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

#41

Post by romanows » Sun, Mar 29, 2020, 7:49 PM UTC

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…

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?

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

#42

Post by throwawaynerdy » Sun, Mar 29, 2020, 7:49 PM UTC

dTal wrote: post #6

m0xte wrote: post #2

I’ve always said that governments should use our tax money to design and validate key health and infrastructure components and only outsource manufacturing and only to local businesses. Governments are so utterly broken and inefficient that they can’t do it. However even if they produced a design now we have supply chain problems globally. Edit: I seem to have stirred up capitalist defence here. To clarify: The gover…

Have you considered that maybe broken inefficiency is not necessarily a property of governments in general? The local optimum might be to avoid having the government do things, but the global optimum is to fix your government.

If you look at history, I'm not sure it's possible for a government to get better. I'm not aware of any historical examples. Revolution can happen, but that means a new government.

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

#43

Post by pdonis » Sun, Mar 29, 2020, 7:49 PM UTC

neffy wrote: post #34

pdonis wrote: post #22

Earlier quoted context omitted.

> Why should hospital X buy 100 ventilators...just in case Well, of course. That's what we're talking about, right? Somebody has to do the long-term planning for emergencies like this one. I understand that most of us thought it was the government's job to do this long-term planning so individual facilities wouldn't have to, but this article shows that the government failed at that job. Unless we have some reason to…

But private entities can't do it, because the market forces them not to - those that the spend the money will be out-competed in the short term by those that don't.

> private entities can't do it, because the market forces them not to

Private entities don't have to be subject to the market. Someone like Bill Gates or Elon Musk could set up a privately owned company, not publicly traded, that would not be subject to investors' demands for consistent quarterly growth. Matter of fact, maybe that's what Bill Gates should switch his attention to from malaria.

The fact is, a private individual, or a small group of them, can have a longer time horizon than the government does, and a longer time horizon is exactly what is needed for something like this.

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

#44

Post by pdonis » Sun, Mar 29, 2020, 7:50 PM UTC

maxerickson wrote: post #38

pdonis wrote: post #18

Earlier quoted context omitted.

But the government agreed to cancel the contract at the big company's request. I don't see how the deliverable being the design instead of the ventilator itself would have changed that.

Sure. If I had a government slush fund to develop a low cost ventilator, I would try to structure the payments in the contract to be based on milestones with concrete deliverables. Not a tenuous agreement to buy a bunch of ventilators at below market price (it's implied in the article that the sales to the stockpile wouldn't justify the project for the company). There's of course a possibility that the government wro…

> There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened.

Why do you doubt that?

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

#45

Post by VectorLock » Sun, Mar 29, 2020, 7:50 PM UTC

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…

I've been wondering if there is any way to improve this as well. Say we get the new ventilators but now we're short on people. You can't overnight train nurses, but can you get people just enough training for this specific task? Is there any inefficiencies in the process of dealing with these patients that can be improved? Can some of these tasks be delegated to less experienced people who can be trained quickly, while the processes that need in depth knowledge and experience can still be performed by the qualified health care workers?

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

#46

Post by onetimemanytime » Sun, Mar 29, 2020, 7:51 PM UTC

pdonis wrote: post #22

onetimemanytime wrote: post #15

Earlier quoted context omitted.

Why should hospital X buy 100 ventilators...just in case, unless the gov made them do it?

> Why should hospital X buy 100 ventilators...just in case Well, of course. That's what we're talking about, right? Somebody has to do the long-term planning for emergencies like this one. I understand that most of us thought it was the government's job to do this long-term planning so individual facilities wouldn't have to, but this article shows that the government failed at that job. Unless we have some reason to…

The government failed here but they are the only ones that can really prepare. A pandemic is as much as a threat as USSR, Bin Laden was, or China is, so just as they have these billion dollar planes they should prepare for Covid like situations.

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

#47

Post by pdonis » Sun, Mar 29, 2020, 7:51 PM UTC

worik wrote: post #40

pdonis wrote: post #37

Earlier quoted context omitted.

> If the government had done it in house they could have succeeded. Ok, so how do we get the government to do it in house, and stick to it long enough so that the stockpile is there when the next disease crisis happens, which might not be for another 10 years? That's five Congressional elections and at least two changes of Presidential administration.

Government is not congress, or a president. It is civil servants beavering away.

> Government is not congress, or a president. It is civil servants beavering away.

The civil servants work on what Congress and the President set as priorities. They cannot execute plans that span multiple Congresses and Presidential administrations unless every single Congress and Administration over that time period agrees to support the plan.

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

#48

Post by cycrutchfield » Sun, Mar 29, 2020, 7:52 PM UTC

romanows wrote: post #41

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…

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.

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

#49

Post by m0xte » Sun, Mar 29, 2020, 7:54 PM UTC

pdonis wrote: post #5

maxerickson wrote: post #3

Earlier quoted context omitted.

I wonder how that project would have gone had the design been the deliverable instead of ventilators. It wouldn't necessarily have been trivial for another company to pick the design up and produce it, but it would have been possible.

> I wonder how that project would have gone had the design been the deliverable instead of ventilators. The big company that bought the small one would simply have claimed that the design was their intellectual property and nobody else could build it.

There is no big or small company, just a government registered design and companies who can produce it if requested.

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

#50

Post by toomuchtodo » Sun, Mar 29, 2020, 7:54 PM UTC

lukevp wrote: post #33

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.

What’s the limiting factor there? The pressure regulation, pressure production, measurement accuracy? There’s open source ECUs that measure dozens of sensors at 1000hz+ and keep an engine perfectly timed using a $35 raspberry pi. Is this problem harder somehow?

Validation and quality assurance in my opinion.