training and good intentions... Well, my intuition is that you'd have better outcomes with the latter.

The point is not "can we do this without killing people." Nope. More people will die with amateur ventilator-operators than professionals. What I'm suggesting is that more people will die without amateur ventilator-operators in the event hospitals are overwhelmed.

If we think hospitals are going to be overwhelmed in thirty days then the time to start training amateur ventilator-operators is now.

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

#187

Post by zwily »

greedo wrote: post #184
joe_the_user wrote: post #181

Earlier quoted context omitted.

Indeed, If you read my parent post in context, I hope it's clear that I mean currently in Italy, people are not dying at a rate higher than the seasonal flu BUT this has a big potential change if the infection rate were to shoot up (we know this is prevented by extreme quarantine measures, enforced by the army).

Your point still isn't clear or accurate. The worldwide CFR is over 4%. In Italy, it's currently at over 11%. The flu is nowhere near that level of risk. It's normally around 0.1% depending on demographic. Are you saying that the seasonal flu in Italy normally kills 11% of those who become infected? If that's the case, the facts don't bear that out.

But the CFR is mostly just a function of how many people get tested, no? And Italy seems to only be testing at hospitalization.

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

#188

Post by hiram112 »

onetimemanytime wrote: post #126
verytrivial wrote: post #82

Earlier quoted context omitted.

The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.

Technically I should provide a citation and searched, but couldn't find it. I'm almost certain that I've read that wayyy more than 50% (prob 70% die) once placed on ventilator. Maybe because those ending there are already with one foot+ on the grave. The ventilator can save,say 30%, and also make us feel good "we did all we could," after all, we will all reach that point one day ;)

There is a small study / report released with 32 patients in Wuhan who were put on ventilators. 31 died.

I have not been able to find any larger case reports. Though on Tucker Carlson a few nights ago, a doctor on the front lines in NYC was interviewed and gave a similar report: If you reach the point of intubation and ventilation, the chances of survival is quite low.

A lot of these stats now coming out are going to be harder and harder to interpret going forward, regardless of the true numbers, as the media twists things around for their own political purposes. If ventilators turn out to be not the difference between life and death, even according to the raw stats, the media who wants to use lack of ventilators to blame one political party or another for the incompetency, isn't likely to tell the truth anyway.

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

#189

Post by hiram112 »

ohbleek wrote: post #87
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…

This conversation begins when the number of residencies increases. And that will not change until congress approves more funding for residencies. Until then, there will be no change.

Is it Congress making this decision, or the lobbyists for the AMA?

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

#190

Post by robomartin »

Erwin wrote: post #174
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.

Here's the fallacy with what you are saying:

Click-through-rates are not going to increase because people signed-up for a free account with an email address. Greater revenue comes from greater traffic. Simple as that. If every time I see an interesting link from the NY Times and try to read it I am hit with a modal subscription request, well, very soon I just stop clicking NY Times links.

The other side of that is paid subscription to these newspapers-turned-web-news outlets. My guess is this is a bad (or let's just say, non sustainable) approach. If these outlets had to survive on paid web subscriptions they would likely shrink severely or evaporate. There's a reason for which television can still garner massive audiences. Imagine if every single TV channel demanded a subscription or registration.

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