GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization(bloomberg.com)
bloomberg.com
GM’s CEO Offers to Make Ventilators in WWII-Style Mobilization
https://www.bloomberg.com/news/articles/2020-03-18/kudlow-says-gm-ceo-offered-to-make-ventilators-for-outbreak
563 comments
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It already does a lot of inflexible manufacturing, often by outsourcing overseas, but I'd love to see part of the US military converted to a rapid-response, highly flexible, fully-domestic manufacturing system. LOTS of very flexible automation, so they could take a wide range of designs and raw materials and rapidly switch from making one thing to making another and the ability to hugely ramp up production on demand without having to retrain people or recertify facilities. The people involved would be trained to set up for a different product every couple of weeks or so.
The system could be kept almost constantly humming, making one thing, switching and certifying, making another, switching and certifying, keeping them pre-trained, tested, and certified. The military itself has an ongoing need to rapidly adapt to new situations, but things are needed domestically for planned infrastructure, sudden large-scale destruction from earthquake/fire/flood/tornado disasters, sudden economic changes (ex: some sort of trade cutoff), strategic domestication (ex: immediately end reliance on some import), round-robin top-off of local emergency prep supplies, individual citizen preparedness supplies, etc.
The system could be kept almost constantly humming, making one thing, switching and certifying, making another, switching and certifying, keeping them pre-trained, tested, and certified. The military itself has an ongoing need to rapidly adapt to new situations, but things are needed domestically for planned infrastructure, sudden large-scale destruction from earthquake/fire/flood/tornado disasters, sudden economic changes (ex: some sort of trade cutoff), strategic domestication (ex: immediately end reliance on some import), round-robin top-off of local emergency prep supplies, individual citizen preparedness supplies, etc.
This is literally what the military is now. Under the berry amendment a lot of what the military buys needs to be 100% domestic. A significant fraction of military spending is to ensure that the logistics are in place in case of a greater need in the future, not just to fulfill current needs and training, or any specific mission.
This is a great 99PI podcast about the US Army Natick center, which develops military rations.
https://99percentinvisible.org/episode/war-and-pizza/
Part of the mission is to develop the technology and then commercialize it. Now you have a number of factories that are capable of switching into ration production if the need arises.
Things like powdered cheese, condiment packets, and retort packaging came out of this research.
https://99percentinvisible.org/episode/war-and-pizza/
Part of the mission is to develop the technology and then commercialize it. Now you have a number of factories that are capable of switching into ration production if the need arises.
Things like powdered cheese, condiment packets, and retort packaging came out of this research.
Off-topic, but my podcast list has been so enriched through reading HN comment. Thanks for the link.
Same reason there are rules about ships going between US ports been manufactured in the US - to keep strategic ship building capacity in the event of a war.
That well meaning law means there’s one cruise ship that fits the requirements, all the others visit one foreign port. https://en.wikipedia.org/wiki/Pride_of_America
It looks like the cargo ship law, Jones Act, is more successful in creating capacity.
It looks like the cargo ship law, Jones Act, is more successful in creating capacity.
Even then, it took a special exemption from Congress since it was towed to and finished in Germany after the initial company filed bankruptcy.
> Norwegian Cruise Line Ltd acquired the unfinished ship and was towed to Germany for completion as Pride of America for their newly launched NCL America division. > A special exemption on the part of the U.S. government allowed the modified, mostly German-built ship to attain U.S. registry. [1] https://en.wikipedia.org/wiki/Pride_of_America
> Norwegian Cruise Line Ltd acquired the unfinished ship and was towed to Germany for completion as Pride of America for their newly launched NCL America division. > A special exemption on the part of the U.S. government allowed the modified, mostly German-built ship to attain U.S. registry. [1] https://en.wikipedia.org/wiki/Pride_of_America
The Jones act is a complete failure. https://www.cato.org/publications/policy-analysis/jones-act-...
I was going to say: surely the US military maintains a manufacturing core?
I’m a metal fabricator by trade, and one thing you quickly notice is: with a machine shop and a fabrication shop you are tooled up to build the machines to manufacture almost anything.
I’m a metal fabricator by trade, and one thing you quickly notice is: with a machine shop and a fabrication shop you are tooled up to build the machines to manufacture almost anything.
Folks, military physician here, operating at the national level on the analysis that informs these projects. The recent post on HN about the MIT $100 ventilator is one of the things that got this rolling.
Manufacturing is spinning up. What I really need is developers on this project:
https://github.com/joshua-s/coronavirus-diary
Manufacturing is spinning up. What I really need is developers on this project:
https://github.com/joshua-s/coronavirus-diary
Josh you should put a call to action on the repo. There are no issues listed. I don't see links to anywhere that would let me help listed on the readme.
How can I contact you?
There is an app already in use in the Netherlands. They are field testing at scale and releasing better versions twice a day. Next monday it will be distributed to all hospitals and most citizens. Dutch PBS prime time news had a 5 minute documentary on the app yesterday March 18th.
There is an app already in use in the Netherlands. They are field testing at scale and releasing better versions twice a day. Next monday it will be distributed to all hospitals and most citizens. Dutch PBS prime time news had a 5 minute documentary on the app yesterday March 18th.
From the README file on the coronavirus-diary:
Coronavirus Diary is a mobile application that allows users to record their medical status, location, and activities to an encrypted vault on their device. If the user experiences symptoms in line with the disease, they will be prompted to contact their physician.
In the case that a user contracts the disease, they can release their historical data to a physician to aid in treatment, research, and containment effort.
Coronavirus Diary is a mobile application that allows users to record their medical status, location, and activities to an encrypted vault on their device. If the user experiences symptoms in line with the disease, they will be prompted to contact their physician.
In the case that a user contracts the disease, they can release their historical data to a physician to aid in treatment, research, and containment effort.
There are a lot of software projects spinning up -- how do we know that this one is going to see active use?
As an example for my concern -- I've had a consistently-updated pull-request[1] outstanding for the JHU data repository for more than a week. It is their prerogative not to pull, but it means my contribution is largely wasted.
The coronavirus-diary project has one contributor, no issues, and no pull requests.
[1]https://github.com/CSSEGISandData/COVID-19/pull/296
As an example for my concern -- I've had a consistently-updated pull-request[1] outstanding for the JHU data repository for more than a week. It is their prerogative not to pull, but it means my contribution is largely wasted.
The coronavirus-diary project has one contributor, no issues, and no pull requests.
[1]https://github.com/CSSEGISandData/COVID-19/pull/296
OP here (and no, I'm not josh). We need the project to get from 1 to 2 to 10 to N. That 1 to 2 bit is hard. Please, push a bit.
JHU is bandwidth-constrained. Put your effort where it can have effect.
JHU is bandwidth-constrained. Put your effort where it can have effect.
What help do you need?
- testers?
- docs?
- code reviews?
Need more developers:
* security engineer
* iOS engineer
* Android developer
* Dart engineers
* Flutter developers
* Engineers with health industry experience
* backend infrastructure
* backend security
Goal: 1-2 months to MVP deployment. Maybe sooner if people pile on.
* security engineer
* iOS engineer
* Android developer
* Dart engineers
* Flutter developers
* Engineers with health industry experience
* backend infrastructure
* backend security
Goal: 1-2 months to MVP deployment. Maybe sooner if people pile on.
Wow...really? A MIT project with HN post is what kicked this off. As in...no one thought of this until then?
welcome to the information age, where even the top brass can't make sense of it all and consequences will never be the same
Machine shops are Turing complete. You can use a machine to fabricate the machine you are using.
Very few are. Making ball bearings, for example, requires very special machines that no regular shop has.
...but you can make machines in machine shops, as pointed out above. or machines to make machines, if needed.
or in the simpler case you might fall back to scraped and oiled ways and bushings
or in the simpler case you might fall back to scraped and oiled ways and bushings
'Their Optical Section performs optical alignment on shafting, masts, and other equipment.'
That's me! Norfolk Naval Station is just one shipyard in the area. There are similar yards with all of the same equipment. BAE/Colanna/NASSCO/NNSY/Lyons/ECSR. It's the same story in San Diego, Pascagula, Jacksonville, Hawaii.
That's me! Norfolk Naval Station is just one shipyard in the area. There are similar yards with all of the same equipment. BAE/Colanna/NASSCO/NNSY/Lyons/ECSR. It's the same story in San Diego, Pascagula, Jacksonville, Hawaii.
Cool!
That's the cleanest link I came across to illustrate the point. I think people forget how much end-to-end manufacturing capability the military retains (especially the Navy), even in these days of outsourced procurement pressure.
That's the cleanest link I came across to illustrate the point. I think people forget how much end-to-end manufacturing capability the military retains (especially the Navy), even in these days of outsourced procurement pressure.
Required to buy from USA manufacturers for nearly every thing. There are a substantial number of small shops supporting the US Navy.
This should be distributed geographically, meaning the pork could be spread around, meaning it is remotely possible to pass.
I love this idea. Non-wartime competition with contractors.
Manufacture of medical devices has specific regulation around Good Manufacturing Processes [1] (GMP, one of many GxPs). This requires a Quality Management System [2] (QMS) and very specific training for everyone involved. Pretty much any manufacturer that is not already manufacturing in accordance with 21 CFR Part 820 [3] and related regulations will have a ton of work to establish a suitable QMS.
I'd like to think that at least some auto workers already have some taste of working under the eye of regulators and auditors and as such their adjustment to GMP has the potential to be smooth. The days of leaving empty beverage containers in the hollow of a door are long past, right?
Management that is not experienced in FDA regulations will try to ignore or short-cut them. In the best of cases, this turns into fines and manufacturing delays. In the worst of cases, it turns into deaths due to defective product or manufacturing delays. Every level of management needs to be experienced in GxP.
The most reasonable path to getting a QMS in place and having compliant manufacturing would seem to be to have the manufacturing capacity be leant to an established manufacturer that has a solid QMS, the expertise to adapt it to the new reality, and a solid relationship with the FDA. That is, the auto manufacturer's management would need to be out of the picture or 100% subservient to the experienced medical device manufacturer.
Once that is worked out, I suspect that manufacture of the devices is comparatively easy. Put another way, it's probably easier to switch from sedans to tanks than it is to switch from SUVs to almost any medical gizmo.
1. https://en.wikipedia.org/wiki/Good_manufacturing_practice 2. https://en.wikipedia.org/wiki/Quality_management_system 3. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFR...
I'd like to think that at least some auto workers already have some taste of working under the eye of regulators and auditors and as such their adjustment to GMP has the potential to be smooth. The days of leaving empty beverage containers in the hollow of a door are long past, right?
Management that is not experienced in FDA regulations will try to ignore or short-cut them. In the best of cases, this turns into fines and manufacturing delays. In the worst of cases, it turns into deaths due to defective product or manufacturing delays. Every level of management needs to be experienced in GxP.
The most reasonable path to getting a QMS in place and having compliant manufacturing would seem to be to have the manufacturing capacity be leant to an established manufacturer that has a solid QMS, the expertise to adapt it to the new reality, and a solid relationship with the FDA. That is, the auto manufacturer's management would need to be out of the picture or 100% subservient to the experienced medical device manufacturer.
Once that is worked out, I suspect that manufacture of the devices is comparatively easy. Put another way, it's probably easier to switch from sedans to tanks than it is to switch from SUVs to almost any medical gizmo.
1. https://en.wikipedia.org/wiki/Good_manufacturing_practice 2. https://en.wikipedia.org/wiki/Quality_management_system 3. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFR...
I think you are a bit confused about the position the country is in right now.
Regulations and regulators can and will be damned in an emergency.
Of course, all reasonable precautions should be taken when producing medical equipment. But if someone needs a ventilator, they are going to die without it. It doesn't matter that there is a small chance that complications arise or some flaw in the ventilator causes it not to work correctly. They would have died without the ventilator in nearly 100% of cases.
Like many regulations right now, they will be temporarily suspended within reason.
Regulations and regulators can and will be damned in an emergency.
Of course, all reasonable precautions should be taken when producing medical equipment. But if someone needs a ventilator, they are going to die without it. It doesn't matter that there is a small chance that complications arise or some flaw in the ventilator causes it not to work correctly. They would have died without the ventilator in nearly 100% of cases.
Like many regulations right now, they will be temporarily suspended within reason.
Sure, the regulatory regime needs to be relaxed to quickly bring on more manufacturing capacity. I believe it will be. Throwing it out entirely and allowing anybody to manufacture and sell medical devices from their garage is not going to happen.
That being said, auto manufacturers likely have no experience manufacturing these devices. The don't know which optimizations will be dangerous. They may not recognize they are doing anything different from an experienced manufacturer.
When quality breaks down, it will be important to have appropriate records to know which other devices are also defective so that they can be replaced, repaired, or used with appropriate caution. If manufacturing is still ongoing, corrective action in the manufacturing plant will be needed. GxP regulations require this type of record keeping for very good reason.
An experienced manufacturer will be needed to get manufacturing going and to supervise it to ensure it has an acceptable level of quality. Even if the experienced medical device manufacturer has legal indemnity, failures of the temporary factory could stain its reputation. I find it unlikely that any reputable medical device manufacturer would want to take on supervision of an inexperienced workforce in an unproven facility without the force of the regulation they are accustomed to as a means to force behavior that they know leads to predictable outcomes. Surely, experienced members of a quality organization and the FDA will figure out how to right-size some of the practices called for by regulation.
That being said, auto manufacturers likely have no experience manufacturing these devices. The don't know which optimizations will be dangerous. They may not recognize they are doing anything different from an experienced manufacturer.
When quality breaks down, it will be important to have appropriate records to know which other devices are also defective so that they can be replaced, repaired, or used with appropriate caution. If manufacturing is still ongoing, corrective action in the manufacturing plant will be needed. GxP regulations require this type of record keeping for very good reason.
An experienced manufacturer will be needed to get manufacturing going and to supervise it to ensure it has an acceptable level of quality. Even if the experienced medical device manufacturer has legal indemnity, failures of the temporary factory could stain its reputation. I find it unlikely that any reputable medical device manufacturer would want to take on supervision of an inexperienced workforce in an unproven facility without the force of the regulation they are accustomed to as a means to force behavior that they know leads to predictable outcomes. Surely, experienced members of a quality organization and the FDA will figure out how to right-size some of the practices called for by regulation.
> Throwing it out entirely and allowing anybody to manufacture and sell medical devices from their garage is not going to happen.
The situation we are in is the same as a doctor doing an emergency tracheotomy in a restaurant using a pen sterilized with some gin. No one really wonders what the serial number is of that pen or whether it was made with the high quality requirements of surgigcal equipment.
The machines produced in a mobilization shouldn't even be compared with those produced in peacetime. They should be compared to nothing at all. So when the question arises "is this device safe"? The relevant answer is "well this patient is dying on a stretcher in a tent next to a thousand others like him, so we'll use it".
It follows that it's important that these devices are either destroyed or quality certified after the fact. These can't be used in five years in during a routine surgery, of course.
The situation we are in is the same as a doctor doing an emergency tracheotomy in a restaurant using a pen sterilized with some gin. No one really wonders what the serial number is of that pen or whether it was made with the high quality requirements of surgigcal equipment.
The machines produced in a mobilization shouldn't even be compared with those produced in peacetime. They should be compared to nothing at all. So when the question arises "is this device safe"? The relevant answer is "well this patient is dying on a stretcher in a tent next to a thousand others like him, so we'll use it".
It follows that it's important that these devices are either destroyed or quality certified after the fact. These can't be used in five years in during a routine surgery, of course.
If GM makes 10,000 ventilators and they all turn out defective, that could be worse then never making the ventilators at all.
GM won't make ventilators. They'll make plastic parts, hoses, valves etc. It's not that GM couldn't pivot to building something else, but they can't do that within weeks. They can probably start churning out metal or plastic parts whose speciifcations can be verified by the ventilator manufacturer before they are assembled into one of their ventilators.
I'm hoping that what they are asking car manufacturers to do is allow the medical industry to use their equipment (e.g. plastic molding equipment) to supply parts that either can't be sourced at all because of the crisis, or can't be supplied in the volumes needed.
I'm hoping that what they are asking car manufacturers to do is allow the medical industry to use their equipment (e.g. plastic molding equipment) to supply parts that either can't be sourced at all because of the crisis, or can't be supplied in the volumes needed.
Correct, this is also why we can skip animal trials for vaccine development but not human trials.
A vaccine that is supposed to be deployed across the board will affect many millions of people and if even a minuscule issue exists we may cause way more harm than good!
The situation is dire and we need fast countermeasures but regulations exist for a reason. This is about health & safety after all.
A vaccine that is supposed to be deployed across the board will affect many millions of people and if even a minuscule issue exists we may cause way more harm than good!
The situation is dire and we need fast countermeasures but regulations exist for a reason. This is about health & safety after all.
A vaccine is given to healthy people. A drug that is given to a small number of people that are so sick that they will die within days and there is no other cure, has different safety requirements from a vaccine that is given to a huge number of people that are healthy. In the vaccine case, even a relatively rare (1/10000) side effect might mean that the vaccine is worse than the cure. Not so with the treatment of dying people.
Safety wise, using untested equipment is the same as the drug for dying people scenario, not the vaccine scenario.
A similar example is this: in normal circumstances these devices are operated by ICU doctors. In a time of crisis you can already see this delegated to doctors that have never used a ventilator, and only given a brief introduction or even just a pamphlet describing it.
I suspect that within the next months there will be places where recently trained nurses perform the duties of ICU doctors. And laid off hotell staff perform nursing duties.
> regulations exist for a reason. This is about health & safety after all.
They do, but most regulations are surprisingly flexible in a crisis. E.g. already the rest time requirements for truck drivers are lifted in many countries to keep supply lines.
In the military (where a crisis is planned for) there are two different sets of safety requirements, with a stricter one that only applies in peacetime (e.g. max speeds, minimum distances bewteeen vehicles, requirements to use ear protection and pretty much every single safety requirement there is)
Safety wise, using untested equipment is the same as the drug for dying people scenario, not the vaccine scenario.
A similar example is this: in normal circumstances these devices are operated by ICU doctors. In a time of crisis you can already see this delegated to doctors that have never used a ventilator, and only given a brief introduction or even just a pamphlet describing it.
I suspect that within the next months there will be places where recently trained nurses perform the duties of ICU doctors. And laid off hotell staff perform nursing duties.
> regulations exist for a reason. This is about health & safety after all.
They do, but most regulations are surprisingly flexible in a crisis. E.g. already the rest time requirements for truck drivers are lifted in many countries to keep supply lines.
In the military (where a crisis is planned for) there are two different sets of safety requirements, with a stricter one that only applies in peacetime (e.g. max speeds, minimum distances bewteeen vehicles, requirements to use ear protection and pretty much every single safety requirement there is)
> That being said, auto manufacturers likely have no experience manufacturing these devices. The don't know which optimizations will be dangerous. They may not recognize they are doing anything different from an experienced manufacturer.
Given that this is a crisis, the existing ventilator manufactures need to send over a couple experienced ventilator engineers to help.
Given that this is a crisis, the existing ventilator manufactures need to send over a couple experienced ventilator engineers to help.
And open source all their blueprints, schematics and software.
Getting a supply chain for parts up and running is going to be the tricky part.
Getting a supply chain for parts up and running is going to be the tricky part.
Producing safe medical devices is about more than just schematics. It is a social process with people having a huge impact on how safe the result is. All the blueprints in the world have no value if you don’t know whether they’ve been followed and the materials used are correct. And when there are defects you need to have socialized how people are to respond to those defects or your not building a competent organization. I see many comments about blueprints on here that miss the point. It’s like saying your software product is just the source code. The reality is that you have to build a competent knowledgeable organization around those blueprints or what you’re making will kill or injure patients.
I agree that we are in a unprecedented situation but I am not sure that the regulations will just be “damned”.
Liability will be damned.
If there's a military requisition of ventilators, the government alone sets the standards and quality. And the government alone gets to complain about violations. Maybe it wants ISO 9000, but I imagine they'll take 1960s class ventilators if they can be ready by a date certain.
You, citizen, can sue the government and allege that the MASH ventilator spec was reckless and deprived you of your constitutional rights. And you will be laughed out of court at ISO 9000 levels. With few exceptions, soldiers don't get sued for shooting people with guns, and battlefield surgeons don't commit malpractice.
If there's a military requisition of ventilators, the government alone sets the standards and quality. And the government alone gets to complain about violations. Maybe it wants ISO 9000, but I imagine they'll take 1960s class ventilators if they can be ready by a date certain.
You, citizen, can sue the government and allege that the MASH ventilator spec was reckless and deprived you of your constitutional rights. And you will be laughed out of court at ISO 9000 levels. With few exceptions, soldiers don't get sued for shooting people with guns, and battlefield surgeons don't commit malpractice.
Just to add to this: We don't put pilots in jail for shooting down an enemy aircraft. In an extreme case, we cannot file a lawsuit for mistakenly launching nuclear missiles because of miscommunication - war would have ensued.
I think people are too hung up on the societal fabric, daily life and normal circumstances that when an emergency arrives at your doorstep, you're too clumsy, too weak and too ignorant of what the reality demands.
I think people are too hung up on the societal fabric, daily life and normal circumstances that when an emergency arrives at your doorstep, you're too clumsy, too weak and too ignorant of what the reality demands.
I am with you but the issue with medical devices and therapeutics is that if at least a base set of regulations is not followed than a potentially corrupt fix to the Corona virus (e.g. faulty vaccine) may introduce a lot of health issues and harm on a scale even higher than Corona just by itself.
That's how it's an emergency when regulations are ignored. If everyone's following regulations and life is as usual -- it's not an emergency
Honestly, you're spitting the truth... and I don't understand why people don't understand this point?
