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

nytimes.com

221–230 of 355 posts

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

#221

Earlier quoted context omitted.

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 accu…

As the contrarian, can you at least enlighten us to what, in your opinion, would be the best strategy to proactively address potential bottlenecks? I think we can all agree, career shaming aside, that medical professionals and engineers of all varieties actively participate in mindsets geared towards problem solving. So in a hypothetical situation, where existing permanent healthcare infrastructure is at capacity, fi…

I fail to see how explaining that, "Yes, you need to know medicine to practice medicine, or people will die" is considered being contrarian. Would you rather just revel in ignorance?

So here's my idea: stop treating invasive medical procedures as something that can be trivially learned in a short amount of time. In short, drop the God complex. You're out of your depth here.

The need for action doesn't mean acting foolish. Irrational behavior in the name of "just doing something" will needlessly deplete more resources.

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

#222
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 think some European countries have tried to deploy Dermatoloists and Gynecologists, etc s into ER in the present scenario after a training course.

Some medical students also could be utilised, if there is acute shortage, perhaps.

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

#223
post #216
post #81

Earlier quoted context omitted.

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first. But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definit…

Curious what your SO thinks of this... If a health care worker has a positive test and no or mild symptoms, seems to me they could sleep alongside COVID patients and continue to treat just fine? Save a lot on PPE while you’re at it. A lot of workers would prefer that, rather then being quarantined at home where they will infect their families.

There's talk along those lines. Not sure what they've settled on? Keep in mind, they don't really know how crowded these facilities are gonna get. Space may be at a premium. But yeah, at the same time going home is not always the best idea.

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

#224
post #216
post #81

Earlier quoted context omitted.

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first. But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definit…

Curious what your SO thinks of this... If a health care worker has a positive test and no or mild symptoms, seems to me they could sleep alongside COVID patients and continue to treat just fine? Save a lot on PPE while you’re at it. A lot of workers would prefer that, rather then being quarantined at home where they will infect their families.

Patients are continuing to emit more viruses as they breathe and cough. Put enough viral load into the health care worker and they'll be in just as bad shape as the patient regardless of how naturally resistant they are.

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

#225

Earlier quoted context omitted.

> 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 lon…

Life is not a movie, some stuff is just hard ...

I think this sort of language is why a lot of non-professionals are sort-of balking. Life currently is like a movie. A zombie or some similar disaster movie, a situation where things are changing fast, where the normal plans are expected to fail.

...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.

We are talking about a situation, coming up in X many days, when it won't be a matter of the authorities "letting" people try but a matter of the entire health system being overwhelmed. What are the other, workable plans you have for people dying in the parking lots of the emergency room? And yeah, this is a different world, one where we expect people to end up dead and we're asking how to decrease that are much as possible.

This horrible movie is the consensus of most projections. The question is not "could we deal with this? Can we play doctor, please!" but rather "how should we best deal with an ongoing disaster where we're assured, the doctors will be gone. Surely there's something one could beside 'die in place'?".

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.

If the ICUs have a different, workable plan for when they are overrun with a massive number of patients, I'll be tremendously happy. The only thing I hear is "this won't work" "but what can we do?" "don't you understand that this won't work"....

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

#226

Earlier quoted context omitted.

We believe many things to be true, that are not true. And not only do we believe them, we passionately defend them! I don't think many of us would recommend writing software on top of such uncertainty, yet we seem to think it's possible to do so with a society and economic system. Then we're surprised when it blows up in our faces every decade or so. The surprised Pikachu meme seems fitting. EDIT: To those who disagr…

Not voted in any way, but I cannot figure out what you tried to tell and how that would contribute to this discussion.

The short answer is, much of what we believe, both individually and collectively, is simply incorrect. In this case, my perception is that a person believed something to be untrue due to the idea having been labelled a conspiracy theory, and then after reading this story, he was less confident in the belief.

Generalized, we might state this as: the perception of high accuracy in our beliefs is illusory. Not only does this occur at the individual level, but also at the group level (see: religion, Trump supporters, etc)

I then compared that to the manner in which different people exhibit "unexpected" differences in insistence in accuracy/quality across different domains, demonstrating that the inner workings of this behavior can be counter-intuitive at times.

In light of this ongoing global pandemic, I am curious whether this "illusion of truth" phenomenon that psychologists suggest occurs within human consciousness may possibly have been a contributing factor to some of the perceived shortcomings involved in our response.

For example, as I understand it, Donald Trump seemed to believe that this pandemic was not terribly important, and the result of this was that the response from the United States government was slower than it could have been.

Similarly, prior administrations, I'm not sure going how far back, were also aware of the possibility and consequences of the outbreak of a global pandemic. It would have been possible at that time to make a significant permanent investment in nationwide infrastructure for stockpiling critical supplies, but for specific reasons not known to any of us, it seems like very few countries went forward with such an initiative. Not only in the United States, but many other countries.

Generally, I think it's fair to say that historic decisions related to pandemic response were less than optimal. Assuming this is true, it seems reasonable to speculate that a misunderstanding of risk was a contributing factor to the imperfect responses.

If we take a hypothetical example of two different countries, one with a brash, super confident leader, and the other with a much more restrained, cautious leader, one who is naturally distrustful of casual optimism and a culture of "don't worry about it", might these two leaders have had different perceptions of risk, and as a result made different decisions and taken different approaches, both during and in the years before an actual outbreak occurred?

I believe this is possible, and also that the magnitude of the difference may be significant, depending on the circumstances

And if that scenario is possible, might this phenomenon also occur in other domains, and if so, what might the plausible range of possible consequential variances look like?

Take the Iraq war as an example. Might it be possible that errors in perception of risk were a contributing factor in the decision to go forward with the war? Using a similar example to the one above, might a leader or society that insisted on a higher standard of certainty and trustworthiness of evidence have made a different choice on whether to proceed with a war? And if so, might this have had an effect on the amount of money spent as well as the number of casualties? I suspect that if the Iraq war did not take place, both cost and casualties would be significantly lower than they were under the scenario that actually did play out.

So what? Well...if we made better decisions, might we realize better outcomes? This seems both plausible and potentially significant to me.

If one assumes this is true, a question arises in my mind: should we perhaps consider collectively exerting additional effort towards the goal of making better decisions, and what are some of the things we could do in an effort to achieve that?

To be clear, I'm not suggesting we do such a thing at this particular point in time, and I'm certainly not insisting we do it. It's mostly just an idea I've had knocking around in my head for a while.

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

#227

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…

Maybe I'm the first to bring up this comparison, but don't people deliver babies incidentally all the time (couldn't make it in time to the hospital, etc.) An event where I'm sure some would say only a doctor is qualified to handle it. And yet we still do what we have to.

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

#228
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…

Do you have any idea how long it took your wife to learn to achieve the level of skill she is at? Let's say this was WW3, and we somehow lost 75% of these specialized personnel, what would be a ballpark estimate to get a reasonably intelligent person with no medical experience up to a "functional" level?

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

#229
post #173

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. 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…

An empty school, at that.

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

#230

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…

Maybe I'm the first to bring up this comparison, but don't people deliver babies incidentally all the time (couldn't make it in time to the hospital, etc.) An event where I'm sure some would say only a doctor is qualified to handle it. And yet we still do what we have to.

Childbirth is a bodily function that the species is biologically predispositioned to perform. It will happen whether a doctor is present or not, to say nothing of the numerous possible complications. Ventilation is not a comparable analogy here.
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