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

#201

Post by Kalium » Mon, Mar 30, 2020, 12:55 AM UTC

ALittleLight wrote: post #186

alxlaz wrote: post #123

Earlier quoted context omitted.

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 betwee…

I've sure you've already considered this, but wouldn't any kind of training program of the sort you describe risk diverting resources from current operations?

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

#202

Post by empath75 » Mon, Mar 30, 2020, 1:00 AM UTC

cycrutchfield wrote: post #65

ALittleLight wrote: post #62

Earlier quoted context omitted.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

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?

That will change when they have 20 times as many patients and the alternative is to let people die alone in the hallways with no help at all.

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

#203

Post by ciceryadam » Mon, Mar 30, 2020, 1:02 AM UTC

In the meantime COVID19CZ created an open source version - https://news.ycombinator.com/item?id=22724130, crowdfunded the first batch of 100 ventilators, and they start producing them in the first week of April

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

#204

Post by SkyPuncher » Mon, Mar 30, 2020, 1:13 AM UTC

greedo wrote: post #194

zwily wrote: post #187

Earlier quoted context omitted.

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

And how does Italy test the flu? In the US, there's minimal flu testing and most of the metrics are based around surveys.

I'm not disagreeing with you. However, at this point, some of the flu estimates are actually inferred/modeled by the CDC.

The flu is a well-enough study disease that they're able to, relatively accurately, model population statistics based on a sub-set of tested patients.

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

#205

Post by ALittleLight » Mon, Mar 30, 2020, 1:16 AM UTC

omar_a1 wrote: post #198

ALittleLight wrote: post #195

Earlier quoted context omitted.

Again, nobody is saying that ventilator boot camp graduates should replace doctors. If there is a concern that there will be more people who need ventilators than we have medical professionals to operate ventilators - then the answer is that we need to quickly increase numbers of ventilator-operators - even if they are substandard. Perhaps you think our capacity won't be overwhelmed. Then it would make perfect sense…

No, it's that I'm aware that "ventilator bootcamps" would be a resounding failure that would kill more people than it saves. Going from zero to medical professional - not a doctor, just someone who can perform invasive medical procedures without killing a large number of people - isn't 30 days of work. Ignoring that reality will recklessly endanger people's lives. If we're talking veterinarians, dentists, nurses, res…

Earlier in this thread it's stipulated that the bottleneck is not the number of ventilators but the trained people to operate them. As such, training more operators is an obvious solution, and allowing the new operators to be substandard will mean we can get more operators faster.

This pretty much dissolves your only real objection, that we'd be keeping a ventilator occupied that would otherwise be in use. Nope. The solution to a deficit of ventilators is producing more - not letting people die without them.

Generally, you are trying to invent reasons and restrictions to make trying to train ventilator-operators seem like a bad idea rather than understanding or advancing how the idea might be viable. An example of this is how you acknowledge that training other medical adjacent professionals (e.g. vetrenarians) would likely work. Great, you agree the idea could work. If you expect that our capacity will be overwhelmed then presumably you think we should training additional operators. Instead of reaching that conclusion you imagine reasons to object to the idea though.

A SWE would likely be worse than a vet after a bootcamp. That's a good reason to have some entry requirements to the bootcamp and those requirements could be relaxed or strengthened depending on where we expect demand to be in 30 days relative to supply. A SWE through a 30-day bootcamp would likely be better than nothing.

The other main constraint you've imagined is that they would need to save more people than they kill to be worthwhile. No, they'd need to save more people than would die without them. If it would be better to just struggle to breathe than have an amateur operator, that would be an argument against them.

Your credentials, whatever they are, haven't equipped you to clearly communicate your reasons for opposing this idea. As I mentioned, it seems like you actually support some version of it.

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

#206

Post by ALittleLight » Mon, Mar 30, 2020, 1:20 AM UTC

Kalium wrote: post #201

ALittleLight wrote: post #186

Earlier quoted context omitted.

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 betwee…

I've sure you've already considered this, but wouldn't any kind of training program of the sort you describe risk diverting resources from current operations?