There is a really simple to solution to this: the government limits prices and mandates based on how badly the regulation is skirted. Basically limit profit so it matches the dubious use-value. (Neither utility nor profit is actually linear wrt units produce, but just smart about that and know your adversary.)
Maybe GM could be renting space and manpower to a ventilator manufacturer?
This should apply to the vaccine testing protocols too.
We cannot wait for 18 months for a vaccine.
We cannot wait for 18 months for a vaccine.
I think there is way too much potential for unintended consequences in relaxing vaccine development regulations. The Cutter Incident in the 50s was a turning point on this: during the race to market a polio vaccine, 120k doses were produced that actually contained the live virus, infecting thousands and causing additional outbreaks.
https://en.m.wikipedia.org/wiki/Cutter_incident
https://en.m.wikipedia.org/wiki/Cutter_incident
It seems that in time of actual crisis, we're all libertarians.
Well, maybe we're (almost) all pragmatists.
I have pretty libertarian impulses. I'm pretty pleased to see a lot of pointless (or point-light) regulations get kicked to the curb, although I certainly wish the circumstances weren't necessary.
I also hate immigration restrictions of all sorts. But... okay, right now, travel restrictions make some sense. I'll take it (and then fight to undo them in 12 months).
It turns out, some of the things I really really care about, my preferences would do harm in a pandemic. Maybe that's true outside of a pandemic, too -- but it's a lot easier to recognize when the magnitude of the effect is large!
I think at the end of the day, that's part of what's driving all this pragmatism: the effect size of "getting policy right" is suddenly much larger than it usually is. Life is no longer close to being a zero-sum game, and everybody can see it. That's what "we're all in this together" means, and people are acting like they believe it.
I have pretty libertarian impulses. I'm pretty pleased to see a lot of pointless (or point-light) regulations get kicked to the curb, although I certainly wish the circumstances weren't necessary.
I also hate immigration restrictions of all sorts. But... okay, right now, travel restrictions make some sense. I'll take it (and then fight to undo them in 12 months).
It turns out, some of the things I really really care about, my preferences would do harm in a pandemic. Maybe that's true outside of a pandemic, too -- but it's a lot easier to recognize when the magnitude of the effect is large!
I think at the end of the day, that's part of what's driving all this pragmatism: the effect size of "getting policy right" is suddenly much larger than it usually is. Life is no longer close to being a zero-sum game, and everybody can see it. That's what "we're all in this together" means, and people are acting like they believe it.
Personally I’m in favor of a (partially) centrally planned emergency economy manufacturing and distributing (and possibly rationing) medical equipment, pharmaceuticals, personal protective gear, antiseptics, etc. where needed around the country; paying for medical costs of anyone who catches COVID19; directly disbursing cash to residents who are quarantined, isolated, or lose their jobs during the crisis; banning evictions, doing whatever possible to delay personal/small business expenses like rent or loan payments; directly hiring large numbers of young people without dependents to do socially necessary jobs like distributing food to quarantined people or tracing contacts of anyone infected or manning phone hotlines to call people who don’t follow mass media and to screen patients before they talk to medical personnel; forcing media outlets to play regular publicly produced informational content and shutting down media outlets spreading misinformation; and so on..
I would hardly call that libertarian, but YMMV.
I would hardly call that libertarian, but YMMV.
I've designed medical devices. They're not rocket science. Yes, being tolerant of a single-point-of-failure is important, but not in this climate. Military should cut through fines. And as for lives, they just need to be more safe than not having a ventilator. You don't put a healthy patient on a ventilator.
I think if 10,000 come out which kill people, that's a problem, but it's not a particularly hard one to catch. If 10,000 come out where 1% kill people, that wouldn't pass any sort of bar in normal times, but these are not normal times. That's much better than not having them at all.
I think if 10,000 come out which kill people, that's a problem, but it's not a particularly hard one to catch. If 10,000 come out where 1% kill people, that wouldn't pass any sort of bar in normal times, but these are not normal times. That's much better than not having them at all.
Wonderful. I'd rather have an unregulated ventilator and maybe live than no ventilator and die for sure.
You're overlooking additional options like "The patient would have survived without a ventilator, but one was used to improve their condition and it turned out it was a defective GM ventilator because who needs regulations"
Also "the ventilator was fine but 12 months later it's still in service - who's going to throw out a working ventilator? - and now it's killing people because who needs regulations"
You can't just throw out all the regulations. "Any treatment" is not better than No Treatment. You have to identify which regulations are appropriate to discard in the situation - many, sure, but not all. You wouldn't want someone 3D printing your ventilator with materials that will off-gas toxic fumes and kill you when you would have survived (barely) without the ventilator...
Also "the ventilator was fine but 12 months later it's still in service - who's going to throw out a working ventilator? - and now it's killing people because who needs regulations"
You can't just throw out all the regulations. "Any treatment" is not better than No Treatment. You have to identify which regulations are appropriate to discard in the situation - many, sure, but not all. You wouldn't want someone 3D printing your ventilator with materials that will off-gas toxic fumes and kill you when you would have survived (barely) without the ventilator...
> You can't just throw out all regulations
It needs to be emphasized over and over that this is a national emergency. Think "War". Would you rather have a surgeon operate your wounded brain matter with rusted implements or watch you die?
When youre living in a city where every hotel, every gymnasium and every school is full of ill people going through pneumonia - I am sure you would change your mind.
Another way to think is - if COVID-19 had a mortality rate of 100%, and R0 of 3; what would you do about regulations? We are lucky this virus isn't as deadly as Ebola (50% CFR) and as contageous as measles (R0 6-7). If there is death to humanity looming in the future, that's the virus its waiting for a human contact in some bat cave. What regulations then?
It needs to be emphasized over and over that this is a national emergency. Think "War". Would you rather have a surgeon operate your wounded brain matter with rusted implements or watch you die?
When youre living in a city where every hotel, every gymnasium and every school is full of ill people going through pneumonia - I am sure you would change your mind.
Another way to think is - if COVID-19 had a mortality rate of 100%, and R0 of 3; what would you do about regulations? We are lucky this virus isn't as deadly as Ebola (50% CFR) and as contageous as measles (R0 6-7). If there is death to humanity looming in the future, that's the virus its waiting for a human contact in some bat cave. What regulations then?
Medical devices have a lower fault tolerance and higher need for traceability because manufacturing defects mean lost lives.
In your example using rusty tools for brain surgery is a good analogy, as it highlights the false dichotomy you've created. A surgeon could also potentially stabilize you for long enough to search for less obviously deadly impliments. Or decide that, rusty tools or not, you're too far gone to help, and divert their attention to people who have a fighting chance.
Emergency doesn't mean we abandon common sense and decide rogue medicine is the only way forward. Even during a time of war, you'd need your tanks to operate as intended, not randomly fire or seal off the interior so tightly it causes suffocation.
This isn't fiddling with your laptop's inner workings. Medicine has a high enough need for precision that doing it poorly, or even forgetting one minor, necessary step in the process will cause more death and suffering than if you had just sat on your hands. The tight regulations are there for a reason. That doesn't mean we need bureaucracy for sake of bureaucracy, but some skeleton regulatory infrastructure will need to be observed for manufactuers efforts to save more lives than it loses.
Rogue medicine is a waste of resources and lives that will only serve to make this situation worse, as will unreliable medical devices.
In your example using rusty tools for brain surgery is a good analogy, as it highlights the false dichotomy you've created. A surgeon could also potentially stabilize you for long enough to search for less obviously deadly impliments. Or decide that, rusty tools or not, you're too far gone to help, and divert their attention to people who have a fighting chance.
Emergency doesn't mean we abandon common sense and decide rogue medicine is the only way forward. Even during a time of war, you'd need your tanks to operate as intended, not randomly fire or seal off the interior so tightly it causes suffocation.
This isn't fiddling with your laptop's inner workings. Medicine has a high enough need for precision that doing it poorly, or even forgetting one minor, necessary step in the process will cause more death and suffering than if you had just sat on your hands. The tight regulations are there for a reason. That doesn't mean we need bureaucracy for sake of bureaucracy, but some skeleton regulatory infrastructure will need to be observed for manufactuers efforts to save more lives than it loses.
Rogue medicine is a waste of resources and lives that will only serve to make this situation worse, as will unreliable medical devices.
Unfortunately the ventilator alone is insufficient. You also need a medical team to administer it, and they may choose not to expose themselves to the liability of using a ventilator of unknown provenance.
I’m not a doctor but in this setting it seems that letting you die of a disease is much more palatable than killing you in an attempt to treat it.
I’m not a doctor but in this setting it seems that letting you die of a disease is much more palatable than killing you in an attempt to treat it.
No one cares about any of this stuff. Rules need to be tossed aside to minimize loss of life. All FDA rules surrounding drugs need to be suspended for COVID19 patients. We need to start doing what china did and start using non approved anti-virals to save people's lives.
We need to start vaccinating at risk populations(75 or older) with the trial vaccine if it is shown to be effective in the upcoming weeks. We cant wait a year.
We need to start vaccinating at risk populations(75 or older) with the trial vaccine if it is shown to be effective in the upcoming weeks. We cant wait a year.
Woah there. Don't be so hasty to throw out the baby with the bathwater.
Don't need another Thalidomide dropped on us just because things are looking a bit grim. It's one thing to ask "Do we really need to let this stand in our way right now?"; It's an entirely different kettle of fish to say "Screw it, if it kills the virus anything goes!"
Don't need another Thalidomide dropped on us just because things are looking a bit grim. It's one thing to ask "Do we really need to let this stand in our way right now?"; It's an entirely different kettle of fish to say "Screw it, if it kills the virus anything goes!"
>Woah there. Don't be so hasty to throw out the baby with the bathwater.
Agreed. I may absolutely hate the documentation I have to complete as a microbiologist in a GMP company, but there is a reason for it. I just wish that GMP wasn't filled with so much BS. The parent comment here is being ridiculous and deserves to be argued against.
Agreed. I may absolutely hate the documentation I have to complete as a microbiologist in a GMP company, but there is a reason for it. I just wish that GMP wasn't filled with so much BS. The parent comment here is being ridiculous and deserves to be argued against.
So when given a choice to a 65 year old to die or take an unapproved drug. We should let them die. We are going to run out ventilators and will ration them. Our hospitals are already at capacity. Italy is at 8% mortality rate and climbing. We need to do anything to cut icu rate and spread. Virus is showing long term effects even in children. Known long terms issues is worse than hypothetical issues. Cautious thinking is why western civilization has failed to contain the virus.
>So when given a choice to a 65 year old to die or take an unapproved drug.
Did not say that. Allow them to elect to take the drug, however, we still need to follow up, and keep track of the outcomes. Data is critical to avoid outcomes where we end up dropping bombs on houses to put out the housefire. Again, see Thalidomide.
>We are going to run out ventilators and will ration them.
Likely. I also believe that there should be a much greater tolerance allowed for expediting supply chains to make components for new ones; but data is also key. A fabrication method that results in immediate complications needs to have a quickly followed audit trail to ensure remedial action can take place quickly to minimize additional harm. That doesn't mean you can't compromise on some non or less critical tolerances while you're at it.
>Virus is showing long term effects even in children.
Noted, let's try not to add onto that by releasing something untested that causes severe side-effects as well.
>Known long terms issues is worse than hypothetical issues.
Difference: the known long term issues from the virus alone would happen with or without intervention in some portion of the population. Long term issues that arise as a complication via treatment would not happen except that weren't diligent enough.
Many of the GxP's are, in fact, written in blood. I'm fine with getting adventurous and experimenting, but we need to be tracking outcomes so interventions can take place at the first sign of trouble too.
It isn't easy. Quality never is. There is a damn good reason for you to put in the extra work to make it happen regardless.
Did not say that. Allow them to elect to take the drug, however, we still need to follow up, and keep track of the outcomes. Data is critical to avoid outcomes where we end up dropping bombs on houses to put out the housefire. Again, see Thalidomide.
>We are going to run out ventilators and will ration them.
Likely. I also believe that there should be a much greater tolerance allowed for expediting supply chains to make components for new ones; but data is also key. A fabrication method that results in immediate complications needs to have a quickly followed audit trail to ensure remedial action can take place quickly to minimize additional harm. That doesn't mean you can't compromise on some non or less critical tolerances while you're at it.
>Virus is showing long term effects even in children.
Noted, let's try not to add onto that by releasing something untested that causes severe side-effects as well.
>Known long terms issues is worse than hypothetical issues.
Difference: the known long term issues from the virus alone would happen with or without intervention in some portion of the population. Long term issues that arise as a complication via treatment would not happen except that weren't diligent enough.
Many of the GxP's are, in fact, written in blood. I'm fine with getting adventurous and experimenting, but we need to be tracking outcomes so interventions can take place at the first sign of trouble too.
It isn't easy. Quality never is. There is a damn good reason for you to put in the extra work to make it happen regardless.
Yeah, I'm personally not too concerned with the "stuff" end of things. This is America; in spite of rhetoric to the contrary, we remain a manufacturing powerhouse. Apply enough money and we'll get whatever "stuff" we need on pretty short order.
I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at. Perhaps the military could provide medical technicians the fastest? lots of healthy young people who are trained in the use of serious PPE? (I wonder how the procedures differ between nuclear, chemical and biological threats like these?)
People talk about beds... but the problem isn't physical beds. I could make you a physical bed. the problem is doctor and medical technician labor to make the bed useful.
I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at. Perhaps the military could provide medical technicians the fastest? lots of healthy young people who are trained in the use of serious PPE? (I wonder how the procedures differ between nuclear, chemical and biological threats like these?)
People talk about beds... but the problem isn't physical beds. I could make you a physical bed. the problem is doctor and medical technician labor to make the bed useful.
The problem is threefold. We need: 1. ventilators 2. PPE 3. healthcare personnel (respiratory therapists). In the short term we should train existing doctors, physician assistants, and nurse practitioners in respiratory therapy ASAP. But without PPE they put themselves at risk, and without ventilators the patient may die anyway.
We need all three, and there's a worldwide shortage. That is the bottleneck.
We need all three, and there's a worldwide shortage. That is the bottleneck.
I'm not questioning the need. I'm just saying that it seems to me a lot more realistic that we'll be able to short-term ramp-up production of 1 and 2 than it is to think we'll be able to adequately ramp up 3.
The stories I hear from medical people I know (and this is just anecdotal) is that they are only given serious PPE when they know there is an infection, but it's less clear if that's just standard policy or if that is due to limited supply.
I do agree that if PPE isn't used early and often here, we're going to be short medical personnel, and I think getting those back online is probably going to take longer than throwing money at manufacturers to build more PAPRs.
The stories I hear from medical people I know (and this is just anecdotal) is that they are only given serious PPE when they know there is an infection, but it's less clear if that's just standard policy or if that is due to limited supply.
I do agree that if PPE isn't used early and often here, we're going to be short medical personnel, and I think getting those back online is probably going to take longer than throwing money at manufacturers to build more PAPRs.
It’s not that we’re bad at training medical personnel. It’s that the AMA acts as a cartel to limit the number of physicians train to keep income high. We just need to allow more people into medical schools and make more residencies available.
The number of hospitals and hospitals beds is also controlled by certificates of need.
Certificates of Need were something _hospitals_ themselves lobbied for. It's a case of "this is awesome when it protects me, and an aberration when I'm on the losing end".
Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.
Certainly politicians enacted such things, but I'm not losing sleep over the hospitals. Only us mortals, stuck with the cost of the system.
Yeah, remove the limiter, and how long does it take to make a doctor? I mean, sure, some people are saying that this thing is still gonna be here in four years (I am not a medical person, but that's what some of them say. something about the type of virus this is that will make a vaccine difficult) so that might not be a bad idea, but... I think we probably need to be focusing on how we can increase medical capacity four weeks from now more than four years from now.
Hell, we'll make it so med students can get a proper night's sleep during their residencies while we're at it.
the disrespect for sleep the medical profession has is insane.
If someone is gonna be cutting on me, I want them to have a good night's rest. They tell me to sleep consistently and well quite often. seems like if it's good for me it would be good for them, too.
If someone is gonna be cutting on me, I want them to have a good night's rest. They tell me to sleep consistently and well quite often. seems like if it's good for me it would be good for them, too.
It's easy if we are willing to cut red tape and willing to prioritize people over pets. Veterinarians need almost no training to do the job. Test runs done for emergency preparation have proven that veterinarians do a better job than all medical professionals who aren't already specialized in respiratory care.
>Test runs done for emergency preparation have proven that veterinarians do a better job than all medical professionals who aren't already specialized in respiratory care.
That's amazing.
That's amazing.
> Yeah, remove the limiter, and how long does it take to make a doctor?
Undergraduate entry medical degrees in Ireland are either five or six years with summers off and ample other holidays. Post graduate is four years like the US but pre-med doesn’t exist. You have to learn the necessary content yourself ahead of time and if you fail the exams that’s your problem. You can get in with a degree with no science content whatsoever as long as you have high enough grades in your Bachelor’s. I believe during WWII the US ran some schools at three semesters a year so people were done in two years, eight months. A newly graduated doctor then has residency, a year of 60-100 hour weeks of on the job training. If some of the generalist training was cut you might be able to get someone able to do routine medical care in their specialty, like a nurse practitioner in three years.
Undergraduate entry medical degrees in Ireland are either five or six years with summers off and ample other holidays. Post graduate is four years like the US but pre-med doesn’t exist. You have to learn the necessary content yourself ahead of time and if you fail the exams that’s your problem. You can get in with a degree with no science content whatsoever as long as you have high enough grades in your Bachelor’s. I believe during WWII the US ran some schools at three semesters a year so people were done in two years, eight months. A newly graduated doctor then has residency, a year of 60-100 hour weeks of on the job training. If some of the generalist training was cut you might be able to get someone able to do routine medical care in their specialty, like a nurse practitioner in three years.
We need to do whatever we can to increase capacity, and that involves breaking up the AMA cartel. This isn’t a two weeks and gone crisis, sorry.
Two weeks...
The problem with this is that until we have better means to train people without exposing them to real situations, increasing the number without lowering the overall skill level is an incredibly hard problem.
There's no shortage of people with ailments... A lot just go untreated or are queuing for a long time.
No, but there is a sufficiently large number of problems that relatively few people suffer from that even with people specialising there are plenty of problems where getting people to a point where they are competent enough to participate in operations on real people, and then get them enough experience to be able to do it unsupervised is a challenge.
We can specialize more, but that has its own problems in terms of e.g. availability to deal with urgent cases. And ultimately we do not get away from the fact that giving enough people enough experience even with relatively rare situations is a big challenge.
Eventually we will be able to simulate the situations well enough, and this problem will go away, but it simply is not as simple as throwing more bodies at it.
We can specialize more, but that has its own problems in terms of e.g. availability to deal with urgent cases. And ultimately we do not get away from the fact that giving enough people enough experience even with relatively rare situations is a big challenge.
Eventually we will be able to simulate the situations well enough, and this problem will go away, but it simply is not as simple as throwing more bodies at it.
Well there are about to be a lot of real situations.
For one specific type of illness. But we do not need staff that knows how to handle only rare exceptions, and that is the problem.
Training people to respond to this one situation so that they can respond to this one situation is fine. After covid19 is resolved they wont be needed anyway.
Just an idea (that would never happen)-
Why not make it like Engineering?
You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.
I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.
I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.
Why not make it like Engineering?
You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.
I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.
I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.
The medical system works pretty much like this. After studying medicine you have a long practical education where nobody trusts you.
Yes, but we also have the “fellowship bottleneck” and limited med school seating we use to keep doctor salaries artificially high.
In addition to training new doctors, we should also just loosen restrictions for doctors to enter the US and use their medical expertise.
In addition to training new doctors, we should also just loosen restrictions for doctors to enter the US and use their medical expertise.
When choosing a primary physician at one of the San Francisco Kaiser Permanente campuses, I noticed that a substantial number of doctors had overseas medical training. Which was fine by me--I'm an enthusiastic Kaiser member and support their cost management strategies--but I found it interesting.
Kaiser also recently opened their own medical school: https://en.wikipedia.org/wiki/Kaiser_Permanente_Bernard_J._T...
So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.
Kaiser also recently opened their own medical school: https://en.wikipedia.org/wiki/Kaiser_Permanente_Bernard_J._T...
So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.
> So they're now using a mixed strategy of both out-sourcing and in-sourcing medical training to address high costs.
Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)
We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.
Not as much as they could though - there are still federal caps on the number of fellowship seats available as well as pretty strong restrictions for physicians coming from overseas (although if I recall correctly, California has less stringent restrictions than most)
We discuss insurance as a big part of the cost problem, but regulatory capture on the supply end is another huge (and unnecessary) factor.
You don't need full MDs for respiratory therapy, or for many medical treatments. PAs and RNs can do a lot, and it's far easier and less expensive to attain those certifications than full MD.
For sure and we should also expand the jobs that PAs and RNs are allowed to do.
Doctors wouldn't let either of those things happen because it would lower their salary. The AMA is a powerful lobbying association, no way any law that lowers doctor salary would pass.
Lobbying power can be confronted by other considerable lobbying interests. Large healthcare conglomerates would seem to have considerable interest in reducing labor costs.
A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.
A crisis like this would be the perfect opportunity to fix some of these supply side issues. Lobbying is less effective when voters are paying attention and the government is in crisis-response mode.
How do you think medical education works? Because it's basically exactly this.
No. there is an extra 4+ years of classes.
There are two extra years of classes for med students, at which point they begin doing rotations through all the different specialties. During rotations, they are essentially “reserved for paperwork and unskilled labor which is also checked.”
This process continues in intern year and residency, during which time they gradually build competency and trust.
Much of medicine in the US is delivered by nurses, who have a training regime even more similar to what you suggest.
This process continues in intern year and residency, during which time they gradually build competency and trust.
