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

#191

Post by robomartin » Sun, Mar 29, 2020, 11:43 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.

I could no longer edit, so I'll add this. I guess it may have not been obvious from my short post:

My comment has NOTHING to do with business during normal times. Paywalls or subscription forms are OK for that stuff. No problem.

I simply don't think it good citizenship to write COVID-19 articles and lock them behind paywalls or modal subscription forms.

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

#192

Post by blunte » Sun, Mar 29, 2020, 11:48 PM UTC

AdrianB1 wrote: post #93

blunte wrote: post #24

Earlier quoted context omitted.

> somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins Perfectly normal and common in the US low-regulation economic system. > and void the contract Most likely the government officials with the ability to allow this cancelation were bribed, or rather lobbied, to allow it.

It does not look like a regulation problem, but a contract breach: the buyer corporation should be held accountable to execute the contract as agreed, it bought the company with everything - assets and obligations.

The government often makes decisions about companies buying other companies.

If a company has a contract with the government, then the government should have (specified already in the contract, perhaps) the right to prevent the sale of the company (with some specific exceptions).

The primary problem here is that in theory, the government works for the people; but also in theory, the (publicly traded) corporations work for the shareholders.

But yes, even without regulation, the government should have made more effort to enforce the contract. Perhaps the key government people with the power to do so were influenced somehow... But even if the contract had been upheld, there's certainly no guarantee that the new big company would have put their best effort into meeting the original goals of the contract (especially if it was against their "best" (profit) interest).

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

#193

Post by rumanator » Mon, Mar 30, 2020, 12:02 AM UTC

thepangolino wrote: post #185

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…

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.

> Thr absolute worst estimates are between 0.5 and 1 percent of the population dying.

There are news reports right now on HN on how the real death rate on countries that are not falsifying reports might be up to 4 times the assumed rate.

The hypothesis is supported by the increase in total deaths compared with the baseline, and after subtracting deaths linked to covid19.

This being true, we might be looking into 2 to 4% of the population.

Link to the HN thread:

https://news.ycombinator.com/item?id=22723647

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

#194

Post by greedo » Mon, Mar 30, 2020, 12:03 AM UTC

zwily wrote: post #187

greedo wrote: post #184

Earlier quoted context omitted.

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.

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

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

#195

Post by ALittleLight » Mon, Mar 30, 2020, 12:06 AM UTC

omar_a1 wrote: post #146

cycrutchfield wrote: post #115

Earlier quoted context omitted.

> 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.

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 not to bother training amateur operators. If you think an amateur operator is worse than no operator, I'd like to see your evidence. If all you have is your intuition then my intuition is that you're wrong.

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

#196

Post by omar_a1 » Mon, Mar 30, 2020, 12:16 AM UTC

wildmusings wrote: post #180

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?

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 under a competent practitioner.

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

#197

Post by nradov » Mon, Mar 30, 2020, 12:17 AM UTC

Nambia wrote: post #23

toomuchtodo wrote: post #9

Earlier quoted context omitted.

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?

Scuba divers are at ambient pressure and breathe through demand valve regulators. Pressures inside their lungs are almost exactly the same as outside so there's no extra stress.

Increasing pressure with depth does increase work of breathing due to higher gas viscosity. Beyond a certain depth, divers can no longer ventilate enough to take in O2 and remove CO2. This problem can be mitigated to an extent by breathing lower density gasses such as helium. Occasionally hospitals even have patients with severely impaired lung function breathe heliox just to get better gas flow.

In theory it's possible to use a 2nd-stage scuba regulator as an improvised mechanical ventilator by partially blocking the exhaust valve with your hand and pressing the purge button. In practice it's unlikely to work, but if I was trying to rescue someone who had stopped breathing in the water and had no way to get them back to shore or a boat quickly then I might try it as a last-ditch effort.

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

#198

Post by omar_a1 » Mon, Mar 30, 2020, 12:28 AM UTC

ALittleLight wrote: post #195

omar_a1 wrote: post #146

Earlier quoted context omitted.

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.

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, residents, MDs in unrelated specialties - then sure! They actually have the requisite knowlege and manual dexterity to cross-train. But going from, say SWE to ventilator operator, is not a 30 day crash course.

> If you think an amateur operator is worse than no operator, I'd like to see your evidence. If all you have is your intuition then my intuition is that you're wrong.

Because then you end up wasting a life and keeping a ventilator occupied, when there are much more efficient ways to kill patients that don't involve misusing a ventilator.

Former scientist, including (lab side) FDA trials. Medicine is complicated. Even sterile technique, to make sure you don't inadvertently give your patient a life-threatening infection in the process of "helping" them, can take years to get right. This is true of the most routine aspects of any kind of medical work.

But, do tell: since my "intuition" is so obviously wrong, I want to hear all about your empirical research. Or let's just start with your credentials, medical or otherwise.

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

#199

Post by ALittleLight » Mon, Mar 30, 2020, 12:28 AM UTC

ahelwer wrote: post #172

cycrutchfield wrote: post #115

Earlier quoted context omitted.

> 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.

Overconfidence is one class of error. Imagining that a ventilator is a magic machine you can only operate with the sorcerous reagent of a medical degree is another.

Do you know how to operate a ventilator? Why do you think that volunteers couldn't learn to do it?

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

#200

Post by yibg » Mon, Mar 30, 2020, 12:36 AM UTC

jacquesm wrote: post #167

yibg wrote: post #127

Earlier quoted context omitted.

I’m not a medical professional so hopefully someone more knowledgeable and confirm or counter. From what I’m reading the treatment of COVID19 seems to require a pretty narrow set of practices. Mostly around monitoring, administering of medication, ventilation / oxygen and general bedside care. If this is true can we not cross train adjacent areas like EMT, army medics etc fairly quickly to provide care? They don’t ev…

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.