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

nytimes.com

231–240 of 355 posts

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

#231
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…

I wonder if that decision was optimal for the circumstances, and if not, what actions we could take as a society to improve upon it?

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

#232
post #133

Earlier quoted context omitted.

> I don't think we really need to create more skilled medical professionals, USA has 5 million medical professionals, almost as much medics per capita as Cuba.

Because it is a very, very unhealthy country in normal times.

Nah, we don't have all those doctors for the sick. We have doctors for every type of plastic surgery you can imagine, doctors for aging, doctors for athletic training, doctors that specialize in hips, others in just ankles, also shoulders only, others that only do laser eye surgery, others that only do teeth, some just for gums, some only do tooth implants. And on and on.

There is a shortage of doctors that actually treat sick people.

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

#233

Earlier quoted context omitted.

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 d…

> 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.

No, because after a movie you get to go home, no matter how terrible it was. And in real life you don't get to go home. So you will have to trust in the people that have spent their lives preparing for stuff like this while we, the software smartasses were 'changing the world' with our SaaS toys.

Right now the best programmer is worth less than a mediocre ICU nurse, and that will remain so for a while. Afterwards we can all go back to pretending they don't matter but right now this is how it is.

> 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.

That's a past station in some places.

> What are the other, workable plans you have for people dying in the parking lots of the emergency room?

I don't have any plans. They will die. Because we were too stupid to listen to those sounding the alarm when it mattered.

> 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.

We can decrease it as much as possible by stopping to move around so much. And yet, that seems to be too much to ask. Just now in another thread some religious guy claiming an exception just because the risk was low. I sincerely hope they'll all be fine, I also hope that if they are not that they'll trust their god rather than to hog precious ICU capacity needed by people who were careful and who did not seek this out on purpose.

> 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"....

The ICU staff is working double shifts and around the clock in plenty of places. They too get ill, plenty of them have already died. It's a bit late to stick your oar in now and make it your mission, I totally sympathize with the intentions but this isn't your fight other than to stay put, tell other people to stay put and accept that this story will not have a Hollywood ending for many people.

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

#234

Earlier quoted context omitted.

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 d…

> The only thing I hear is "this won't work" "but what can we do?" "don't you understand that this won't work"....

I find it doubly frustrating because the majority of these are asserted as fact, typically based on flawed reasoning, when what they really are, are estimations/predictions.

If this lack of concern (if not outright disdain) for correctness becomes too prevalent within a society, I worry that it may affect the quality of our decision making.

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

#235

Earlier quoted context omitted.

> [...] 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.

Because the difference between letting someone die under inappropriately-applied ventilation versus just letting someone die is the occupation of a perfectly good ventilator. One that could be used to actually save someone. If you're in the business of killing patients, a gun would be more economical than a ventilator.

I believe there is a third possible outcome that you overlooked.

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

#236

Earlier quoted context omitted.

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 foo…

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

I am genuinely interested in what your suggestion would be though. This is me asking. What would you do to address in the hypothetical I proposed?

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

#237

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?

Has such a survey of doctors actually been performed, that also includes a range of scenarios under which the doctor might have to make such a decision?

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

#238
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…

There is an ophthalmologist/comedian on Twitter @dglaucomflecken with an entertaining, somewhat tongue in cheek feed with similar sentiments (https://twitter.com/DGlaucomflecken/status/12389545581407723...)

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

#239
post #91

Earlier quoted context omitted.

I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a f…

> That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task. This thread isn’t about automating medical professionals responsibilities one…

I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments.

Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this.

Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.

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

#240
post #91

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 believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort. To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a f…

> I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort.

Point of contention is what it seems like to me. There's certainly no shortage of people asserting that point, but what confuses me is, how does everyone know with such high certainty what is or is not possible, when it's never been tried before (afaik)? Has anything even remotely similar been tried before?

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