Much of medicine in the US is delivered by nurses, who have a training regime even more similar to what you suggest.
Categorically false for modern medical school. My daughter started rotations almost immediately, alternating with classes every couple of months throughout. She rarely did 'paperwork' (computers), had close patient contact immediately and was doing procedures almost from the start, under close supervision. Her final rotations had her in the operating room, handling her own patients from triage to discharge, doing night shifts etc along with a resident.
Things have changed rapidly in medical education. At least some places.
Things have changed rapidly in medical education. At least some places.
More medical personel would be great. Another option would be to train contact tracers, much easier to train than medical personel. That is one of the reasons for Singapore's success, I belive. https://www.bbc.com/news/world-asia-51866102
Until we lock down, I suspect that it is far too late to trace contacts. I know of at least 3 different secondhand exposures to Covid, just for me.
Just spitballing here, but to what extent can we streamline or automate COVID-19 treatment for non-comorbid cases?
My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at
Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed.
By the time they are imposed, it will be too late and more people are going to die because of that.
Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed.
By the time they are imposed, it will be too late and more people are going to die because of that.
Nationally lock down now, and once we unlock down the virus will come back from foreign countries and be just as much of an issue.
Slightly more of an issue in fact, because we will have just shot ourselves in the foot in terms of capability to deal with it via manufacturing.
Slightly more of an issue in fact, because we will have just shot ourselves in the foot in terms of capability to deal with it via manufacturing.
Exactly. The goal of the lockdowns is to reduce the number of concurrent cases, thereby allowing time for medical infrastructure to scale up.
I wish this was true, but from all appearances the medical infrastructure is not scaling up at a reasonable pace... i.e.
> The Trump administration has not yet formally asked GM to use its network of plants and suppliers to make any medical equipment, the person said. (From the Article)
> Tesla makes cars with sophisticated hvac systems. SpaceX makes spacecraft with life support systems. Ventilators are not difficult, but cannot be produced instantly. Which hospitals have these shortages you speak of right now? (From twitter 9 hours ago https://twitter.com/elonmusk/status/1240492347835604992)
> The Trump administration has not yet formally asked GM to use its network of plants and suppliers to make any medical equipment, the person said. (From the Article)
> Tesla makes cars with sophisticated hvac systems. SpaceX makes spacecraft with life support systems. Ventilators are not difficult, but cannot be produced instantly. Which hospitals have these shortages you speak of right now? (From twitter 9 hours ago https://twitter.com/elonmusk/status/1240492347835604992)
It's a very difficult problem. Here is a paper outlining the cost in lives of your proposal.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
This is a messaging failure.
We cannot just lockdown and “none of this is necessary.” There is no scenario short of locking down for 10 years that would be able to manage with the number of critical beds we actually have. We need to dramatically upscale capacity (which means training new doctors) and quarantine.
It cannot be an either/or.
We cannot just lockdown and “none of this is necessary.” There is no scenario short of locking down for 10 years that would be able to manage with the number of critical beds we actually have. We need to dramatically upscale capacity (which means training new doctors) and quarantine.
It cannot be an either/or.
You're forgetting the development of a vaccine. With enough time (10 years is way more than enough), a vaccine will be developed and deployed, and that capacity won't be needed because far fewer people will contract the disease and develop symptoms requiring hospitalization.
The problem is, developing and testing a vaccine takes some time. How much time do we have before the global economy totally collapses?
The problem is, developing and testing a vaccine takes some time. How much time do we have before the global economy totally collapses?
> With enough time (10 years is way more than enough), a vaccine will be developed and deployed
Based on what? It’s been more than 10 since SARS and we still don’t have a vaccine. I think you’re making a lot of assumptions about immunization when it is far, far too early to know. Also, the point is that we don’t want to be quarantined for 10 years, we want to build the capacity now.
Based on what? It’s been more than 10 since SARS and we still don’t have a vaccine. I think you’re making a lot of assumptions about immunization when it is far, far too early to know. Also, the point is that we don’t want to be quarantined for 10 years, we want to build the capacity now.
They probably never developed a SARS vaccine because it didn't turn into a major worldwide pandemic. There's lots of diseases that don't have vaccines mainly because it's seen as not worth the effort or cost. SARS and MERS looked scary at first but never got this big.
As an addition here, look at Ebola. It was perfectly feasible to create a vaccine, but no one bothered as long as it was confined to Africa. As soon as white people in western nations started getting it, then suddenly there was a huge effort to create a vaccine.
I agree with you... last week.
I mean, sure, we should lock down now, but my feeling is that it's mostly too late for the urban areas.
The rural areas might have a chance... they need to lock down hard right now. But... from talking to rural family... I'm not sure that's culturally possible.
I mean, sure, we should lock down now, but my feeling is that it's mostly too late for the urban areas.
The rural areas might have a chance... they need to lock down hard right now. But... from talking to rural family... I'm not sure that's culturally possible.
Yes you're probably right.
No this isn't true. The competition to get any residency slot is insanely difficult. There are people who graduate from medical school that apply to hundreds of residencies every year and still don't get anything.
There are more residency spots than med school grads. If a grad doesn't match its because they didn't list undesirable programs, not because all the slots filled.
This is definitely great and uplifting news but I am not sure why GM or Ford is the one on top of list for this endeavor? There are a bunch of second source assembly houses that build medical equipment for the big players. Seems like it would make more sense for them to build it with some sort of FDA fast pass.
Discretion, I work for a carmaker company but my opinion is of my own only.
Discretion, I work for a carmaker company but my opinion is of my own only.
> why GM or Ford is the one on top of list for this endeavor?
Ford and GM were massive manufacturers when WWII reared its head. That gives them a rich history of wartime production [1].
The principal cost in these sorts of shifts can be bureaucratic. Having cultural capital to call on is invaluable.
[1] https://en.m.wikipedia.org/wiki/Automotive_industry_in_the_U...
Ford and GM were massive manufacturers when WWII reared its head. That gives them a rich history of wartime production [1].
The principal cost in these sorts of shifts can be bureaucratic. Having cultural capital to call on is invaluable.
[1] https://en.m.wikipedia.org/wiki/Automotive_industry_in_the_U...
> Having cultural capital to call on is invaluable.
How similar is the culture today compared to 75+ years ago?
How similar is the culture today compared to 75+ years ago?
> How similar is the culture today compared to 75+ years ago?
Doesn’t matter. “We did this before and must do it again” is a powerful call to action. That cultural capital spins up the bureaucratic flywheel.
Doesn’t matter. “We did this before and must do it again” is a powerful call to action. That cultural capital spins up the bureaucratic flywheel.
I first heard the song "We Did It Before and We Can Do It Again" on some old Looney Tunes.
https://www.youtube.com/watch?v=veYIbxaU0A8
https://www.youtube.com/watch?v=veYIbxaU0A8
As a local, I don't know the exact differences in culture today compared to 75 years ago. Though after hearing enough ranting from workers, line bosses, and industrial engineers about exciting topics like quality control, line efficiency, production planning since I was young... I personally think the culture is pretty valuable, especially given the size of the manufacturing workforce.
I think a more pressing question is if any workers will want to come in if GM and Ford commit to this.
I think a more pressing question is if any workers will want to come in if GM and Ford commit to this.
On the surface it’s very different. But in practice it’s surprisingly close as successfully running any truly large scale manufacturing means direction flows down from the top and innovation flows up from the bottom. Automation may be replacing a lot of labor, but cars are also vastly more complex and have far tighter tolerances.
[deleted]
Mary Barra volunteered in a meeting. That's why GM's getting the press. Later on in the article it mentions other manufacturers currently working to do this in Britain.
The industry that can help is the kind that can quickly provide the parts that ventilator manufacturers can't source. If a molded plastic part is missing, the auto industry would be able to answer that I think. I'm not sure though how much of such manufacturing actually takes place at the car manufacturers themselves, vs. how much they are just assembling such parts sourced from other sources? I imagine the industries that can really help are these specialized plastic part manufacturing companies (for example). Assembly lines for cars won't help, it's the part production that can help.
Considering how we've massively bailed GM out with public funds, they may as well be considered to be partly responsible for the health of the public.
Quote from a recent Scott Manley episode seems appropriate:
Many HN readers work in software development. We constantly deal with stakeholders who have completely unrealistic timeframe expectations. Do we really think GM could, in effect, create an entirely new division in a couple of sprints? How long do you think simply creating new injection molds would take? Does GM even know how to handle the kinds of plastics used in ventilators?
Edit: Think war-room. The worst thing a manager can do during an emergency is try to create new processes or add people to make things go faster. My job is to let the folks who already know what to do do it. Sweep all obstacles out of the way. Order pizza, arrange for day-care, rent the hotel across the street. The only really quick ways to increase availability of medical equipment is to give existing manufacturers whatever help they need to run 24x7, and to help their suppliers run 24x7.
At this point, anyone who is "offering to help" is going to be of little use. If you have the infrastructure in place, you had better be doing everything you can to be ramped up. If you need resources you should be screaming for them--no one else is going to be able to tell you what you need or what to do. If you don't have the infrastructure, knowledge, or contacts, then you're just going to get in the way.
[0] https://www.youtube.com/watch?v=graC_Vib1IE @8:40
We choose to do these things not because they are easy, but because we asked ourselves "how hard could it be?"[0]
Many HN readers work in software development. We constantly deal with stakeholders who have completely unrealistic timeframe expectations. Do we really think GM could, in effect, create an entirely new division in a couple of sprints? How long do you think simply creating new injection molds would take? Does GM even know how to handle the kinds of plastics used in ventilators?
Edit: Think war-room. The worst thing a manager can do during an emergency is try to create new processes or add people to make things go faster. My job is to let the folks who already know what to do do it. Sweep all obstacles out of the way. Order pizza, arrange for day-care, rent the hotel across the street. The only really quick ways to increase availability of medical equipment is to give existing manufacturers whatever help they need to run 24x7, and to help their suppliers run 24x7.
At this point, anyone who is "offering to help" is going to be of little use. If you have the infrastructure in place, you had better be doing everything you can to be ramped up. If you need resources you should be screaming for them--no one else is going to be able to tell you what you need or what to do. If you don't have the infrastructure, knowledge, or contacts, then you're just going to get in the way.
[0] https://www.youtube.com/watch?v=graC_Vib1IE @8:40
"Do we really think GM could, in effect, create an entirely new division in a couple of sprints?"
Actually, such things are done with some frequency, and the way you do it is precisely that you don't make "GM" do it. You spin people off entirely, fund them, take ownership of the resulting entity, and then tell GM qua GM to just take a hike. Run it as a startup that happens to have a really, really big brother.
In my observations, it's an unstable structure. Eventually the sponsor in the parent organization loses interest or power, and then someone in the parent corporation decides that their organization needs credit for what this little startup is doing, and sucks them back in, of course completely destroying the whole thing in the process. Behold the awesome destructive power of basic politics. Still, it can work for a while. In this particular case, "a while" is all we need.
AIUI, for at least a good long while, this was almost an officially unofficial way to get Microsoft to do something it lacked confidence in to do directly or couldn't get the organization as a whole to move on; grab a few of your buddies & spin yourself out, prove it works, and get acquihired back in.
Actually, such things are done with some frequency, and the way you do it is precisely that you don't make "GM" do it. You spin people off entirely, fund them, take ownership of the resulting entity, and then tell GM qua GM to just take a hike. Run it as a startup that happens to have a really, really big brother.
In my observations, it's an unstable structure. Eventually the sponsor in the parent organization loses interest or power, and then someone in the parent corporation decides that their organization needs credit for what this little startup is doing, and sucks them back in, of course completely destroying the whole thing in the process. Behold the awesome destructive power of basic politics. Still, it can work for a while. In this particular case, "a while" is all we need.
AIUI, for at least a good long while, this was almost an officially unofficial way to get Microsoft to do something it lacked confidence in to do directly or couldn't get the organization as a whole to move on; grab a few of your buddies & spin yourself out, prove it works, and get acquihired back in.
FWIW automanufacturers in China did this. So this isn't anything, or out of the realm of possibility (we do have more red tape in the US, i.e. see what happened w/ the Seattle Flu Study when people tried to be helpful).
I don't have any English source for this. But Boris Johnson requested the same in England, too.
I don't have any English source for this. But Boris Johnson requested the same in England, too.
A quick search finds some articles stating they will do this, but nothing about results. But of course politicians and CEOs would never make empty promises...
Wikipedia says one Chinese manufacturer, Geely, sold 1.5 million vehicles last year [0]; that probably includes 700K Volvos [1] (they bought Volvo from Ford in 2010), so I'm guessing 600-700K domestic Chinese-produced vehicles. If they had successfully switched production, we'd be talking, what, 100s of thousands of devices a month? But not a word. If they were even making a few 10s of thousands a month I don't think we'd be having this conversation.
[0] https://en.wikipedia.org/wiki/Geely#Figures
[1] https://en.wikipedia.org/wiki/Volvo_Cars#Annual_sales_(all_m...
Wikipedia says one Chinese manufacturer, Geely, sold 1.5 million vehicles last year [0]; that probably includes 700K Volvos [1] (they bought Volvo from Ford in 2010), so I'm guessing 600-700K domestic Chinese-produced vehicles. If they had successfully switched production, we'd be talking, what, 100s of thousands of devices a month? But not a word. If they were even making a few 10s of thousands a month I don't think we'd be having this conversation.
[0] https://en.wikipedia.org/wiki/Geely#Figures
[1] https://en.wikipedia.org/wiki/Volvo_Cars#Annual_sales_(all_m...
UK asks automakers to join efforts to scale up ventilator production: https://uk.reuters.com/article/uk-health-coronavirus-britain...
Yeah - I mean I didn't have an English source for the same initiative that in China.
Wouldn't it make more sense to make masks and other PPE first?
You don't need a ventilator if you don't get sick in the first place, masks are much faster to put into immediate production, and impacting the curve earlier is going to have a much bigger effect than later.
I mean make everything. But I have family members working in hospitals right now and they are asking me to search the internet and find masks for them. Not ideal.
You don't need a ventilator if you don't get sick in the first place, masks are much faster to put into immediate production, and impacting the curve earlier is going to have a much bigger effect than later.
I mean make everything. But I have family members working in hospitals right now and they are asking me to search the internet and find masks for them. Not ideal.
Can’t say I agree. Surprisingly few people wear masks even when they are available - my local hardware stores have had plenty in stock and yet they barely get used. Finally, the benefit of masks is questionable since most people are now performing social distancing.
Ventilators are needed for serious cases and cannot be produced as quickly as masks. While masks may or may not help, more ventilators will definitely help.
Ventilators are needed for serious cases and cannot be produced as quickly as masks. While masks may or may not help, more ventilators will definitely help.
Because masks don't help prevent you getting it https://www.who.int/emergencies/diseases/novel-coronavirus-2...
Your link says “ If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.” - in other words, it does help prevent someone from getting it.
The reason health organizations outside of Asia are not recommending mask wearing by the general public is there are not enough to go around, so they are trying to stop the public from hoarding them when the masks are vital equipment needed by medical providers.
Wearing the masks also helps prevent infected persons (some of whom are asymptomatic with this coronavirus) from spreading it, if previous research on flu viruses is considered applicable. https://www.hsph.harvard.edu/news/features/face-masks-flu/
“These results suggest an important role for aerosols in transmission of influenza virus and that surgical facemasks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
The reason health organizations outside of Asia are not recommending mask wearing by the general public is there are not enough to go around, so they are trying to stop the public from hoarding them when the masks are vital equipment needed by medical providers.
Wearing the masks also helps prevent infected persons (some of whom are asymptomatic with this coronavirus) from spreading it, if previous research on flu viruses is considered applicable. https://www.hsph.harvard.edu/news/features/face-masks-flu/
“These results suggest an important role for aerosols in transmission of influenza virus and that surgical facemasks worn by infected persons are potentially an effective means of limiting the spread of influenza.”
But it helps asymptomatic infected people to infect others
i was thinking, if this ends up being long term, better make full spacesuits for everyone
Everyone is going to get sick. The best thing you can do is get sick now and let your immunity act as your PPE.
> Australia's military is on standby to dispatch more engineers and health professionals to deal with the outbreak of coronavirus as the nation's response to the global pandemic ramps up.
> The Australian Defence Force has already deployed specialist staff to work with the federal Department of Health as part of its response to the spread of COVID-19.
> ADF engineers have also been sent to the regional Victorian town of Shepparton to help manufacture face masks to combat a global shortfall.
...
> Discussions are also taking place for engineers and other specialist staff within the ADF to help establish pop-up fever clinics.
> The ADF has appointed three-star general John Frewen to head a new taskforce to lead the military's response to the pandemic.
> The Australian Defence Force has already deployed specialist staff to work with the federal Department of Health as part of its response to the spread of COVID-19.
> ADF engineers have also been sent to the regional Victorian town of Shepparton to help manufacture face masks to combat a global shortfall.
...
> Discussions are also taking place for engineers and other specialist staff within the ADF to help establish pop-up fever clinics.
> The ADF has appointed three-star general John Frewen to head a new taskforce to lead the military's response to the pandemic.
This made me feel a twinge of patriotism. Something I haven’t felt in a long time.
I listened to today's episode of "The Daily" [1] and it had me feeling similarly.
I can't find a transcript, but he basically said, "Put aside the political differences. Forget about the hit to the economy. We are at war with this virus and human lives are at stake. Do your part."
[1] https://www.nytimes.com/2020/03/18/podcasts/the-daily/cuomo-...
I can't find a transcript, but he basically said, "Put aside the political differences. Forget about the hit to the economy. We are at war with this virus and human lives are at stake. Do your part."
[1] https://www.nytimes.com/2020/03/18/podcasts/the-daily/cuomo-...
We are Americans, we have gone through a lot in this country. In dire times, when humans get together to solve problems - I get goosebumps and tears in my eyes. In our normal day to day life, consuming media and seeing how fragmented this nation has become - incidents like this bring us all together to fight a common enemy. We should have the onus and the courage to help everyone in the world, not just the US. Our image is blemished but the fabric of our principles is still strong. I've never felt patriotism in my whole life in America - but times like this, fuck its amazing.
It's times like this that make us so great. We've been riding on success for so long, it's been easy to forget how we have a goal in the world and that our existence is not guaranteed.
Definitely, most city dwellers I know do not feel proud of being an American, but they only choose to do so to avoid nationalism and patriotism from clouding their judgement - not because of the lack of the American spirit.
The American spirit is always there. They will always seek truth, keep a tab on the government and fearlessly criticize authority, value freedom of speech, liberty and freedom of press. This isn't unique to US, but to Canada, EU, UK, Switzerland, India, Japan, Korea, Australia, New Zealand and many other democracies around the world.
The American spirit is always there. They will always seek truth, keep a tab on the government and fearlessly criticize authority, value freedom of speech, liberty and freedom of press. This isn't unique to US, but to Canada, EU, UK, Switzerland, India, Japan, Korea, Australia, New Zealand and many other democracies around the world.
A line at the top says "Musk tweets Tesla will make ventilators if there’s a shortage". Well, the "if" part does not really seem to be a question.
With US cases at 10^4 today, and a doubling time of 2.5 days (note 1), and with the estimates of available stockpile, it seems well past time to get started on this. I doubt that making a ventilator is as simple as knitting a scarf.
Another way to contribute would be to figure out a way to make masks quickly.
There's lots to do, and help from the innovative and diligent will be greatly appreciated by those who remain.
1. Doubling time inferred from a regression in log space of the last 2 weeks of data provided at https://github.com/CSSEGISandData/COVID-19/tree/master/csse_....
With US cases at 10^4 today, and a doubling time of 2.5 days (note 1), and with the estimates of available stockpile, it seems well past time to get started on this. I doubt that making a ventilator is as simple as knitting a scarf.
Another way to contribute would be to figure out a way to make masks quickly.
There's lots to do, and help from the innovative and diligent will be greatly appreciated by those who remain.
1. Doubling time inferred from a regression in log space of the last 2 weeks of data provided at https://github.com/CSSEGISandData/COVID-19/tree/master/csse_....
Viral spread is more complicated than a simple exponential curve. This is even visible when just eyeballing graphs in log space, e.g. here: https://mackuba.eu/corona/#total
The world-wide total numbers are a very unfortunate choice of graph. It overlays the earlier development in China and their static number of cases (no new ones) with exponential growth in the rest of the world (= the beginning of a logistic curve looks like an exponential).
Better look at each of the different countries.
China and South Korea as examples when the problem is managed ; Italy, Germany and Spain as examples when country did not yet.
https://mackuba.eu/corona/#china
https://mackuba.eu/corona/#south_korea
https://mackuba.eu/corona/#italy
https://mackuba.eu/corona/#germany
https://mackuba.eu/corona/#spain
Better look at each of the different countries.
China and South Korea as examples when the problem is managed ; Italy, Germany and Spain as examples when country did not yet.
https://mackuba.eu/corona/#china
https://mackuba.eu/corona/#south_korea
https://mackuba.eu/corona/#italy
https://mackuba.eu/corona/#germany
https://mackuba.eu/corona/#spain
While we do need some equipment, instead of treating the symptoms, we could lock ourselves down and avoid the surge.
We saw China stop the problem a month ago. South Korea seems to have stopped the problem with testing.
Buy ourselves a month so we can ramp up testing.
The US just past South Korea and France yesterday in covid-19 cases.
We have 9400 cases and 150 deaths.
By the way, China is reporting no new domestic cases.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
We saw China stop the problem a month ago. South Korea seems to have stopped the problem with testing.
Buy ourselves a month so we can ramp up testing.
The US just past South Korea and France yesterday in covid-19 cases.
We have 9400 cases and 150 deaths.
By the way, China is reporting no new domestic cases.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
China didn't just hunker down though. They built out hospital capacity.
The US can and should be doing that as well.