It's possible. That's something that would have to be weighed against how bad we expect shortages to be and how much we expect amateur ventilator-operators to help.

Given that we likely have more spare doctor cycles now than we will in the future, we should utilize them now. We can also do things like hire doctors from countries not as badly stressed to come teach the classes.

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

#207

Post by omar_a1 » Mon, Mar 30, 2020, 1:23 AM UTC

ALittleLight wrote: post #205

omar_a1 wrote: post #198

Earlier quoted context omitted.

No, it's that I'm aware that "ventilator bootcamps" would be a resounding failure that would kill more people than it saves. Going from zero to medical professional - not a doctor, just someone who can perform invasive medical procedures without killing a large number of people - isn't 30 days of work. Ignoring that reality will recklessly endanger people's lives. If we're talking veterinarians, dentists, nurses, res…

Earlier in this thread it's stipulated that the bottleneck is not the number of ventilators but the trained people to operate them. As such, training more operators is an obvious solution, and allowing the new operators to be substandard will mean we can get more operators faster. This pretty much dissolves your only real objection, that we'd be keeping a ventilator occupied that would otherwise be in use. Nope. The…

I'm sorry, I still haven't seen your empirical research and relevant credentials.

So, to be clear, you can blindly assert that sending incompetent pseudo-medics to perform invasive procedures will be beneficial, and assert that claim with absolute certainty and zero evidence.

But when I explain that, no, medicine is more complicated than you think, and back that up with concrete examples of how that is factually accurate, it's purely imagined. What a quaint little world you must live in.

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

#208

Post by jacquesm » Mon, Mar 30, 2020, 1:34 AM UTC

yibg wrote: post #200

jacquesm wrote: post #167

Earlier quoted context omitted.

So, just to reset your mental image of what a typical ventilator ICU setup looks like (don't click if you're squeamish): https://pbs.twimg.com/media/EUNYuOuU4AApgBX?format=jpg&name=... Still want to gamble on that 'narrow set of practices'?

Is that the typical setup for covid icu patients though? I imagine ventilators are used for all sorts of patients, some requiring much more involved care.

That's about as simple as it gets. This is a pediatric ICU ward, I just wanted a picture that shows you the essentials. It can get much more complex than that and not a whole lot simpler. Once you are intubated you are kept sedated (it's not exactly a pleasant experience) so you rely 100% on the world around you for your vitals and needs. Essentially you are in a controlled coma for the duration with all the difficulties that brings.

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

#209

Post by jacquesm » Mon, Mar 30, 2020, 1:39 AM UTC

SkyPuncher wrote: post #178

jacquesm wrote: post #147

Earlier quoted context omitted.

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…

There are exactly 6 known instances of talk down landings that I'm aware of. All concerned general aviation and in one of them the person had prior flight experience. Several of those ended in a crash. A general aviation plane is in no way comparable to a large airliner, and no instance of such a landing has ever been recorded, nor has it been attempted.

Life is not a movie, some stuff is just hard and requires a long time of training before we'll let you go 'solo'. One mistake and someone ends up dead, there are no do-overs, there is no undo button.

The last thing ICU's need right now is on top of all the stress already going on there to be overrun by eager rookies that are trying to help.

The best we can do - and this is happening in some places - is to move up the training schedule and to graduate ICU nurses early. This is need for several reasons: to man the extra ICU capacity that is coming online and to take the place of those who have died or can't take it anymore due to psychological stress.

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

#210

Post by marnett » Mon, Mar 30, 2020, 2:10 AM UTC

omar_a1 wrote: post #196

wildmusings wrote: post #180

Earlier quoted context omitted.

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…

> Yes, people in this thread are letting the perfect be the enemy of the good No, it's because medicine has a very low fault tolerance, and requires a large body of technical knowledge to even understand what needs to happen for your patient. Having a team of incompetent clinicians perform complicated medical procedures "good" as a layperson still results in disproportionate people dying, that would have survived und…

> [...] would have survived under a competent practitioner.

Bringing us back to the topic of this thread, a potential lack of competent practitioners if the pandemic worsens, and what the best solution to address this would be, such as a COVID-specific ventilator training.