We've got the most advanced logistics networks the world has ever seen installed on our phones.
We've got thousands of young, unlikely to die people who clearly need to be put to work. Time to build and ship hardware like it's WW2.
Will blunt the economic impact of this pandemic, and hopefully the pandemic itself.
The US can and should be doing that as well.
We've got the most advanced logistics networks the world has ever seen installed on our phones.
We've got thousands of young, unlikely to die people who clearly need to be put to work. Time to build and ship hardware like it's WW2.
Will blunt the economic impact of this pandemic, and hopefully the pandemic itself.
China destroyed data and tried to cover up when the outbreak first started, now they are kicking journalist out of the country.
I would not believe anything they are saying at this point in time.
I would not believe anything they are saying at this point in time.
That's an over reductive view, and throws out the baby with the bathwater. China is not a monolithic entity, and while the CCP has, and exerts a lot of control, it is not omnipotent. The number of cases as reported by China will always be suspect, but we are already seeing some information from China being borne out elsewhere. In particular, Italy has been showing similar numbers as China - Covid-19 is particularly lethal to those over 80, less so in children. There are other bits of information we can learn from them, even if we never believe the number of cases is accurate.
As far as the emergency hospital situation and the number of cases in China, I'm sure the US government has been keeping track of the situation via spy satellite. The CCP would never have let the fact that one of the hospitals collapsed escape the country otherwise.
As far as the emergency hospital situation and the number of cases in China, I'm sure the US government has been keeping track of the situation via spy satellite. The CCP would never have let the fact that one of the hospitals collapsed escape the country otherwise.
Need both I’m afraid
Cases are irelevent - that’s a function of how widespread the tests are. Do more tests, find more cases. Test people with symptoms find more cases. Allow anyone to take a test find less symptoms.
Cases are irelevent - that’s a function of how widespread the tests are. Do more tests, find more cases. Test people with symptoms find more cases. Allow anyone to take a test find less symptoms.
Yes, South Korea tested themselves out of the problem.
We should be able to ramp testing up quickly, much quicker than building ventilators.
How long did it take South Korea to control the outbreak?
China records no new local cases:
https://www.nytimes.com/2020/03/19/world/coronavirus-news.ht...
We should be able to ramp testing up quickly, much quicker than building ventilators.
How long did it take South Korea to control the outbreak?
China records no new local cases:
https://www.nytimes.com/2020/03/19/world/coronavirus-news.ht...
For every problem there is a solution that is simple, neat—and wrong.
-H. L. Mencken
We need to lock ourselves down, and some counties in California and elsewhere have already done so.
We also need equipment and doctors.
-H. L. Mencken
We need to lock ourselves down, and some counties in California and elsewhere have already done so.
We also need equipment and doctors.
This is something I've been hoping to see since the pandemic started.
But, I'm pretty ignorant regarding this industry and I've also wondered this:
There are numerous manufacturing plants within the US, but how easy is it switch from manufacturing knew product to another? Is the equipment and machine used generally the same?
But, I'm pretty ignorant regarding this industry and I've also wondered this:
There are numerous manufacturing plants within the US, but how easy is it switch from manufacturing knew product to another? Is the equipment and machine used generally the same?
I'm working on the setup of a new factory line. It's amazingly complex and makes just one thing... a washing machine bowl. Here's a video of an older version of the line. https://vimeo.com/306316617
If a place makes plastic parts of similar size, switching just means changing out the dies/molds that form the plastic. Auto part suppliers, often not the actual auto companies, should have no problem with this.
Meanwhile, actual ventilator manufacturers are not getting many orders:
https://www.washingtonpost.com/health/2020/03/18/ventilator-...
https://www.washingtonpost.com/health/2020/03/18/ventilator-...
Manufactures like Hamilton Medical that are local here are currently working overtime and also work on Saturdays to keep up with demand.
They are not raising prices, but they're also not selling to new customers, as they're afraid intermediate buyers are taking advantage and raising prices on their end.
They also said they have about 2-3 months of runway until their supplies dry up, since parts from China aren't coming in. They did however get supplies ordered in December, because they anticipated the crisis.
They are not raising prices, but they're also not selling to new customers, as they're afraid intermediate buyers are taking advantage and raising prices on their end.
They also said they have about 2-3 months of runway until their supplies dry up, since parts from China aren't coming in. They did however get supplies ordered in December, because they anticipated the crisis.
How did they know to order more supplies in December?
China reported the new novel strain of the coronavirus to the WHO on December 31. [1] If correct, then this means they were monitoring the news, and reacted immediately, and on the very same day of the fresh report.
[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6905e1.htm
China reported the new novel strain of the coronavirus to the WHO on December 31. [1] If correct, then this means they were monitoring the news, and reacted immediately, and on the very same day of the fresh report.
[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6905e1.htm
We just didn’t know how serious this would get. We had H1N1, swine flu, ebola, SARS, MERS, none got out of hand this crazy.
Our own president and task force kept on downplaying it for so long and giving us the wrong information. Even CDC was downplaying for a long time.
Our own president and task force kept on downplaying it for so long and giving us the wrong information. Even CDC was downplaying for a long time.
Perhaps this shows that industry experts, with skin in the game, are better at determining the relevant trends than the people and institutions you mention.
China spent more than a week attempting to cover coronavirus up. By the time the Chinese government made a statement the problem was pretty well known among the Wuhan medical community.
Hamilton are also facing problems supply chain problems. The last thing I read about them a few days ago (in the Swiss press) was that Romania had stopped exporting a component they needed because they didn't seem to understand it wasn't a "medical device" but only a component for one. I assume that got resolved quite quickly.
It also sounds like many patients don't need a full hospital ventilator. A CPAP machine could do. Those are already made in bulk for sleep apnea patients.
It also sounds like many patients don't need a full hospital ventilator. A CPAP machine could do. Those are already made in bulk for sleep apnea patients.
Hospitals are hamstrung by their bureaucracies and financial policies. The best thing that can be done is an independent assessment of need and start "airdropping" supplies if a shortage is apparent.
Did no one bother to actually read the article? It says that there can potentially be a shortage but that there isn't currently.
The fed has 13000 and the military an extra 2000. It currently seems more hamstrung by bureaucracy or lack of information. Hospitals have to request their state governments which have to then request them from the federal government. Only one state has requested them so far.
"“We have received, so far, only, I think, one request for just several ventilators,” he said. In contrast to Fauci’s disclosure that the stockpile contains nearly 13,000, Azar said the number was not disclosed for national security reasons."
The fed has 13000 and the military an extra 2000. It currently seems more hamstrung by bureaucracy or lack of information. Hospitals have to request their state governments which have to then request them from the federal government. Only one state has requested them so far.
"“We have received, so far, only, I think, one request for just several ventilators,” he said. In contrast to Fauci’s disclosure that the stockpile contains nearly 13,000, Azar said the number was not disclosed for national security reasons."
For some context, we might have a shortage of over 100,000 ventilators in the US if we fail to flatten the curve (or over a million if we don't take any precautions).
Some numbers for a conservative estimate where only low-risk people are infected: https://news.ycombinator.com/item?id=22590692
Some numbers for a conservative estimate where only low-risk people are infected: https://news.ycombinator.com/item?id=22590692
If we really don't flatten the curve, then the estimates are over 400,000 shortage.
The problem is that, if you wait to act until the shortage is actually upon you, you’ll act too late. These things take time to make and distribute. You have to act before the tidal wave hits if you want to have them in place when it does.
The first problem to solve is information and distribution. Get organized quickly first so that hospitals know that they can request them and that their requests are quickly met.
This double request structure is stupid.
This double request structure is stupid.
Unless the US central bank is hoarding ventilators, "the feds" have 13000, not "the fed".
Read article and assumed the hospitals aren't anticipating the need for whatever their reasons are. We just barely have enough vents in hospitals as is and they are in use.
>>Did no one bother to actually read the article? It says that there can potentially be a shortage but that there isn't currently.
By the time we see a shortage is late, way too late. Lungs need oxygen and cannot wait for purchase orders and negotiations. You'll need MILLIONS of them, and doctors that know how to use them, like yesterday.
By the time we see a shortage is late, way too late. Lungs need oxygen and cannot wait for purchase orders and negotiations. You'll need MILLIONS of them, and doctors that know how to use them, like yesterday.
Currently there is more than enough. The problem is lack of information and lack of distribution. Making more without solving those problems is ineffectual.
You can do both simultaneously - make more while solving the issue of communication and distribution. Again, you seem to miss the point - while there are currently enough, it is likely there will not be enough in the near future. If we don't produce more before that point, it is too late.
You're gonna need 20 million of them
Right, because no one has stepped up to write a check. Hospitals are businesses, they're not going to do this on their own. GM is a business, they're not donating those ventilators, they're trying to make a sale into a new market. States, most of them, can't do it because their budgets are fixed by their constitutions and they can't take a loan or write a bond without a referendum.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
Whoever thought that running your healthcare system in a commercial fashion was the right idea in the first place? A lot of fundamental decisions are going to be re-thought in the aftermath of this virus' impact, but for now we can ignore all that and focus on what matters: eradicating the thing. And if GM making ventilators on a war footing is what it takes I'm all for it, let's divert some of those funds to them and give the hospitals what they need.
The US has more intensive care unit beds per capita than any other country. Among developed nations they will not come out of this with the highest COVID death toll per capita. The Italian healthcare system is closer to the not for profit ideal and it’s not doing great right now.
I’m not sure where you’re getting that from. There is no universally accepted definition of “intensive care unit bed“ due to fundamentally different approaches to healthcare in different countries.
What you can easily compare are hospital beds for acute care - this is a much bigger pool than just icu.
You can also easily compare number of doctors per capita.
In both of these measures the US system lags behind places like Italy.
What you can easily compare are hospital beds for acute care - this is a much bigger pool than just icu.
You can also easily compare number of doctors per capita.
In both of these measures the US system lags behind places like Italy.
I agree with the parent. There are a number of places in these comments where the number of ICU beds per capita seem to be justification for personal viewpoint; all cite the same sources.
In the interest of avoiding possible hubris, I think it's worth noting that the numbers in the Statisica chart on ICU beds/100k persons (included in the oft cited link [1]) counts in its data for the USA all ICU beds, while the European numbers come from a study that explicitly exclude [2]:
"...private healthcare providers, neonatal and paediatric intensive care beds, coronary care, stroke and pure renal units"
The 34.7/100k number for the US does not exclude the above. According to [1] the US has:
"There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds."
Attempting to match the criteria of both studies gives the USA about 46,795 beds. Assuming 320 MM people gives 14.5, not 34.7, per 100k. I haven't looked at the sources for other countries, but we can expect differences in methodologies of ICU bed counting.
I think this casual sort of comparison of national capabilities (like [3]) which lacks rigor is more dangerous than useful. I hope one will take a deeper dive if they're evaluating risks based on the numbers that have been posted.
[1] https://sccm.org/Blog/March-2020/United-States-Resource-Avai... [2] https://link.springer.com/article/10.1007%2Fs00134-012-2627-... [3] https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
In the interest of avoiding possible hubris, I think it's worth noting that the numbers in the Statisica chart on ICU beds/100k persons (included in the oft cited link [1]) counts in its data for the USA all ICU beds, while the European numbers come from a study that explicitly exclude [2]:
"...private healthcare providers, neonatal and paediatric intensive care beds, coronary care, stroke and pure renal units"
The 34.7/100k number for the US does not exclude the above. According to [1] the US has:
"There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds."
Attempting to match the criteria of both studies gives the USA about 46,795 beds. Assuming 320 MM people gives 14.5, not 34.7, per 100k. I haven't looked at the sources for other countries, but we can expect differences in methodologies of ICU bed counting.
I think this casual sort of comparison of national capabilities (like [3]) which lacks rigor is more dangerous than useful. I hope one will take a deeper dive if they're evaluating risks based on the numbers that have been posted.
[1] https://sccm.org/Blog/March-2020/United-States-Resource-Avai... [2] https://link.springer.com/article/10.1007%2Fs00134-012-2627-... [3] https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
There are many factors to why Italy isn't do great. Including their population skews on the older side and they have the oldest population in Italy...which unfortunately has a 1 in 5 chance of dying if they catch the virus.
I think the healthcare system and medical supply chain are two separate things. A universal healthcare system (for E.g. Sweden) still has a normal supply chain. The only difference is the profit motives are not present and the government can effectively pump money in without violating economic principles of supply/demand and pricing.
A commercialized health care system has lots of perverse incentives leading to price increases and profiteering. This sets the weakest fraction of the population up for losing all they've built up in the last 3 months of their life while barely impacting the strong. It also means that those hospitals don't care about overpaying for their supplies and medication (but not their workforce) because they get to pass those costs on to those already weakened people.
FWIW: Gall bladder operation in NL all in: 1500 euros, non-subsidized and paid for out of pocket because I wasn't paying into the local healthcare system when it happened. Same procedure in the USA: $24000!
https://www.lendingpoint.com/blog/gallbladder-surgery-costs-...
FWIW: Gall bladder operation in NL all in: 1500 euros, non-subsidized and paid for out of pocket because I wasn't paying into the local healthcare system when it happened. Same procedure in the USA: $24000!
https://www.lendingpoint.com/blog/gallbladder-surgery-costs-...
The US has had a private healthcare system for its entire history. Economics and incentives were the same throughout that history. Meanwhile prices only became stupid very recently.
A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal efficiency point, which essentially is very close to "no unused resources in the nimal situation". But societal resiliency requires that health care, utilities, food supply, etc, has some excess capacity just because at some point something will happen. A public system can at least be responsive to the value society puts on resiliency.
Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives.
Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place.
Open the March update pdf here and look at the "excess" column on page 4:
https://www2.illinois.gov/sites/hfsrb/InventoriesData/Monthl...
The state has big impact on the capacity of the medical system.
Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place.
Open the March update pdf here and look at the "excess" column on page 4:
https://www2.illinois.gov/sites/hfsrb/InventoriesData/Monthl...
The state has big impact on the capacity of the medical system.
> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies.
I disagree, I'd say it's the opposite.
A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity.
Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
I disagree, I'd say it's the opposite.
A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity.
Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
this assumes that health care scales in the same way that an online retailer does, no?
the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in.
scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in.
scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
>A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense.
>ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
You're right. A private company would just fire the nurses instead.
Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense.
>ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
You're right. A private company would just fire the nurses instead.
Private providers are not immune to oversights and waste.
Atleast they get punished for it, unlike public systems which might get punished once every 20 election cycles.
How does that square with a system that has the most critical care beds per capita:
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers.
It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
Second most at best. Turkey has 46 / 100k.
https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...
Interesting, the last number I saw was 10x less. That is comforting
Yes, definitely, American healthcare system needs a reboot - this might be a good time to do that. The only difference is that I would be paying about the same but the insurance would cover the rest. The problem being - if you're well off, you pay $1500, if you're not, you pay $24000 and potentially go broke. That is the problem with the American healthcare system.
it may have been mentioned already but in the US healthcare prices are negotiable. It's strange because you can't go to a US grocery store and haggle over the price of cucumbers like you can in many other nations but you can do that with healthcare.
So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.
To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.
So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.
To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.
There are a couple possible re-thinkings. The disturbing one is where it is noticed that we are essentially sacrificing a bit of the economy to reduce fatalities. So next time it is decided that company valuations are worth the extra deaths[1]
I submit that rethinking needs to be started early rather than late so the discussion isn't dominated by euphemisms for some very dark path.
[1] As we know, social isolation is to spread out the pace of acute cases so as not to overwhelm hospitals. But it obviously slows the economy considerably. The alternative would be to not to isolate, keeping businesses wide open and allow the medical system to be overwhelmed with its accompanying higher mortality rate.
I submit that rethinking needs to be started early rather than late so the discussion isn't dominated by euphemisms for some very dark path.
[1] As we know, social isolation is to spread out the pace of acute cases so as not to overwhelm hospitals. But it obviously slows the economy considerably. The alternative would be to not to isolate, keeping businesses wide open and allow the medical system to be overwhelmed with its accompanying higher mortality rate.
America has been on the dark path where lives are equated to money for a long time now. It will take something quite dramatic to shock the system to the point where people are willing to re-think it from the ground up. Maybe this is that shock. If not now, then probably never.
Except that quality-adjusted life expectancy changes due to side effects of drugs are valued much more higher than people dying due to being too broke to get any non-ER-care for acute, but not yet emergency-posing illnesses.
Even within the drug certification process there is an issue with relatively niche drugs wasting a lot on overly-extensive studies, if you calculate how many people would get how much benefit from getting/affording these niche drugs. IIRC there is about an order of magnitude higher weight on side-effect deaths compared to lack-of-medicine deaths for niche drugs.
to be fair, you can adopt europe/wuhan-style total lockdown but you could also adopt developed-asia-style mass tracing.
The latter seems to have been way more effective in containing the epidemic and less impactful on the economy.
So, there was third option which saves both people and economy, but it's probably politically unfeasible.
The latter seems to have been way more effective in containing the epidemic and less impactful on the economy.
So, there was third option which saves both people and economy, but it's probably politically unfeasible.
It's too early to evaluate the tracing approach. The problem is what happens when other people come in from the outside. This is now a major problem in Beijing; not internal transmission but cases brought by arrivals.
It is perfectly possible to rapidly buy things in a commercial setting. You just need a good credit rating and someone to sign the purchase order or contract. Why should the vendor care if the customer is breaking an internal rule about purchasing?
Because it’s not really about the access to capital, it’s about rules designed for non-pandemics slowing them down during one.
To be clear: I'm certainly not opposed the idea of air-dropping GM-manufactured ventilators to needy hospitals (though I'll admit I don't see how it's ever going to work in time and genuinely think this sounds like marketing on GMs part more than a serious idea).
I'm just saying that the person that needs to get off their ass and move on these ideas isn't Mary Barra but Donald Trump (and McConnell and Pelosi of course).
I'm just saying that the person that needs to get off their ass and move on these ideas isn't Mary Barra but Donald Trump (and McConnell and Pelosi of course).
You need to start thinking of this as a logistics problem, not a tech problem. Ventilators is a solved problem. What is needed is a stream of parts and manufacturing capability. I'm not sure if car manufacturers are the right partners but they do have a lot of people that know how to put stuff together. They can put an assembly line for ventilators together; get a stream of parts going and start manufacturing long before we reach the peak of this epidemic. Their workers are not going to be doing anything else so let's let them have their shot. Meanwhile, other companies could start on parts manufacturing. Some design should be chosen; standardized and then we need to start moving. Everywhere. Ditto portable ICU units, negative pressure environments and training for people to help others during this epidemic. If not many more more lives will be lost.
Let’s throw masks and other PPE onto your list as well.
Those are closer to nanomachine fabrication tasks, but different. Lots of specialized, uncommon, high-precision machines: everything is a one off, there is no bulk, and it's all expensive and fiddly.
Ironically the way to make this stuff cheaper would be a three-fold attack.
* Make MORE things that use the same parts, so that making the raw materials is commodity.
* Reduce waste in use (if sterilizing the filters for reuse / etc is possible, etc).
Part 3: Look for alternatives that are feasible.
A hot-zone (book) style line supplied breathing air positive pressure suit that can be scrubbed clean on the outside, OR a similar glove-box (negative draw?, scrubbed inside?) style phone-booth like I think I saw on TV from South Korea (IIRC) would be much better replacements.
Ironically the way to make this stuff cheaper would be a three-fold attack.
* Make MORE things that use the same parts, so that making the raw materials is commodity.
* Reduce waste in use (if sterilizing the filters for reuse / etc is possible, etc).
Part 3: Look for alternatives that are feasible.
A hot-zone (book) style line supplied breathing air positive pressure suit that can be scrubbed clean on the outside, OR a similar glove-box (negative draw?, scrubbed inside?) style phone-booth like I think I saw on TV from South Korea (IIRC) would be much better replacements.
Yes, absolutely. In NL one quarter of the total confirmed infections is hospital employees and other healthcare workers!
As for actual air-dropping - this is actually not that far from reality here in Europe. Two days ago Czech army transport aircraft (nothing fancy, just a A319) got back from Shenzen with 100k quick-tests for the virus, that can give results in about half an hour for a symptomatic infected person. Then the test were distributed to main hospitals via police helicopters.
Reportedly the Hungarian government learned about this operation & are likely to do something similar in the next days.
Also in parallel, Czech Airlines aircraft have been pretty much drafted and sent to China for more stuff - like more tests, respirators and personal protective equipment. And one of the huge Ukrainian AN-124s has been chartered and is already on way for ~100 tons of medical supplies in one go, with more likely to follow.
Basically any classical goods transfer methods are far too slow for this and time is of essence.
Reportedly the Hungarian government learned about this operation & are likely to do something similar in the next days.
Also in parallel, Czech Airlines aircraft have been pretty much drafted and sent to China for more stuff - like more tests, respirators and personal protective equipment. And one of the huge Ukrainian AN-124s has been chartered and is already on way for ~100 tons of medical supplies in one go, with more likely to follow.
Basically any classical goods transfer methods are far too slow for this and time is of essence.
the people that are most likely to need the ventilators aren't exactly hospitals' profit centres either.
are those businesses really going to want to fill all their space with Medicare patients? with fewer ventilators, I imagine they can decline care to more people?
are those businesses really going to want to fill all their space with Medicare patients? with fewer ventilators, I imagine they can decline care to more people?
Don't states have emergency budgets that become available during state of emergency?
Yes and no, some states are constantly on the border of being insolvent. California has a big 'rainy day fund' but this recession is projected to eat into a significant chunk of it. The way hospitals are funded and administered may make it tricky for a state to buy a bunch of ventilators with state funds and then donate them to a hospital... if you "lend" them then after the crisis the state owns a bunch of used ventilators it needs to offload.
So mothball them the same way the military does equipment. We don't have a shortage of land in this country.
Because the equipment requires very sensitive measurements on the order of tenths of cmH2O and tenth of a milliliter of air, a very small leak in any one of the seals can cause a significant inaccuracy in ventilation and especially in the alarms which govern whether the equipment isn’t overinflating your lungs. This isn’t like a car where you can just start it up periodically to keep seals lubricanted. You need to maintain them or to have a plan for how you’ll check them before putting them into service. And you need biomedical technicians who are trained to repair them and clean them. If you mothball the equipment there is a very real danger that without re-qualifying the equipment it will kill or injure patients.
The biggest effect GMs announcement seems to have had is convincing people that a car company that builds to PSI tolerances can build anything to the kind of tolerance needed to safely ventilate patients. I think this is a PR move and GM and Tesla will study the problem enough internally to determine they have no idea what they’re doing. Worst case we get ventilators from Tesla with the same manufacturing defects and quality issues which their cars have had. I personally would not feel safe on a Tesla or GM ventilator built without FDA oversight.
The biggest effect GMs announcement seems to have had is convincing people that a car company that builds to PSI tolerances can build anything to the kind of tolerance needed to safely ventilate patients. I think this is a PR move and GM and Tesla will study the problem enough internally to determine they have no idea what they’re doing. Worst case we get ventilators from Tesla with the same manufacturing defects and quality issues which their cars have had. I personally would not feel safe on a Tesla or GM ventilator built without FDA oversight.
Absolutely on requalification.
IYHO, would that be more or less time that manufacturing fully new units?
IYHO, would that be more or less time that manufacturing fully new units?
In some cases, it's complicated, yada yada. I'm certainly no expert on state-level budgeting in the US. In the case of NY specifically, I know it's been reported that Cuomo specifically asked the federal government for help getting ventilators and was rebuffed.
Right, because no one has stepped up to write a check.
If only billionaire Elon Musk knew someone who could pay.
If only billionaire Elon Musk knew someone who could pay.
Almost all of his wealth is the value of the companies he runs. He's so cash-poor that he couldn't even pay a $75k fine.[1]
1. https://observer.com/2019/10/elon-musk-british-diver-lawsuit...
1. https://observer.com/2019/10/elon-musk-british-diver-lawsuit...
Let's not exaggerate. His companies are public - he has quick access to hundreds of millions in cash.
As of last night, Musk does not believe there is a shortage.
https://twitter.com/elonmusk/status/1240486275892662273
https://twitter.com/elonmusk/status/1240486275892662273
Because they are not the bottleneck. Intensivists that can operate the vents are the bottleneck
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly.
Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.
Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.
I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy.
Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause them life-altering complications if you don't know what you're doing, even for the actually trivial techniques. Operating a ventilator incorrectly will result in death. Likely a grisly one, as incorrect pressure differentials and human lungs are not a good combination.
Now that doesn't mean we need to stick to these bureaucratic rules as they are for this situation, but the people on here advocating for trying complicated medical procedures while knowing fuck all about medicine (or even biology) really need to take a step back and take an inventory of what they don't know, and can realistically expect to accomplish with neither the technical knowledge nor manual dexterity of a trained clinician. A YouTube video and a technical manual aren't going to cut it, folks.
Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause them life-altering complications if you don't know what you're doing, even for the actually trivial techniques. Operating a ventilator incorrectly will result in death. Likely a grisly one, as incorrect pressure differentials and human lungs are not a good combination.
Now that doesn't mean we need to stick to these bureaucratic rules as they are for this situation, but the people on here advocating for trying complicated medical procedures while knowing fuck all about medicine (or even biology) really need to take a step back and take an inventory of what they don't know, and can realistically expect to accomplish with neither the technical knowledge nor manual dexterity of a trained clinician. A YouTube video and a technical manual aren't going to cut it, folks.
I am getting frustrated by the comments that miss the big picture. There are likely going to be lots of people that are going to die without ventilator. Now, who with any common sense and decency[1] cares if 30% of them are dying because the device was not used properly/broke/whatever if the only other available option is that 100% of them die?
[1] Sigh... I know, I know. American lawyers and legal system.
[1] Sigh... I know, I know. American lawyers and legal system.
In your example, a 30% mortality rate is a very big deal. If we had a hypothetical cure that killed 30% of the people it was administered to, I doubt it would get very far.
I'm not saying the alternative is do nothing. But playing doctor because you think that you're reasonably qualified to administer a ventilator, then we're going to end up with, say 30% mortality rates from patients whose lungs were sucked through a ventilator tube because you guessed the wrong pressure. Or, more realistically, a terrible infection because you decided soap and water in the bathroom sink would be sufficient to clean the apparatus.
And then what do you suppose will happen after 30% of these amateur medical procedures go South? Are you going to throw in the towel, try something even more reckless, or decide that you need to get an actual doctor involved to clean up your mess? At which point, you've just added yet another case to the already overburdened medical system. And at a 30% failure rate, that would become a major burden.
There's a lot of room for action between doing nothing and acting foolishly (such as claiming a 30% mortality rate for botched medical procedures is a rational tradeoff). There are ways to help the situation here that don't involve magically becoming a nurse overnight.
I'm not saying the alternative is do nothing. But playing doctor because you think that you're reasonably qualified to administer a ventilator, then we're going to end up with, say 30% mortality rates from patients whose lungs were sucked through a ventilator tube because you guessed the wrong pressure. Or, more realistically, a terrible infection because you decided soap and water in the bathroom sink would be sufficient to clean the apparatus.
And then what do you suppose will happen after 30% of these amateur medical procedures go South? Are you going to throw in the towel, try something even more reckless, or decide that you need to get an actual doctor involved to clean up your mess? At which point, you've just added yet another case to the already overburdened medical system. And at a 30% failure rate, that would become a major burden.
There's a lot of room for action between doing nothing and acting foolishly (such as claiming a 30% mortality rate for botched medical procedures is a rational tradeoff). There are ways to help the situation here that don't involve magically becoming a nurse overnight.
The thing you’re missing is these new RTs wold not just be treating COVID-19 patients. There are tons of people who will need ventilator therapy because they were injured or sick and they would have gotten injured or sick anyway. These are people who can be saved with proper treatment or injured by improper treatment. Barotrauma and lack of tidal volume have implications beyond simply alive or dead. We need people but we must make sure they can actually provide adequate treatment.
I'm not suggesting that you or I operate the ventilators, but I refuse to believe that hospitals can't get someone decently qualified to do the job. If the need arise, those 160000 ventilators will be in operation in a heartbeat. The only reason not to get more is if you believe that there won't be that many patients.
I'm sure the hospital nurses can learn via on-the-job training in a day. This is an emergent situation. No one is suggesting pulling a random person off the street to do it
Setting up a ventilator for treating ARDS (caused by the viral infection and inflammatory response) is at the much harder end of respiratory therapy unfortunately. This is also one reason why just building the simplest possible ventilator simply isn't possible / useful here. Yes you could basically build a 1960s design en-masse but at the moment 50% of people on modern vents are surviving so this is no panacea.
The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.
The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.
That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety.
Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps.
BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.
Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps.
BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.
CPAP machines generate continuous positive pressures though, they assist breathing. I know they have slow ramp capabilities for comfort reasons (start off at low positive pressure when you fall asleep and then increase) but I don't think they can swing pressure fast enough to enable inhalation and exhalation.
You need: -Gas blending (relatively trivial) -A source of pressure (CPAP has this) -A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this) -A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP) -A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others)
So I'm really not sure that you can do this with a modified CPAP machine.
BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.
You need: -Gas blending (relatively trivial) -A source of pressure (CPAP has this) -A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this) -A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP) -A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others)
So I'm really not sure that you can do this with a modified CPAP machine.
BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.
CPAP machines technically can't but CPAP has become a generic term that also encompasses bi-level/APAP machines that can swing pressure fast enough to track inhalation/exhalation. Both mine do. They're not that old but they're not top-end either.
I don't know how many active machines are pre-APAP/BiPAP/A-Flex (there are different names for it). A comment below says 90% but this seems very high to me.
I wonder if it's possible some doctors don't realise the machines have this feature or it's importance? When I first was prescribed CPAP the machine did not come with bi-level flex enabled, it made it very hard to tolerate. I pushed through it for months but when I "cracked" the doctor-only DRM (i.e. looked up the cheat code on Google) and enabled A-Flex it instantly became way easier to handle the machine and my AHI scores were super low; big success. Doctor was quite happy with my altered configuration. I was just surprised such a basic thing hadn't been explained to me.
I suspect a lot of CPAP machines support bi-flex but it either isn't activated or could be added via a software update. I don't think you need extra components.
Oxygen valves come from here: https://learningenglish.voanews.com/a/volunteers-produce-3d-...
I don't know how many active machines are pre-APAP/BiPAP/A-Flex (there are different names for it). A comment below says 90% but this seems very high to me.
I wonder if it's possible some doctors don't realise the machines have this feature or it's importance? When I first was prescribed CPAP the machine did not come with bi-level flex enabled, it made it very hard to tolerate. I pushed through it for months but when I "cracked" the doctor-only DRM (i.e. looked up the cheat code on Google) and enabled A-Flex it instantly became way easier to handle the machine and my AHI scores were super low; big success. Doctor was quite happy with my altered configuration. I was just surprised such a basic thing hadn't been explained to me.
I suspect a lot of CPAP machines support bi-flex but it either isn't activated or could be added via a software update. I don't think you need extra components.
Oxygen valves come from here: https://learningenglish.voanews.com/a/volunteers-produce-3d-...
Very interesting, thanks. If that is the case then it may indeed simply be a software thing. Specifically for treating ARDS you need:
-High PEEP (obviously any CPAP machine can do this)
-Low plateau pressure (probably possible, that's just software)
-Low tidal volume and high breathing rate. Breathing rate is just a cycling variable so should be software only issue. Managing low tidal volume will require the machines to have a flow sensor. Do you know if any of your machines do? If so, then this is likely fixable with only software.
My interpretation of that article is it must refer to the patient valve as those are one-time use (as they in contact with contaminated patient exhalations) rather than O2 inlet valves which are not disposable. Patients are breathing high-ish O2 but obviously not HP pure O2 so 3d printed is fine for that.
3D printing is useful for cases like that where due to logistics there is a temporary shortfall in local supply. I suspect that 3 months from now we are unlikely to be using those measures as global production and distribution of ventilator consumables ramp up.
-High PEEP (obviously any CPAP machine can do this)
-Low plateau pressure (probably possible, that's just software)
-Low tidal volume and high breathing rate. Breathing rate is just a cycling variable so should be software only issue. Managing low tidal volume will require the machines to have a flow sensor. Do you know if any of your machines do? If so, then this is likely fixable with only software.
My interpretation of that article is it must refer to the patient valve as those are one-time use (as they in contact with contaminated patient exhalations) rather than O2 inlet valves which are not disposable. Patients are breathing high-ish O2 but obviously not HP pure O2 so 3d printed is fine for that.
3D printing is useful for cases like that where due to logistics there is a temporary shortfall in local supply. I suspect that 3 months from now we are unlikely to be using those measures as global production and distribution of ventilator consumables ramp up.
Yes, they all have flow sensors. They track vast quantities of data, in fact they track and record the flow of every breath on SD card and can upload that data via Bluetooth.
There's an open source app called SleepyHead that can show you all the data in detail. It appears the maintainer burned out but the downloads are still available.
So it seems modern CPAP has all that's needed? Doctors can even monitor it remotely or via the cloud. It's intended to let clinics monitor patient progress without needing visits, so it's all pretty easy to use.
There's an open source app called SleepyHead that can show you all the data in detail. It appears the maintainer burned out but the downloads are still available.
So it seems modern CPAP has all that's needed? Doctors can even monitor it remotely or via the cloud. It's intended to let clinics monitor patient progress without needing visits, so it's all pretty easy to use.
A CPAP is fixed pressure, what your thinking of is a APAP or the bilevel type of positive air-pressure machines. And there lies the problem with you're miniumum feature set; not all *PAPs are fully-featured machines. Maybe only 10% or so are suitable for ventilator duty, which means they too are supply-limited
I own two CPAP machines and yes they both implement bi-level/APAP features. CPAP is a bit of an ambiguous term these days; whilst there are technical differences between them, most people call all such devices CPAP machines. For instance,
https://www.usa.philips.com/healthcare/product/HCNOCTN447/dr...
It's advertised as "CPAP & Bi-Level therapy".
To be clear, I'm talking about the ones that implement bi-level pressure. The difference is (as far as I know) primarily a matter of software; perhaps older machines can be upgraded if pricing/selling upgrades is taken out of the equation?
I've had my machines for I think a couple of years now and they were all bi-level from the start. I'm not sure when that started becoming standard or where you got that 10% figure from, you may well be right. But there are 300,000+ sleep apnea patients being treated in the UK alone. If even only 10% of them use modern machines (seems low given how much better bi-level makes it), that's still 30,000 portable ventilators available to be requisitioned at short notice. Sleep apnea patients don't have a critical need for them.
https://www.usa.philips.com/healthcare/product/HCNOCTN447/dr...
It's advertised as "CPAP & Bi-Level therapy".
To be clear, I'm talking about the ones that implement bi-level pressure. The difference is (as far as I know) primarily a matter of software; perhaps older machines can be upgraded if pricing/selling upgrades is taken out of the equation?
I've had my machines for I think a couple of years now and they were all bi-level from the start. I'm not sure when that started becoming standard or where you got that 10% figure from, you may well be right. But there are 300,000+ sleep apnea patients being treated in the UK alone. If even only 10% of them use modern machines (seems low given how much better bi-level makes it), that's still 30,000 portable ventilators available to be requisitioned at short notice. Sleep apnea patients don't have a critical need for them.
I was reading some accounts on /r/nursing that its relatively complex. The issue you have is that its quite easy to kill a patient if you fuck it up and there are multiple factors that impact the operation of the machine (e.g. patient weight for example).
Any guides to how to set up a ventilator by chance? Asking for a friend...
Very short guide: Put a mouthpiece on the patient, connect the mouthpiece to the tube from the ventilator, turn the ventilator on.
Longer guide: Read the manual for the specific ventilator and have fun adjusting air mixture, pump frequency, pressure, volume and other stuff. Choose one of several different models of mouthpiece, with or without tubes, depending on patient needs. Learn about different failure modes and associated alarms. Learn how to operate the pump manually in case of electronics failure. Learn how to properly clean the machine.
It isn't nothing, there are some things you can do wrong if you don't know what you are doing. But a trained medical professional should get up to speed with a crash course.
Longer guide: Read the manual for the specific ventilator and have fun adjusting air mixture, pump frequency, pressure, volume and other stuff. Choose one of several different models of mouthpiece, with or without tubes, depending on patient needs. Learn about different failure modes and associated alarms. Learn how to operate the pump manually in case of electronics failure. Learn how to properly clean the machine.
It isn't nothing, there are some things you can do wrong if you don't know what you are doing. But a trained medical professional should get up to speed with a crash course.
The type of ventillators required by the most serious cases are much more complicated: as I understand it, it involves push a tube down to the lungs, and the machine breathing instead of the patient, i.e. it has to carefully monitor and regulate the pressure etc. Already the "push tube down to the lungs" part is quite a challenge: avoiding damage to the vocal cords, or to the lungs, etc.
Should we then not be damn sure that there are shitloads of the simpler ventilators so that the complicated ones can be fully reserved for the serious cases?
In the hospital they’re all complicated cases. The simpler vents are for home care use. The hospital doesn’t typically do noninvasive ventilation because it’s meant for patients who are awake and outside of a hospital setting.
Tubes down the lungs is definitely a bit tricky, not all patients will require that model though. As for careful monitoring, that is something the machine does on its own, as long as it has been configured correctly for the individual patient.
This is incorrect on many levels. A ventilator always requires intubation. Sometimes that's through the mouth, sometimes through the nasal passage (both cases are referred to as endotracheal), and rarely through a tracheostomy. Ventilators do have some monitoring capability, but require consistent attention from respiratory therapists. The chances of infection (VAP), pneumothorax etc are serious without careful monitoring by a trained, experienced medical professional. These aren't plug and play devices.
Some patients might need supplementary oxygen delivered through a canula, or through a mask, but that's nothing like the procedure used for a vent.
Some patients might need supplementary oxygen delivered through a canula, or through a mask, but that's nothing like the procedure used for a vent.
A ventilator always requires intubation
Can you elaborate? This ventilator documentation[0] says for invasive and noninvasive ventilation
[0] https://www.usa.philips.com/healthcare/product/HCNOCTN98/res...
Can you elaborate? This ventilator documentation[0] says for invasive and noninvasive ventilation
[0] https://www.usa.philips.com/healthcare/product/HCNOCTN98/res...
Many vents can also operate in BiPAP or CPAP modes or as pure demand O2 supplies for people who can still breathe. That can be done with a mask.
When treating bilateral interstitial pneumonia, you're almost always intubating. Patients presenting BIP require higher oxygenation than a CPAP style mask can provide. Using a limited availability ventilator with just a mask is a waste at this time.
Nonetheless ramping up supply still solves the problem by driving prices down
If any of them have half a brain, they are maintaining their regular prices and ramping up production and stockpiling them for the inevitable demand in a few more weeks.
This is easily resolved by setting the price of ventilators as part of Title IV of the Defense Production Act (I would imagine)
https://fas.org/sgp/crs/natsec/RS20587.pdf
In fairness, if your hourly workers are working overtime to "ramp up production" you need to pay them overtime of 1.5x (In China, it can be double or triple (forgot which one) since their workers were working during Chinese New Year) . Their costs increases and should be able to reasonable increase price to accommodate.
> ramping up production and stockpiling them for the inevitable demand in a few more weeks.
This still prevents future prices from increasing, which is good thing.
This still prevents future prices from increasing, which is good thing.
[deleted]
Only if they actually decide to drive prices down. There is zero indication this is happening.
The mobilization of American industry during WW2 produced some interesting artifacts. For example, many people might know what an M1 Carbine is, if only from movies and video games - but how many know that they were manufactured by, among other companies, IBM, Rock-Ola, and National Postal Meter Co?
After the war, most of those ended up on the civilian market, so even today, you can own a gun that has a legit "IBM" logo on the barrel.
After the war, most of those ended up on the civilian market, so even today, you can own a gun that has a legit "IBM" logo on the barrel.
I'm a simple minded engineer. In my work I use ventilators frequently and I often have to service them so I'm not entirely unknowlegeable about these devices.
There is a large need for mechanical respiratoration (a ventilator) then I have a thought.... Has anyone considered one HUGE pump working as a ventilator? The average hospital has a capacity between 300 and 1000, why not have one huge shared resource as a pump. The pump should have the capacity of sourcing sufficient O2/Air to hundreds or thousands of patients. There are obvious supply chain and technical challenges (thinking of how you create all that O2, the valving, filtering etc).
Example: 6 liters of air/breath * 500 patient bed hosptial so a pump volume of 3000 liters * 12 breaths or 36000 liters/min capacity, pumps of this magnitude should already exist. This effective giant set of bellows could then could source into a large diameter tube which runs throughout an entire hospital or nursing home. Each patient would have individual takeoffs with valve controland similarly a return exhale system (one giant collector, sterilizing-filter, etc).
There is a large need for mechanical respiratoration (a ventilator) then I have a thought.... Has anyone considered one HUGE pump working as a ventilator? The average hospital has a capacity between 300 and 1000, why not have one huge shared resource as a pump. The pump should have the capacity of sourcing sufficient O2/Air to hundreds or thousands of patients. There are obvious supply chain and technical challenges (thinking of how you create all that O2, the valving, filtering etc).
Example: 6 liters of air/breath * 500 patient bed hosptial so a pump volume of 3000 liters * 12 breaths or 36000 liters/min capacity, pumps of this magnitude should already exist. This effective giant set of bellows could then could source into a large diameter tube which runs throughout an entire hospital or nursing home. Each patient would have individual takeoffs with valve controland similarly a return exhale system (one giant collector, sterilizing-filter, etc).
Back flow causing cross contamination, different rate and flow, etc
> Elon Musk said the company would make ventilators if there is a shortage
Well he should better start, because there will be a shortage.
Well he should better start, because there will be a shortage.
I hope companies step up and create surgical masks. It's such a basic item, but we don't have enough. Forget about guns, it's like asking troops to fight without shoes.
Unfortunately, in the past when local companies did that they were punished because the demand evaporated and the government wasn't willing to keep buying and stockpile. https://www.npr.org/sections/health-shots/2020/03/05/8113874... mentions how one manufacturer kept trying to get the government to help maintain supply, but they didn't. Now all the local manufacturers are scrambling and the US stockpiles are insufficient.
The federal government has placed an order for 500 million N95 masks.
https://www.bloomberg.com/news/articles/2020-03-18/trump-say...
https://www.bloomberg.com/news/articles/2020-03-18/trump-say...
What does that even mean? Placing an order doesn't magically solve production shortages.
It protects the manufacturer against ramping up supply only for demand to suddenly disappear.
A one-time order isn't what that company is looking for. They're only responding to hospitals that sign onto a five-year contract, for example. Likely the only way to get to the front of the line with him now is to have an authorized 10-year contract signed by the board of directors with a capped total, with an attached note, "fill in your price, up to this amount", handed over face-to-face by the customer's CEO stepping into the factory.
Even that isn't really sufficient. Looking at the capex depreciation table [1], he'll only depreciate the new machinery in five years, and likely still be paying a note on it. Commercial industrial/flex space leases in the DFW area where he's near are typically around 3-5 years. After all is said and done, he's likely roughly breaking even, and not netting a giant personal profit at the other end.
He needs the Federal and state governments committing to evergreen disaster preparedness on a decades-long timescale. That takes much more than stockpiling.
[1] https://cs.thomsonreuters.com/ua/fixa/cs_us_en/ass_life_tbl/...
Even that isn't really sufficient. Looking at the capex depreciation table [1], he'll only depreciate the new machinery in five years, and likely still be paying a note on it. Commercial industrial/flex space leases in the DFW area where he's near are typically around 3-5 years. After all is said and done, he's likely roughly breaking even, and not netting a giant personal profit at the other end.
He needs the Federal and state governments committing to evergreen disaster preparedness on a decades-long timescale. That takes much more than stockpiling.
[1] https://cs.thomsonreuters.com/ua/fixa/cs_us_en/ass_life_tbl/...
If their shoes were knitted, perhaps.
This is inspiring. Echoes of https://en.wikipedia.org/wiki/Arsenal_of_Democracy
To everyone saying "great, but why didn't this start months ago?"
Well, sure, but the second best time to start is now.
Well, sure, but the second best time to start is now.
It couldn't have started months ago. If this happened mid-January, we'd have be deafened by the screeching of GM's shareholders, angrily rubbing their antennae together. The only time something like this can happen is when people have woken up to the crisis.
[deleted]
It’s getting incredibly frustrating seeing people make this tired point.
Yeah, we SHOULD have started a month ago, but we didn’t, and wasting time at a press conference trying to write some gotcha story about it helps nobody.
Yeah, we SHOULD have started a month ago, but we didn’t, and wasting time at a press conference trying to write some gotcha story about it helps nobody.
Politics as usual. Fault is more important to some than fixing problems.
Yeah let's fix the problems, but when this is all over I am not going to forget the people who were calling this a hoax in January and February. Time where deflection, instead of action, costed lives.
This is just a PR play and an ask for government handouts.
It would be / have been a lot better for the government to just, you know, order ventilators from ventilator manufacturers in advance. Barring that, they could start helping them ramp up manufacturing now.
It would be / have been a lot better for the government to just, you know, order ventilators from ventilator manufacturers in advance. Barring that, they could start helping them ramp up manufacturing now.
No better time to get familiar with the "sunk cost fallacy".
Eh, if you haven't heard of it by now it's not worth reading about.
Because Elon thought that the coronavirus panic is dumb.
https://elonmusk.today/
https://www.thestar.com.my/tech/tech-news/2020/03/11/tesla-c...
https://elonmusk.today/
https://www.thestar.com.my/tech/tech-news/2020/03/11/tesla-c...
The content quoted in the "The Star" makes it seems more to me that he's calling the _panic_ dumb, not the necessities required to fight the pandemic, which he acknowledges exists in his follow-on tweets, at least the ones "The Star" quoted.
I also think the "coronavirus panic" is dumb, but I'm defining the "panic" when I say this as people buying 5 years of toilet paper, and unless there's more context that's what I am also assuming he is referring to.
I also think the "coronavirus panic" is dumb, but I'm defining the "panic" when I say this as people buying 5 years of toilet paper, and unless there's more context that's what I am also assuming he is referring to.
There’s very good reason to panic early when dealing with an exponentially growing threat: https://youtu.be/e2Kga5HeAqk
Exactly. I don't understand why people are so avert to the word "panic". Extreme situations require extreme measures, which sure as hell look like "panic". If somebody is shooting at you - you're expected to panic and run and hide.
"Panic" is associated to irrational decision making, and is usually not what produces the best outcome. This is why there is a lot of training provided to professionals and even everyday people in potentially serious situations. If a plane crashes, they don't want you to panic and storm your way out of the plane, you'll just end up putting more lives at risk.
He also said that COVID-19 is a form of the common cold.
Elon Musk's words-
“My frank opinion remains that the harm from the coronavirus panic far exceeds that of the virus itself. If there is a massive redirection of medical resources out of proportion to the danger, it will result in less available care to those with critical medical needs, which does not serve the greater good.”
“My best guess, for what it’s worth, based on the latest Center for Disease Control data, is that confirmed COVID-19 (this specific form of the common cold) cases will not exceed 0.1% of the US population. Moreover, I do not think when we look back on 2020, that the causes of death or serious injury will have changed much from 2017.”
No, he wasn't talking about toilet paper hoarders. He was yet another overly self-absorbed person who thought that because he knows about something, ergo he knows about everything. HN is full of those types. That the "panic" response of actual professionals who are experts in this field just didn't match his imagination of how to respond to this "form of the common cold".
As an aside - the MAGA brigade is out in heavy force lately. The type of comments that are being flagged is absolutely ludicrous. If you find a comment that's politically unpalatable, be sure to flag it.
“My frank opinion remains that the harm from the coronavirus panic far exceeds that of the virus itself. If there is a massive redirection of medical resources out of proportion to the danger, it will result in less available care to those with critical medical needs, which does not serve the greater good.”
“My best guess, for what it’s worth, based on the latest Center for Disease Control data, is that confirmed COVID-19 (this specific form of the common cold) cases will not exceed 0.1% of the US population. Moreover, I do not think when we look back on 2020, that the causes of death or serious injury will have changed much from 2017.”
No, he wasn't talking about toilet paper hoarders. He was yet another overly self-absorbed person who thought that because he knows about something, ergo he knows about everything. HN is full of those types. That the "panic" response of actual professionals who are experts in this field just didn't match his imagination of how to respond to this "form of the common cold".
As an aside - the MAGA brigade is out in heavy force lately. The type of comments that are being flagged is absolutely ludicrous. If you find a comment that's politically unpalatable, be sure to flag it.
> My best guess ... is that confirmed COVID-19 ... cases will not exceed 0.1% of the US population
My own best guess agrees with that. Really, it's all about how many cases you choose to "confirm". That's not very reassuring though.
My own best guess agrees with that. Really, it's all about how many cases you choose to "confirm". That's not very reassuring though.
That would be 330k. With the current growth rate of 25% per day we'll find out in 16 days.
>As an aside - the MAGA brigade is out in heavy force lately
Partisan conspiracy theories like this are not helpful
Partisan conspiracy theories like this are not helpful
Partisan? Hysterical! There is no universe where disagreeing with a cult of ignorance is "partisan".
Further, it isn't a conspiracy theory to make a banal observation. Flagging is clearly being grossly abused.
Further, it isn't a conspiracy theory to make a banal observation. Flagging is clearly being grossly abused.
And your last line probably gave you lots of flags. Not sure I particularly like this forum anymore.
It is dumb. In the USA Corona deaths @ 150 so far while flu deaths @ 34K/year. Even Swine Flu had 4K deaths and MSM didn't bat an eye. Italy proving single payer socialized medicine has less talented clinicians and administration.
So here is a legitimate question:
At some point a few months from now, IF you are proven tragically wrong; what action will you undertake?
Apologize and review your assumptions and outlook for all future circumstances?
Or, as I suspect, pretend you never posted this and create a revisionist history of what your thoughts, opinions and stances were?
The first sentence indicates ignorance of math / timescales; second one indicates ignorance of other places; and I'll be genuinely curious if there is any way facts will ever penetrate, or whether you will find some way to rewrite history of your opinions in the future :-/
At some point a few months from now, IF you are proven tragically wrong; what action will you undertake?
Apologize and review your assumptions and outlook for all future circumstances?
Or, as I suspect, pretend you never posted this and create a revisionist history of what your thoughts, opinions and stances were?
The first sentence indicates ignorance of math / timescales; second one indicates ignorance of other places; and I'll be genuinely curious if there is any way facts will ever penetrate, or whether you will find some way to rewrite history of your opinions in the future :-/
Guarantee you deaths will be less than swine flu deaths. But you will just say it's because of our amazing response, the same response being treated by MSM as inadequate. Just remember it was the Democrats/MSM willing to go scorched earth on the economy to push this pandemic narrative.
You can stick your guarantees ... somewhere. Nobody cares about them.
Why don't they offer assistance to the companies already manufacturing them? Can they send supply chain specialists? Even things like sending material handling staff to relieve their regular staff will help.
I’m not actually sure the bottleneck will be our stock of ventilators, nor do I think it will be very difficult to build enough within the next month or two — at least not to the point where we’d need a wartime mobilization
They don’t run themselves, however. They require specialists, many of whom that will themselves catch the virus and have to quarantine. It’s not just doctors but anesthesiologists, nurses, technicians, etc.
Not to mention just having physical room in the hospitals.
They don’t run themselves, however. They require specialists, many of whom that will themselves catch the virus and have to quarantine. It’s not just doctors but anesthesiologists, nurses, technicians, etc.
Not to mention just having physical room in the hospitals.
The issue as you highlighted is correct. We lack intensivists. In terms of ventilators and critical care beds, the US is actual well ahead of most other countries.
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
The reason people think we have fewer beds per capita is because they are counting regular hospital beds and don't include beds available in outpatient facilities.
What I was unable to find out is how many intensivists per capita are available per country. If anyone can find that data, I'd be curious to see it.
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
The reason people think we have fewer beds per capita is because they are counting regular hospital beds and don't include beds available in outpatient facilities.
What I was unable to find out is how many intensivists per capita are available per country. If anyone can find that data, I'd be curious to see it.
But it took one very capable, talented and gifted person (“Cast Iron Charlie”) to make Ford become the largest manufacturer of B24 bombers during WW2.
Read on Willow Run Assembly plant and how it came about.
https://www.assemblymag.com/articles/94614-how-fords-willow-...
Read on Willow Run Assembly plant and how it came about.
https://www.assemblymag.com/articles/94614-how-fords-willow-...
There are probably more ventilators in the US than the total number of hospitalized covid patients in China at the peak.
This is getting crazy.
Has anyone happened to notice that this disease is not ravaging the rest of China, malayasis, Vietnam, Japan, or the US for that matter?
It's been FOUR months -- at least -- and there are fewer dead worldwide than the deaths in Florida during a nasty flu season.
Can they also manufacturer anesthesiologists and acute care nurses? Medical beds? Hospitals? Effective PPE so what few staff we have can carry on working? What about safe, medical grade oxygen?
It's not enough to have ventilators and beds for 15% of your population. You need a joined up response across the board. This is good, but it's not enough.
It's not enough to have ventilators and beds for 15% of your population. You need a joined up response across the board. This is good, but it's not enough.
> Can they also manufacturer anesthesiologists and acute care nurses?
There's a lot of smart and talented people currently sitting home, doing nothing right now. It may not be medical school but four weeks on Khan Academy can get you up to speed on routine tasks. Then you work under the supervision of a real medical practitioner handles corner cases. This is how medics are trained in wartime.
> Medical beds? Hospitals?
Tons of hotels are sitting empty. Their beds could easily be retrofitted into field hospitals.
> Effective PPE
Apparel companies. H&M and other fast fashion outlets can boot a new design pattern in as little as six days.
> What about safe, medical grade oxygen?
Tons of Scuba shops have gas compressor capacity, which is obviously safe for human consumption. Most of those shops are sitting empty, because of the current collapse in tourism.
There's a lot of smart and talented people currently sitting home, doing nothing right now. It may not be medical school but four weeks on Khan Academy can get you up to speed on routine tasks. Then you work under the supervision of a real medical practitioner handles corner cases. This is how medics are trained in wartime.
> Medical beds? Hospitals?
Tons of hotels are sitting empty. Their beds could easily be retrofitted into field hospitals.
> Effective PPE
Apparel companies. H&M and other fast fashion outlets can boot a new design pattern in as little as six days.
> What about safe, medical grade oxygen?
Tons of Scuba shops have gas compressor capacity, which is obviously safe for human consumption. Most of those shops are sitting empty, because of the current collapse in tourism.
Even if those were viable solutions —I have reservations— we're still just talking about this. Medical staff are being exposed today due to lack of PPE. Cases are still rocketing.
If we want to avoid the situation where we can only make our parents and grandparents comfortable in death, leadership needs to emerge and commandeer the resources available to our countries. Waiting for volunteers isn't enough.
If we want to avoid the situation where we can only make our parents and grandparents comfortable in death, leadership needs to emerge and commandeer the resources available to our countries. Waiting for volunteers isn't enough.
As they should.
The United States can manufacturer its way out of this problem, it just needs to mobilize.
Uber is a hyper local, infinitely scalable logistics network.
All of those startups making modular homes out of shipping containers could and should be making temporary hospital wings (which would conveniently fit on an 18 wheeler for easy transportation).
The United States can manufacturer its way out of this problem, it just needs to mobilize.
Uber is a hyper local, infinitely scalable logistics network.
All of those startups making modular homes out of shipping containers could and should be making temporary hospital wings (which would conveniently fit on an 18 wheeler for easy transportation).
I have an M&M Mars Co 1911 that was made by the candy company as a effort to show they could help with WWII efforts.
So definitely not an unheard of scenario to move excess capacity to out of industry items.
But I think my 1911 is more collectible than a Tesla Ventilator. Still, someone might pay decent money for that some day.
So definitely not an unheard of scenario to move excess capacity to out of industry items.
But I think my 1911 is more collectible than a Tesla Ventilator. Still, someone might pay decent money for that some day.
I still can't believe that most large companies were not offering everything they could several weeks ago.
All Army/Navy/Air Force medical personnel should already be deployed to the field with makeshift drive-in testing spots. The Army is good at creating controlled zones. They can direct traffic while someone takes a swab.
All other military personnel should be working with hospitals to do 'anything non-medically related'. Taking names, providing transportation, direction people, providing backup generators.
All labs capable of doing testing should be preparing/getting processes ready.
3D printers printing whatever they can for equipment support.
Anyone laid off should be hired immediately by the government to provide free grocery and medicine delivery to those quarantined. This would serve as an economic stimulus.
All trained medical staff in the country should be triaging based on the 'new normal': family doctors are no longer family doctors, they only treat regular patients if needed, otherwise, it's 4 days a week dealing with Corona.
A tidal wave is about to hit the nation, it's 'all hands on deck'.
All Army/Navy/Air Force medical personnel should already be deployed to the field with makeshift drive-in testing spots. The Army is good at creating controlled zones. They can direct traffic while someone takes a swab.
All other military personnel should be working with hospitals to do 'anything non-medically related'. Taking names, providing transportation, direction people, providing backup generators.
All labs capable of doing testing should be preparing/getting processes ready.
3D printers printing whatever they can for equipment support.
Anyone laid off should be hired immediately by the government to provide free grocery and medicine delivery to those quarantined. This would serve as an economic stimulus.
All trained medical staff in the country should be triaging based on the 'new normal': family doctors are no longer family doctors, they only treat regular patients if needed, otherwise, it's 4 days a week dealing with Corona.
A tidal wave is about to hit the nation, it's 'all hands on deck'.
The military is legally prohibited from operating on US soil (kind of something the framers didn't feel comfortable with). Perhaps you mean the National Guard, which is controlled by the governor of each state?
I mean deploy them without weapons, or possibly uniforms if necessary. If that's still illegal, they put many of them on 'leave without pay' if they were with a different federal agency wherein they operate without rank or difference to their military status i.e. 'bodies for work'. They can be filtered into roles given qualifications.
Uniforms are not necessary and they would have no real legal authority, the legality could be enforced by local law enforcement if necessary.
Don't need guns, uniforms or much training or authority to divert traffic, take peoples names, guide them in parking lots while they wait for test results.
Uniforms are not necessary and they would have no real legal authority, the legality could be enforced by local law enforcement if necessary.
Don't need guns, uniforms or much training or authority to divert traffic, take peoples names, guide them in parking lots while they wait for test results.
>>Chief Executive Officer Elon Musk said the company would make ventilators if there is a shortage
well, there is. Either get off Twitter or shoot a tweet to your underlings to get going. Pretty much countries will buy any ventilator that someone makes, money is no object.
well, there is. Either get off Twitter or shoot a tweet to your underlings to get going. Pretty much countries will buy any ventilator that someone makes, money is no object.
Actually, right now there is not a shortage of ventilators. Few hospitals have ordered more, and there are large stocks. There probably will be a shortage soon, but unless someone orders them and guarantees payment it's hard to imagine any manufacturer re-tooling their factory and spinning up production on a wing and a prayer.
do you really think they will be unsold? No one is willing to export those few that are manufactured so getting guaranteed payment is not an issue, I'm sure. USA, UK, Germany, France, Italy and everyone has opened their wallets...
https://www.wired.com/story/ventilator-makers-race-to-preven...
I hope that, like the world war II manufacturing effort, this puts a lot of out of work people back to work.
I'm already hearing about service industry people getting laid off all around.
I'm already hearing about service industry people getting laid off all around.
[deleted]
Offers schmoffers. Tell me when the first ones come off the production line.
That goes for musk too.
That goes for musk too.
Where's Toyota? Rapid adaptation is their bread and butter.
While tesla decides to illegally keep plant working...
Contrast this w/ Elon Musk's response...
If we were halfway rational, we would have started this in January. Failing that, start now.
Have you ever been in an executive leadership position that required you to make tough decisions? As someone who recently has entered this realm, let me tell you: most of the decisions in front of you are essentially choices between a whole bunch of options that all have one thing in common: they totally suck. You learn quickly that you are going to make harmful decisions because sometimes a good option isn’t in the hand life has dealt you. It’s the nature of the gig. A true executive leader makes a decision quickly and moves on. When they recognize they have made a bad decision (often with more data now available), they change their mind. Most bad leaders are incapable of doing this last bit. They dig in and hold their ground. The good ones just switch. They won’t even admit it because of ego (Steve Jobs is a great example outside politics of someone with this behavior).
If the US had gone into lockdown in January, the ACLU might have sued the government in court (or another civil liberties org). The UAW would have fought GM on shutting down the plants (let alone the shareholders!). College students would be protesting encroachment on civil liberties. Businesses would have been screaming. The stock market would have gone into a tailspin. People in a free society would have flouted the orders out of civil disobedience. For all this stuff to actually work in a free country, a significant percentage of the population has to believe the threat and cooperate. I’m a highly educated person with a degree in molecular biology. I know all about viral illness and epidemics. Even I did not come around on the severity of this until last week (Despite reading all the articles!). It just pattern matched against all the other pandemics that were a big deal in Asia and elsewhere, but didn’t really impact daily life in the US.
If the US had gone into lockdown in January, the ACLU might have sued the government in court (or another civil liberties org). The UAW would have fought GM on shutting down the plants (let alone the shareholders!). College students would be protesting encroachment on civil liberties. Businesses would have been screaming. The stock market would have gone into a tailspin. People in a free society would have flouted the orders out of civil disobedience. For all this stuff to actually work in a free country, a significant percentage of the population has to believe the threat and cooperate. I’m a highly educated person with a degree in molecular biology. I know all about viral illness and epidemics. Even I did not come around on the severity of this until last week (Despite reading all the articles!). It just pattern matched against all the other pandemics that were a big deal in Asia and elsewhere, but didn’t really impact daily life in the US.
Fair enough. But you move towards the target by having leadership that says "This is serious. We need to start doing this now. I am not going to invoke war-like power to force us all to do this (yet), but we've got to understand the seriousness of the risk and start social distancing now while there's still time".
Instead, we got 2 months of "it's nothing".
One of the roles of leadership is to persuade a significant percentage of the population that threats are real and cooperate. The current US leadership utterly failed at this.
Instead, we got 2 months of "it's nothing".
One of the roles of leadership is to persuade a significant percentage of the population that threats are real and cooperate. The current US leadership utterly failed at this.
There was no need for national 'lock down' in January, what was needed was preparation.
Specifically with respect to testing, and the operations behind testing - this should have been sorted out.
There was no reason to 'lockdown' in January. The ACLU would not have sued, it would be irrelevant anyhow. College students would not be protesting en masse, and if they did, it wouldn't matter.
Once America has contained the virus, the rest of the world will need medical staff, beds, ventilators. There are 7 billion people out there, the surpluses will get used.
China was building hospitals over a 'few days' - this should have been a 'shocking moment' for everyone to start thinking about how to 'build hospitals in 2 days' or at least commandeer office towers or whatever as facilities. Knock out doors, widen entries, rip out the carpets, get backup generators, put in tbeds etc. carpenters can do a lot quickly.
There was a lot CEOs could have been doing 8 weeks ago.
Specifically with respect to testing, and the operations behind testing - this should have been sorted out.
There was no reason to 'lockdown' in January. The ACLU would not have sued, it would be irrelevant anyhow. College students would not be protesting en masse, and if they did, it wouldn't matter.
Once America has contained the virus, the rest of the world will need medical staff, beds, ventilators. There are 7 billion people out there, the surpluses will get used.
China was building hospitals over a 'few days' - this should have been a 'shocking moment' for everyone to start thinking about how to 'build hospitals in 2 days' or at least commandeer office towers or whatever as facilities. Knock out doors, widen entries, rip out the carpets, get backup generators, put in tbeds etc. carpenters can do a lot quickly.
There was a lot CEOs could have been doing 8 weeks ago.
There was in fact a game plan in place:
Qualls N, Levitt A, Kanade N, et al. Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017. MMWR Recomm Rep 2017;66(No. RR-1):1–34. DOI: http://dx.doi.org/10.15585/mmwr.rr6601a1
https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm
Referenced in the US CDC's Feb 25 press telebriefing:
https://www.cdc.gov/media/releases/2020/t0225-cdc-telebriefi...
Or you might want to hear from the expert who literally wrote the book on pandemic response, a quarter-centry ago:
"'Every American Should Be Outraged' Says Pandemic Expert About Government Response"
https://www.wbur.org/hereandnow/2020/03/18/us-government-res...
Qualls N, Levitt A, Kanade N, et al. Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017. MMWR Recomm Rep 2017;66(No. RR-1):1–34. DOI: http://dx.doi.org/10.15585/mmwr.rr6601a1
https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm
Referenced in the US CDC's Feb 25 press telebriefing:
https://www.cdc.gov/media/releases/2020/t0225-cdc-telebriefi...
Or you might want to hear from the expert who literally wrote the book on pandemic response, a quarter-centry ago:
"'Every American Should Be Outraged' Says Pandemic Expert About Government Response"
https://www.wbur.org/hereandnow/2020/03/18/us-government-res...
To be fair, if we had started back then there is almost zero chance that we'd need to pull in additional factories like this.
Although arguably there might not be much need now either. The companies that make these have said that production can be increased.
Although arguably there might not be much need now either. The companies that make these have said that production can be increased.
In fairness, this is a discussion of hypotheticals at this point. We're likely to need the ventilators. Other nations are likely to need the ventilators. We have to get as many companies as is reasonable making them to meet the need.
Detroit certainly has the engineering and manufacturing expertise to retool in a hurry. It's the sort of thing they do a lot of, so that sounds like a reasonable place to look for additional capacity.
As for the rest of the discussion? I mean, yeah, I suppose if Lincoln had not been shot, we might have never needed Martin Luther King. But, Lincoln was killed. So we did get MLK. Which is fine, no real reason to harp on how dumb it was to kill Lincoln.
Should've, would've, could've is less than useful when you're still at "need to". Save the shoulda woulda coulda for the post-mortem.
Detroit certainly has the engineering and manufacturing expertise to retool in a hurry. It's the sort of thing they do a lot of, so that sounds like a reasonable place to look for additional capacity.
As for the rest of the discussion? I mean, yeah, I suppose if Lincoln had not been shot, we might have never needed Martin Luther King. But, Lincoln was killed. So we did get MLK. Which is fine, no real reason to harp on how dumb it was to kill Lincoln.
Should've, would've, could've is less than useful when you're still at "need to". Save the shoulda woulda coulda for the post-mortem.
I just saw on Twitter that hospital in NY is already "double respirating" people, meaning two people share one respirator, so it seems the time to act was well before yesterday.
I don't see how people can read that and not say "Holy crap, let's not let people suffocate to death on their own phlegm" if it just means spending a few billion dollars.
I don't see how people can read that and not say "Holy crap, let's not let people suffocate to death on their own phlegm" if it just means spending a few billion dollars.
Obviously the time to act was yesterday. But we've got a chance to act today, so let's get the details of these devices shipped to Detroit in a hurry and get the retooling process started.
We should also be asking China what their capacity is? I do know they've been supplying Italy with extra ventilators, but we should see if they are able to make even more. I mean, we just need to find ways to get the requisite medical equipment into the field on a global scale. That's PPE's, that's masks, that's ventilators, that's the diagnostics, etc. Between China and the US, there is no reason that shouldn't be able to be done.
We can only start from where we are is what I'm saying. Yes, we're unprepared. Yes, we should have been prepared. Now that all that's been conceded, let's hurry up and get prepared.
We should also be asking China what their capacity is? I do know they've been supplying Italy with extra ventilators, but we should see if they are able to make even more. I mean, we just need to find ways to get the requisite medical equipment into the field on a global scale. That's PPE's, that's masks, that's ventilators, that's the diagnostics, etc. Between China and the US, there is no reason that shouldn't be able to be done.
We can only start from where we are is what I'm saying. Yes, we're unprepared. Yes, we should have been prepared. Now that all that's been conceded, let's hurry up and get prepared.
In retrospect sure, but as late as mid-January the WHO was saying there was no evidence of human-to-human transmission [1].
[1] https://twitter.com/WHO/status/1217043229427761152?ref_src=t...
[1] https://twitter.com/WHO/status/1217043229427761152?ref_src=t...
This is pure hindsight. This didn't warrant that kind of response in January, not by a longshot. In January it looked exactly like the other comparatively minor respiratory viruses that pop up every few years. We can't shut down industry and retool factories just in case.
the correct response should look like an overreaction in hindsight. But it's tough to explain the cost of the overreaction if said overreaction prevented all of these problems.
I make the analogy with an engineer receiving accolades for fixing bugs and outages with heroic effort. But the engineer that creates trouble free code, that never has any problems, but takes a long time to create code that's bug free seems to be over-cautious or over-engineering a solution. They get reprimanded for taking too long or using too much resources during development. But they never receive the praise for the non-events like no outages or no errors/issues.
I make the analogy with an engineer receiving accolades for fixing bugs and outages with heroic effort. But the engineer that creates trouble free code, that never has any problems, but takes a long time to create code that's bug free seems to be over-cautious or over-engineering a solution. They get reprimanded for taking too long or using too much resources during development. But they never receive the praise for the non-events like no outages or no errors/issues.
Yes, it probably will look like an overreaction, but that doesn't provide carte-blanche to overreact every time there's a new virus.
As GP mentioned, this happens every few years. Most of the time, it fizzles out. We can't transition all production to hospital equipment every few years, even if it is the right call twice a century.
I have often reprimanded (and have in turn been reprimanded) for overengineering a solution to a problem which just needed a quick fix, because it's not often appropriate to dedicate a lot of resources to ensuring that there are no possible errors. If it is, I'll ask for that specifically.
As GP mentioned, this happens every few years. Most of the time, it fizzles out. We can't transition all production to hospital equipment every few years, even if it is the right call twice a century.
I have often reprimanded (and have in turn been reprimanded) for overengineering a solution to a problem which just needed a quick fix, because it's not often appropriate to dedicate a lot of resources to ensuring that there are no possible errors. If it is, I'll ask for that specifically.
We keep a MASSIVE oversupply surplus for the military at all times.
If that's OK, why not do that for health related issues too?
If that's OK, why not do that for health related issues too?
You'd need to ask someone who thinks it's a good idea to keep a massive oversupply for the military. (Note that I'm not American, so I have no skin in that game.)
I don't, though, disagree with keeping a large stockpile of goods.* I just disagree with constantly kneejerk reassigning production to it.
* I still don't know that it can work, but only because I think people too quickly forget that it's important. If people could be convinced otherwise in the long term, I think it's a great idea.
I don't, though, disagree with keeping a large stockpile of goods.* I just disagree with constantly kneejerk reassigning production to it.
* I still don't know that it can work, but only because I think people too quickly forget that it's important. If people could be convinced otherwise in the long term, I think it's a great idea.
> We keep a MASSIVE oversupply surplus for the military at all times. If that's OK, why not do that for health related issues too?
When your military isn't strong enough, you get fire, rape, pillage, death, starvation and epidemics, and people really really don't like that.
When your military isn't strong enough, you get fire, rape, pillage, death, starvation and epidemics, and people really really don't like that.
Or miscellaneous actors stepping on your oil supply lines and shipping traffic.
Most people would accept that epidemics (let alone pandemics) are bad enough on their own. Many people would say bad enough to avoid a Just In Time approach to public health.
Maybe most people would. But I've heard first hand accounts of how devastating it is to lose a war, and I'll go with that.
May I recommend "Savage Continent":
https://www.amazon.com/Savage-Continent-Europe-Aftermath-Wor...
It was so terrible I abandoned reading it.
May I recommend "Savage Continent":
https://www.amazon.com/Savage-Continent-Europe-Aftermath-Wor...
It was so terrible I abandoned reading it.
So, how many lives will justify spending more money?
Should we spend $1 billion to save 500,000 people? Less? What's your cutoff for (most probable number of lives saved)*(money per life)?
Should we spend $1 billion to save 500,000 people? Less? What's your cutoff for (most probable number of lives saved)*(money per life)?
Why do you assume that lives will be saved by redistributing resources like the ancestor proposed?
Once in fifty years it will save lives, certainly. What about the shortage of other manufactured goods the other twenty times a century that you reassign factories to diseases that turn out to be nothing?
I think it's a bad idea because it will hurt people, not because I want to save money.
EDIT: Removed a political aside.
Once in fifty years it will save lives, certainly. What about the shortage of other manufactured goods the other twenty times a century that you reassign factories to diseases that turn out to be nothing?
I think it's a bad idea because it will hurt people, not because I want to save money.
EDIT: Removed a political aside.
Most of the time it's a new flu for which we can make a vaccine quickly and isn't a huge threat. This one we knew was novel, a spreader and a killer.
SARS, swine flu, bird flu, ebola - just in the past couple of decades these all caused considerable concern of pandemic. We're talking about what we knew of COVID19 in January here, which was basically nothing.
Hindsight justification for which ones were a real problem isn't useful.
Hindsight justification for which ones were a real problem isn't useful.
See also the Y2K bug
Not sure if you recall, but in January China put large portions of the country under lockdown in a quarantine effort of unprecedented scale. At that point, the writing was on the wall that this was not something that "looked exactly like the other comparatively minor respiratory viruses that pop up every few years".
The timeline is interesting. The lockdown started on Jan 23. At this point they had a few thousand cases and 50 or so deaths, less than many countries have now.
The announcement of transmission without symptoms came out on Jan 26. Around this time China also extended restrictions over the whole country.
Many countries including the US started announcing travel restrictions on travelers from China in the next few days, to take effect around Feb 1. The WHO and China called it an overreaction.
The announcement of transmission without symptoms came out on Jan 26. Around this time China also extended restrictions over the whole country.
Many countries including the US started announcing travel restrictions on travelers from China in the next few days, to take effect around Feb 1. The WHO and China called it an overreaction.
> This didn't warrant that kind of response in January
Could China's mobilization of resources have been a hint to us that this would have made sense? Even early on there were stories breaking of people taking double doses of some meds to lower their temperature to get through fever screening. Shortly after that we found out there was a very long incubation period. Shortly after that there was talk of mild/asymptomatic spread.
All the while no one shut down air travel and boarders while China locked down it's country.
It's not the time to play the blame game but saying this is entirely hindsight doesn't make sense to me. Many people were talking about stocking and isolating in Jan/Feb. Back then they are just met with misinformed masses "the flu kills..."
Could China's mobilization of resources have been a hint to us that this would have made sense? Even early on there were stories breaking of people taking double doses of some meds to lower their temperature to get through fever screening. Shortly after that we found out there was a very long incubation period. Shortly after that there was talk of mild/asymptomatic spread.
All the while no one shut down air travel and boarders while China locked down it's country.
It's not the time to play the blame game but saying this is entirely hindsight doesn't make sense to me. Many people were talking about stocking and isolating in Jan/Feb. Back then they are just met with misinformed masses "the flu kills..."
We cancelled international travel plans in mid-January because of the expanding virus within China and the first cases in other countries. It was clear by then that there was no containment and the spread was underway.
The federal govt has even more insight than average people watching the news and should've acted aggressively in closing borders and improving capacity. US (and EU) have reacted terribly late to all of this.
The federal govt has even more insight than average people watching the news and should've acted aggressively in closing borders and improving capacity. US (and EU) have reacted terribly late to all of this.
> The federal govt has even more insight than average people watching the news
We'd like to believe this, but are we sure it is true? The internet and social media have given us realtime global connectivity. Sans filtering out disinformation and accessing truly classified information, we have it all at our fingertips.
> ... and should've acted aggressively in closing borders and improving capacity.
I was laying in bed in January, laid up with the flu, and all I was reading about was this virus and what it was doing to China. I didn't call my representatives to warn them, did you? I think that we Americans should take more responsibility for our self-government than we currently do.
We'd like to believe this, but are we sure it is true? The internet and social media have given us realtime global connectivity. Sans filtering out disinformation and accessing truly classified information, we have it all at our fingertips.
> ... and should've acted aggressively in closing borders and improving capacity.
I was laying in bed in January, laid up with the flu, and all I was reading about was this virus and what it was doing to China. I didn't call my representatives to warn them, did you? I think that we Americans should take more responsibility for our self-government than we currently do.
Yes, we have very capable intelligence services with plenty of resources. I guarantee they knew of the first cases within days back in November.
I don't need to call the government to tell them to do their job.
I don't need to call the government to tell them to do their job.
On January 23rd China quarantined an entire city of 11 million people. Nobody does that for a minor respiratory virus.
By late January the Chinese government had already ordered the lockdown in Wuhan. There were plenty of signs that this wasn't an unremarkable minor respiratory virus.
Maybe if your only source of news was Fox News.
We didn’t know this virus was going to be this bad, but we knew that we were overdue for one and there had been recent epidemics that targeted respiratory systems. Our respirator stockpile was in the tens of thousands—several orders of magnitude lower than would be necessary in a national emergency.
SARS happened less than 20 years ago. We should have been well aware what happens with these types of coronaviruses.
It's pure understanding of middle school math and exponential growth.
We should already have the ventilator in stock beforehand.
A common catchphrase: The best time to plant a tree was 20 years ago. The second best time to plant a tree is today.
This is what Musk should be doing.
Let us all remember that he told the tesla factory workers to come in or take unpaid sick leave.
He has now jumped on the ventilator bandwagon. I'm sure it strikes him am as an excellent way to be considered an essential business.
His behavior during this time of crisis has not been laudable. He deserves to be thoroughly spanked.
He has now jumped on the ventilator bandwagon. I'm sure it strikes him am as an excellent way to be considered an essential business.
His behavior during this time of crisis has not been laudable. He deserves to be thoroughly spanked.
Although, based on his history, he might try to design a “better” ventilator and when medical experts say they’re not fit for purpose he’ll go on a Twitter tantrum and call them pedophiles.
Musk thinks it’s hype
https://twitter.com/elonmusk/status/1239756900255903744
That's an overstatement of what he said. He had been posting about possible medical treatments [1], which is why the tweet you linked to starts with "That said" before talking about panicking and redirecting medical resources away from people who need it.
Do you know why? The drug he was posting about before that tweet, `chloroquine`, is already facing shortages around the globe for people already on it for non-COVID-19 treatments, including people suffering from Lupus [2].
He probably got attacked for promoting it in previous tweets, which is the likely context of the one you linked to, and is regardless a very valid concern for a popular figure tweeting about possible treatments. I've seen others telling people to be cautious promoting it, as we don't need people also needlessly hoarding a critical drug which is quickly becoming a frontline treatment for Coronavirus.
[1] https://twitter.com/elonmusk/status/1239776019856461824
[2] https://twitter.com/search?q=lupus%20shortage
Do you know why? The drug he was posting about before that tweet, `chloroquine`, is already facing shortages around the globe for people already on it for non-COVID-19 treatments, including people suffering from Lupus [2].
He probably got attacked for promoting it in previous tweets, which is the likely context of the one you linked to, and is regardless a very valid concern for a popular figure tweeting about possible treatments. I've seen others telling people to be cautious promoting it, as we don't need people also needlessly hoarding a critical drug which is quickly becoming a frontline treatment for Coronavirus.
[1] https://twitter.com/elonmusk/status/1239776019856461824
[2] https://twitter.com/search?q=lupus%20shortage
Chloroquine is already on the WHO list of 'essential medicines', and can be made very cheaply as a generic. Any shortages would be quite temporary indeed; the last thing you want to do in such circumstances is suppress latent demand for it and repeat the whole masks/respirators/hand sanitizer fiasco.
That doesn't mean much to the people with Lupus having their pharmacist tell them it's on "backorder", far less than not having hand sanitizer. One would hope it's only temporary.
On the brighter side, France has a company promising to produce millions of doses:
> French manufacturer Sanofi has said it could hypothetically offer enough doses of Plaquenil - a drug containing the molecule hydroxychloroquine - to treat up to 300,000 people if necessary.
https://www.connexionfrance.com/French-news/French-lab-Sanof...
Not sure what the status is on other generic pharma companies who produce it. I know Teva produces chloroquine, but not hydroxychloroquine (Plaquenil) which is apparently "3x more effective" with coronavirus, and is mostly based in the US (NJ). I'm sure they've all been aware of this since February at a minimum when it first made the rounds as a possible treatment.
On the brighter side, France has a company promising to produce millions of doses:
> French manufacturer Sanofi has said it could hypothetically offer enough doses of Plaquenil - a drug containing the molecule hydroxychloroquine - to treat up to 300,000 people if necessary.
https://www.connexionfrance.com/French-news/French-lab-Sanof...
Not sure what the status is on other generic pharma companies who produce it. I know Teva produces chloroquine, but not hydroxychloroquine (Plaquenil) which is apparently "3x more effective" with coronavirus, and is mostly based in the US (NJ). I'm sure they've all been aware of this since February at a minimum when it first made the rounds as a possible treatment.
> That doesn't mean much to the people with Lupus having their pharmacist tell them it's on "backorder"
Well, we'd have to choose between telling the people with Lupus that, and telling the folks with SARS-CoV-2 the same thing, except even worse (because suppliers have not had a chance to react to that increased demand). Are we sure that the former is preferable?
Well, we'd have to choose between telling the people with Lupus that, and telling the folks with SARS-CoV-2 the same thing, except even worse (because suppliers have not had a chance to react to that increased demand). Are we sure that the former is preferable?
The question is typically between hoarders and people who need it, at least in the context of a popular figure tweeting about it.
It's available in many countries over the counter, so you can't be sure it will only be purchased with a predefined need.
It's available in many countries over the counter, so you can't be sure it will only be purchased with a predefined need.
He also literally said "The coronavirus panic is dumb":
https://twitter.com/elonmusk/status/1236029449042198528
https://twitter.com/elonmusk/status/1236029449042198528
Yeah, that's not a helpful thing to say, but the comment I'm referring to was his own direct reply to his tweet about Chloroquine (see linked tweets above).
Regarding that tweet, the only pass it was from March 6 (maybe, but probably not, best not to say anything early on). Even our Canadian gov spent the last month or so saying "there's no scientific evidence supporting border closure" [1], including in comments by our health minister a few days before they indeed closed all of Canada's borders. Nearly every person getting diagnosed w/ COVID-19 in Ontario has traveled recently, even the cases from today [2].
Nothing wrong with being wrong and later being educated on the seriousness - Elon seems to have changed his tune recently which is good. A concept that is frequently lost in our social media outrage machine. Not everyone is wise enough to not make public statements with such certainty, even our well-educated health ministers... meanwhile panic buying TP didn't do anyone any good either.
[1] https://www.thestar.com/politics/federal/2020/03/12/after-tr...
[2] https://www.ontario.ca/page/2019-novel-coronavirus#section-0 (note: how travel + country name is next to almost every case, even well into March 18th)
Regarding that tweet, the only pass it was from March 6 (maybe, but probably not, best not to say anything early on). Even our Canadian gov spent the last month or so saying "there's no scientific evidence supporting border closure" [1], including in comments by our health minister a few days before they indeed closed all of Canada's borders. Nearly every person getting diagnosed w/ COVID-19 in Ontario has traveled recently, even the cases from today [2].
Nothing wrong with being wrong and later being educated on the seriousness - Elon seems to have changed his tune recently which is good. A concept that is frequently lost in our social media outrage machine. Not everyone is wise enough to not make public statements with such certainty, even our well-educated health ministers... meanwhile panic buying TP didn't do anyone any good either.
[1] https://www.thestar.com/politics/federal/2020/03/12/after-tr...
[2] https://www.ontario.ca/page/2019-novel-coronavirus#section-0 (note: how travel + country name is next to almost every case, even well into March 18th)
Giving the benefit of the doubt, maybe the emphasis was on the "panic" part.
It doesn't seem unreasonable, even if it might be unhelpful. Most kinds of panic are dumb.
That's just bureaucracy in the West. I have contacts in the East who got me Lariago-DS. Super cheap to manufacture, super compact, easy to ship. In fact, it's in plentiful supply. Just not in the West because you have a customs wall.
Drop the wall and you'll have your drugs in days. If you have 'backorders' for your Lupus patients, then you've already failed at something trivial to solve.
Drop the wall and you'll have your drugs in days. If you have 'backorders' for your Lupus patients, then you've already failed at something trivial to solve.
[deleted]
Elon Musk does not owe people anything. If he decides to produce them, that's fine, but he doesn't have to.
But the governments should buy these ventilators from private companies, so private companies like Tesla or GM were incentivized to produce these ventilators.
Edit: added and then removed a comment about downvotes
But the governments should buy these ventilators from private companies, so private companies like Tesla or GM were incentivized to produce these ventilators.
Edit: added and then removed a comment about downvotes
The point is not whether or not Musk owes it to anyone. But that some people claim to be making the world a better place, and others batten down and actually do make the world a better place. And usually the latter is a lot less glamorous than the former.
Yeah, I'm as big of a Tesla fan as you'll find but the lack of closing the factory in one of the epicenters has really lowered my opinion of his leadership.
While I understand he's one to zig when everyone zags I feel like this will be a case where it will become clear that it was a bad call.
While I understand he's one to zig when everyone zags I feel like this will be a case where it will become clear that it was a bad call.
I guess people at the factory do few close contacts which can lead to virus transmission. And I guess they are supplied with hand sanitizers and handwashing is mandatory.
On the other hand, people get paid, the factory is saved from bankruptcy so people can continue working in the factory even after the end of the outbreak.
I'm not sure that closing the factory is a universally good decision for society.
Edit: English
On the other hand, people get paid, the factory is saved from bankruptcy so people can continue working in the factory even after the end of the outbreak.
I'm not sure that closing the factory is a universally good decision for society.
Edit: English
Considering that the virus can live for up to 9 days on metal, glass or plastic[1] I'm not sure that mandatory hand washing is going to do much in an assembly line where everyone interacts directly vehicles on the line.
[1] https://www.journalofhospitalinfection.com/article/S0195-670...
[1] https://www.journalofhospitalinfection.com/article/S0195-670...
I think the absolute risk must be low for surface transmission. Otherwise we'd just be getting our coronavirus from the grocery store and deliveries?
From what I've seen it survives 2-3x less on cardboard[1] compared to plastic/metal. Probably a vector, but less likely than hard surfaces.
That said the best way to not transmit it is to shut down non-essential services and focus on flattening the curve.
[1] https://www.bbc.com/future/article/20200317-covid-19-how-lon...
That said the best way to not transmit it is to shut down non-essential services and focus on flattening the curve.
[1] https://www.bbc.com/future/article/20200317-covid-19-how-lon...
I think they work in gloves (https://www.vox.com/policy-and-politics/2019/6/26/18744304/c... for the picture).
a factory full of people using gloves and alcohol sanitizers will spread the virus unless the people are trained and experienced in sterile technique.
I guess it will spread it significantly slower than an office, a train or a restaurant. Probably R0 < 1 in the factory.
[deleted]
Those numbers really don't tell you anything about how viable surface transmission is as a vector from person to person. It doesn't seem to be a major transmission pathway based on all the available evidence so far.
I wish more people could have this balanced viewpoint. Maybe it's a good decision, maybe it isn't, but the fact that there's a virus spreading shouldn't cause us to all get one-track minds all of a sudden.
People's economic situation is important to their health too, and their job is usually the biggest part of that.
People's economic situation is important to their health too, and their job is usually the biggest part of that.
Let's be fair, Elon has had plenty of accomplishments in "making the world a better place". I don't see the point of all this concentrated attention on one person as if he's the savior to every problem.
Cite some examples?
Advancements in electric transportation, solar power and battery technology for a cleaner and more sustainable energy grid. Efficient access to space leading to more commercial development including cheap worldwide broadband. 2 major corporations creating thousands of jobs and billions in market value.
- introduced easy payment decades ago (PayPal)
- reduced the cost of launching satellites significantly
- has made electric cars 'cool'
- by doing this has inspired people to take risks and be visionary
Don't get me wrong, he's certainly got his flaws, and Tesla has it's challednges cut out for them. But you have to credit him: he's made his dent, and is working on further dents as we speak.
- reduced the cost of launching satellites significantly
- has made electric cars 'cool'
- by doing this has inspired people to take risks and be visionary
Don't get me wrong, he's certainly got his flaws, and Tesla has it's challednges cut out for them. But you have to credit him: he's made his dent, and is working on further dents as we speak.
Making the ventilators is not the only way to make world a better place.
I consider my daytime job making the world a better place even in these dark days. But I don't work at ventilators factoy (or in hospital, or in anything directly related to coronavirus).
(Edit: clarification; cleanup)
I consider my daytime job making the world a better place even in these dark days. But I don't work at ventilators factoy (or in hospital, or in anything directly related to coronavirus).
(Edit: clarification; cleanup)
Talking about downvoting is very taboo on HN. It's in the FAQ/guidelines.
Relax, I've had countless comments start off downvoted then turn into +30 by the end of the day. It's a silly thing to get upset about, as long as you originally commented with earnest intentions there's nothing to worry about (even being wrong, if misunderstood then try harder next time to communicate it better).
Relax, I've had countless comments start off downvoted then turn into +30 by the end of the day. It's a silly thing to get upset about, as long as you originally commented with earnest intentions there's nothing to worry about (even being wrong, if misunderstood then try harder next time to communicate it better).
I have not found it in the FAQ/guidelines, but anyway, I have removed these notes. Thanks!
> Please don't comment about the voting on comments. It never does any good, and it makes boring reading.
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
> if you decided to downvote, please at least explain why. Because I don't believe lefts conquered the HN.
I downvoted because you assumed it was the “lefts” who were downvoting you.
I downvoted because you assumed it was the “lefts” who were downvoting you.
Well, at least thank you for the explanation!
I'll downvote any comment that complains about downvotes. I didn't get to yours before you edited it, so no downvote from me.
Tbh, I only ever see up arrows beside a comment, Today I learned downvoting is possible.
What are the conditions on being able to downvote ?
What are the conditions on being able to downvote ?
500 >= karma I think
Thanks for your honesty, This barrier to entry just convinced me to consider looking elsewhere for moderated comments.
If there is such a high bar to moderation it pretty much means that only those with the best 'crowd appeal' will get this, and these are not the people that I consider worth listening to in most circumstances.
If there is such a high bar to moderation it pretty much means that only those with the best 'crowd appeal' will get this, and these are not the people that I consider worth listening to in most circumstances.
No one is saying Musk owes people or has to do it. No one.
[deleted]
You're right, Elon has no inherent responsibility to solve this (he's not Batman to call on whenever we need). Many large companies are already open to helping. There's no shortage of willing capacity.
What they need is approval and guidance from the government, that's where the failure is. Notice there's still no reply taking up GM on their offer.
What they need is approval and guidance from the government, that's where the failure is. Notice there's still no reply taking up GM on their offer.
> What they need is approval and guidance from the government
I actually think these companies need orders from the governments, not just approval and guidance.
People compared coronavirus with war in this thread. AFAIK private companies made tanks and guns for money, not for free during WW2 (except for USSR).
I actually think these companies need orders from the governments, not just approval and guidance.
People compared coronavirus with war in this thread. AFAIK private companies made tanks and guns for money, not for free during WW2 (except for USSR).
Yes, there are special provisions during wartime, but it's unlikely we'll have that in response to a virus pandemic.
GM should just start the process of making them anyway.
There are medical equipment manufacturers better suited for this role. GM is a last resort and this is more of a symbolic gesture.
Live saving ventilators of various designs have been around a long time:
http://rc.rcjournal.com/content/56/8/1170
A ventilator that saves lives does not need to be the latest, most sophisticated technology, especially when the alternative is death.
http://rc.rcjournal.com/content/56/8/1170
A ventilator that saves lives does not need to be the latest, most sophisticated technology, especially when the alternative is death.
There's an idea of civic and social duty. The basic idea is that when one's society faces an existential crisis then those in that society with the means to help have a duty to do so. This is because the society in which they exist has provided them with a social structure that has, ideally, provided them with stability, some amount of prosperity, etc. It seems some people don't believe in this. It's sad.
This isn't about "lefts". It's about people who view their society as facing an existential crisis and believing that everyone in the society should respond to their duty. This duty may be as simple as social distancing but for those with productive means, it may mean working on vaccines, producing face masks, producing sanitary supplies, supplying food, etc.
This isn't about "lefts". It's about people who view their society as facing an existential crisis and believing that everyone in the society should respond to their duty. This duty may be as simple as social distancing but for those with productive means, it may mean working on vaccines, producing face masks, producing sanitary supplies, supplying food, etc.
May I add a controversial comment again please? It will be downvoted again, sadly, I'll create a new account after this thread.
People who say that Musk should use all his resources to help society, usually do nothing themselves (I'm not speaking about you personally). It's pure virtue signalling.
Elon musk can loose 10% of his money switching from producing Teslas to producing ventilators.
But everyone can use their 10% of time to help homeless, care for elders. Or at least donate 10% of their income to coronavirus charities.
But somehow people think that Musk has to spend his resoures, but they don't have to. That's not fair.
People who say that Musk should use all his resources to help society, usually do nothing themselves (I'm not speaking about you personally). It's pure virtue signalling.
Elon musk can loose 10% of his money switching from producing Teslas to producing ventilators.
But everyone can use their 10% of time to help homeless, care for elders. Or at least donate 10% of their income to coronavirus charities.
But somehow people think that Musk has to spend his resoures, but they don't have to. That's not fair.
There's nothing controversial about saying some people demand from others that which they won't give themselves. The point, though, as I made in my response to yours, is that people's duty will vary by their means. Some people won't be able to do anything more in this case to help society than simple sheltering in place, some may just be able to donate a few dollars here and there but some people have the ability, because they own the capital, to make outsized impacts.
That said, it is classic whataboutism in this context. That some demand more than they will give doesn't absolve someone of their civic duty in an existential crisis.
That said, it is classic whataboutism in this context. That some demand more than they will give doesn't absolve someone of their civic duty in an existential crisis.
10% of Musk's money is much less of a burden on Musk, marginal utility and all.
This might be true only for the poorest people who are starving, or for people who only spend money, not make them.
When I was younger and did not have savings, I did not care about money at all: I could spend money wherever I wanted, and it did not matter, because I could not spend more than I had. Money were worthless to me.
But now I have to save: every extra penny spent is subtracted from my future home.
But for Musk money even more valuable: I imagine the risk of loosing business is much more important than having to live in a slightly cheaper home in 20 years.
When I was younger and did not have savings, I did not care about money at all: I could spend money wherever I wanted, and it did not matter, because I could not spend more than I had. Money were worthless to me.
But now I have to save: every extra penny spent is subtracted from my future home.
But for Musk money even more valuable: I imagine the risk of loosing business is much more important than having to live in a slightly cheaper home in 20 years.
I don't want to disappoint anyone, but they are stating "we stand ready to do this" but the tacit follow up is "when we are asked to".
The president has stated he is not ready to ask them
"He's casting doubt over whether he will actually implement a move to invoke the Defense Production Act -- that he signed on Wednesday and that gives him authority to order industry to work towards homeland defense and national goals. In this case, it could speed the production of badly needed ventilators, masks and other supplies for hospital workers" - https://www.cnn.com/2020/03/19/politics/donald-trump-leaders...
FEMA and the Army Corp of Engineers have said the same thing. For some reason they are not being mobilized while CA, WA, NY/CT/NJ are dealing with a crisis and have asked for that help, formally and officially. Meanwhile, ICE is fully deployed and arresting people in hospitals, then concentrating them together without adequate separation.
GM and Tesla (and Ford, and all other domestic manufacturers that have done so) should be saluted for volunteering to help. But there is a slow-walking of the response and something very, very rotten is going on in some areas at a coordination level in the US.
The president has stated he is not ready to ask them
"He's casting doubt over whether he will actually implement a move to invoke the Defense Production Act -- that he signed on Wednesday and that gives him authority to order industry to work towards homeland defense and national goals. In this case, it could speed the production of badly needed ventilators, masks and other supplies for hospital workers" - https://www.cnn.com/2020/03/19/politics/donald-trump-leaders...
FEMA and the Army Corp of Engineers have said the same thing. For some reason they are not being mobilized while CA, WA, NY/CT/NJ are dealing with a crisis and have asked for that help, formally and officially. Meanwhile, ICE is fully deployed and arresting people in hospitals, then concentrating them together without adequate separation.
GM and Tesla (and Ford, and all other domestic manufacturers that have done so) should be saluted for volunteering to help. But there is a slow-walking of the response and something very, very rotten is going on in some areas at a coordination level in the US.
Can you point us to some current sources about ICE arresting people at hospitals?
There was a viral photo a few days ago. There a lot of context around it: https://www.motherjones.com/politics/2020/03/the-right-and-w...
It basically boils down to "ICE has a policy of not arresting anyone at hospitals; this was a special case where someone they were in the middle of arresting had to be taken to a hospital, and they continued as soon as he was discharged".
It basically boils down to "ICE has a policy of not arresting anyone at hospitals; this was a special case where someone they were in the middle of arresting had to be taken to a hospital, and they continued as soon as he was discharged".
As a counter point; ICE has recently said they will only be arresting illegal immigrants who pose a public safety risk and will be delaying enforcement actions until after the crisis for others.
https://www.cbsnews.com/news/ice-says-it-will-not-detain-mos...
https://www.cbsnews.com/news/ice-says-it-will-not-detain-mos...
Not a counterpoint. I just hadn't heard that, yet. That would be most welcome news. There are other steps (releasing nonviolent offenders from prison and other confinement) that might be politically unpopular but urgently need to be done.
For me, it's obvious that a virus that starts on the other side of the world and could kill millions of Americans is an urgent national security problem and the defense department should be involved.
And if we don't currently have a need for extra ventilators (which I'm sure we do) there are other countries who do have that need and this virus doesn't care which human defined borders it is within.
If it were me, I'd ramp up production across the US, so that WHEN we have the need, we will be operating at high capacity and if we have excess, we distribute them to the world to save human lives and protect future American lives.
And if we don't currently have a need for extra ventilators (which I'm sure we do) there are other countries who do have that need and this virus doesn't care which human defined borders it is within.
If it were me, I'd ramp up production across the US, so that WHEN we have the need, we will be operating at high capacity and if we have excess, we distribute them to the world to save human lives and protect future American lives.
> For me, it's obvious that a virus that starts on the other side of the world and could kill millions of Americans is an urgent national security problem and the defense department should be involved.
Well, as I understand it, Defense Production Act would mean for-profit companies who are earning lots of money on the current event would earn less money. If any of these people who earn money on the current event is sitting in the current administration, it makes sense that they don't see any huge issues with not using the Defense Production Act. I guess that's what you get when a country solely focuses on capitalism since it's inception.
The following quote, while not exactly for this situation, comes to mind:
> It Is Difficult to Get a Man to Understand Something When His Salary Depends Upon His Not Understanding It
Well, as I understand it, Defense Production Act would mean for-profit companies who are earning lots of money on the current event would earn less money. If any of these people who earn money on the current event is sitting in the current administration, it makes sense that they don't see any huge issues with not using the Defense Production Act. I guess that's what you get when a country solely focuses on capitalism since it's inception.
The following quote, while not exactly for this situation, comes to mind:
> It Is Difficult to Get a Man to Understand Something When His Salary Depends Upon His Not Understanding It
I agree that they may have to stop short-term money making, however I think the opportunity is to convince them that the more damage this virus does to the world, the more damage it does to their market, and therefore to their long-term financial interests. Plus, there could be tremendous goodwill gained by deciding to join the efforts to save people's lives—that alone could guarantee them customers for life. Lastly, I understand that the big 3 automotive companies are shutting down their production of cars right now anyway, so the factories will likely sit idle.
ICE has announced it will not be detaining people other than those deemed a threat to public safety.
https://www.tpr.org/post/ice-halts-most-arrests-amid-coronav...
https://www.tpr.org/post/ice-halts-most-arrests-amid-coronav...
Since the beginning of the crisis it has been clear to the people who know how to do stuff like curve fits that the universal global response policy of every government has been to wait for a need before asking that the need be filled. The closest any country came to a proactive response was the SARS countries who had some pandemic plans. I expect that, in line with history, Trump will wait for a ventilator shortage before doing anything to help increase ventilator production. That's not a criticism of Trump, that's a criticism of the way leaders around the world work.
(Note: the New York ventilator shortage doesn't necessarily count because there are still ventilators available elsewhere.)
(Note: the New York ventilator shortage doesn't necessarily count because there are still ventilators available elsewhere.)
Don't offer.
Do it.
Start making ventilators by the thousand. Screw patents, screw official sanction - when things get dire, the world will take every one we can get.
Do it.
Start making ventilators by the thousand. Screw patents, screw official sanction - when things get dire, the world will take every one we can get.
Yeah I'm not sure that's a good idea. I can only imagine it would cost millions to retool for ventilators - especially if you start just cranking it inventory.
Before you do that you want to make darn sure that they're actually needed or you're just burning money.
Before you do that you want to make darn sure that they're actually needed or you're just burning money.
Offering is the correct first move. Even soup kitchens need structure, guidance, and leadership. You can't just go in as a new volunteer and just do whatever tasks you feel like doing just because you think it needs to be done.
animalnewbie(3)
> There are going to be a lot of comments about how we messed up, wasted time, etc., but they miss the point.
That, ironically, misses the point of the existing comments about how we wasted time.
By wasting time, lots of people are going to die that didn't need to die. None of that has to do with mobilization itself or the issues that we run into during mobilization, it has to do with when we decided to mobilize.
That, ironically, misses the point of the existing comments about how we wasted time.
By wasting time, lots of people are going to die that didn't need to die. None of that has to do with mobilization itself or the issues that we run into during mobilization, it has to do with when we decided to mobilize.
We detached this subthread from https://news.ycombinator.com/item?id=22623990.
I've seen this a lot but never understood what that exactly means. What happens when you detach a subthread?
It becomes a top level comment instead of a child of its original parent. Does that make sense?
At the risk of being argumentative I would point out that many Americans died unnecessarily at the beginning of WWII as well. This is a common pattern in wars.
I think you can take this analogy too far. If I were to do so, I'd say that the OP is suggesting that Pearl Harbor was attacked, the President said it was no big deal, just one Japanese plane, and the country collectively twiddled their thumbs while the enemy advanced.
Well, at the risk of pointing out the obvious, the US did twiddle its thumbs for at least two years after the outbreak of WW2. Earlier intervention may have virtually stopped it (in Europe at least).
Sure, though I believe that during those 2 years the US was also trying to decide which part they should enter the war on. There were influential Nazi supporters in the US, and Russian 'communism' was probably seen as a bigger ideological problem than antisemitism to many.
While there was a certain amount of bi-directional influence (Hitler taking inspiration from the KKK, the German-American Bund being the local Nazi party) there was never any question of entering the war on the Nazi side, and indeed Lend-Lease started in early 1941, months before Pearl Harbor, including supplying arms to the Soviet Union.
The private sector was still supplying Nazi Germany while the US was officially neutral, though.
The private sector was still supplying Nazi Germany while the US was officially neutral, though.
True.
Not sure why everything is always compared to a war in any case? We have a war on this, a war on that. You can compare anything to a war, but that doesn't mean you're going to get useful insights out of the exercise.
I mean, yeah, I suppose it's Pearl Harbor is attacked and we twiddled our thumbs, but what insights useful right now in dealing with this virus does that comparison uncover? It's kind of just noise at this point. Save it for the post-mortem and the history books. It's not terribly useful right now. And it's certainly not useful to tell Americans at this point that it's necessary and common that many of them will need to die unnecessarily because, "that's always the way".
Not sure why everything is always compared to a war in any case? We have a war on this, a war on that. You can compare anything to a war, but that doesn't mean you're going to get useful insights out of the exercise.
I mean, yeah, I suppose it's Pearl Harbor is attacked and we twiddled our thumbs, but what insights useful right now in dealing with this virus does that comparison uncover? It's kind of just noise at this point. Save it for the post-mortem and the history books. It's not terribly useful right now. And it's certainly not useful to tell Americans at this point that it's necessary and common that many of them will need to die unnecessarily because, "that's always the way".
> It's kind of just noise at this point. Save it for the post-mortem and the history books. It's not terribly useful right now.
If we were serving in the White House right now I'd agree with you. But we're just people shooting the shit online, I don't really see what harm it does to discuss the things that are on our minds. Nothing we’re talking about here is really all that useful in terms of tackling the issue in front of us all.
If we were serving in the White House right now I'd agree with you. But we're just people shooting the shit online, I don't really see what harm it does to discuss the things that are on our minds. Nothing we’re talking about here is really all that useful in terms of tackling the issue in front of us all.
[deleted]
Pearl harbor is a bad example as harm prevention was carried out prior to the attack (2 missing aircraft carriers).
American casualties at the beginning of WW2 were actually quite low as the US didn't enter the war until 1942 (WW2 began in 1939).
We are not at war. We are +T two months since the first confirmed case in the USA and had warning nearly a month prior to that, and the Federal government has done almost nothing of substance other than reject tests and advice from nations who have been fighting this far better than we have, because they have functional health services.
Weren't they the first to limit then ban travel from Wuhan / China. To say they have done nothing sounds political. Good and poor decisions were made.
In addition to enacting the CDC effort to distribute tests.
That some of those tests were contaminated, or that the FDA may have made a hard call in proceeding with redistribution or calling an audible to multi-sourced testing, is a strategic problem.
But let's not say nothing was done. I'm sure there were plenty of sleepless nights at the CDC, before we even had confirmed US cases.
(Happened to drive by it today. And it's easy to forget that there are people, just like us, who are trying to do their best there. We all make mistakes. And sometimes we don't, but our bosses do, and we get blamed for it anyway.)
That some of those tests were contaminated, or that the FDA may have made a hard call in proceeding with redistribution or calling an audible to multi-sourced testing, is a strategic problem.
But let's not say nothing was done. I'm sure there were plenty of sleepless nights at the CDC, before we even had confirmed US cases.
(Happened to drive by it today. And it's easy to forget that there are people, just like us, who are trying to do their best there. We all make mistakes. And sometimes we don't, but our bosses do, and we get blamed for it anyway.)
The US refused the WHO tests and wanted to create their own.
https://www.snopes.com/fact-check/us-coronavirus-test/
That's kind of like saying "I've got a motherboard, am missing an Intel CPU, but AMD has CPUs, so I'll just put one of those in there."
Rolling out testing on the scale that was obviously needed even then is a non-trivial thing, requiring coordination of multiple parties, all in a climate of dubious information.
So, yeah, I think it's understandable (a) to stick to a prearranged plan (to avoid the risk of debilitating testing chaos), (b) to desire a domestic supply of tests, & (c) to avoid drawing on a global resource when there was expected to be no need.
As Dr. Fauci says, hindsight is 20/20.
That's kind of like saying "I've got a motherboard, am missing an Intel CPU, but AMD has CPUs, so I'll just put one of those in there."
Rolling out testing on the scale that was obviously needed even then is a non-trivial thing, requiring coordination of multiple parties, all in a climate of dubious information.
So, yeah, I think it's understandable (a) to stick to a prearranged plan (to avoid the risk of debilitating testing chaos), (b) to desire a domestic supply of tests, & (c) to avoid drawing on a global resource when there was expected to be no need.
As Dr. Fauci says, hindsight is 20/20.
What pre-arranged plan?
https://www.cdc.gov/flu/pandemic-resources/national-strategy...
What do you think the CDC does in the years there aren't pandemics?
What do you think the CDC does in the years there aren't pandemics?
I don’t know because most of those materials you linked to from the CDC are from 2005.
I see more recent docs from HHS.
So, what has the CDC been doing the last 15 years?
I see more recent docs from HHS.
So, what has the CDC been doing the last 15 years?
I'm going to leave Googling as an exercise for the reader. :)
Well, if it was a true ban, nobody that had travelled from Wuhan would have been allowed back.
The ban did not apply to US citizens.
The ban did not apply to US citizens.
There were conflicting issues that seem to be coming out now.
https://www.redstate.com/nick-arama/2020/03/18/who-claimed-i...
https://www.thetimes.co.uk/article/chinese-scientists-destro...
https://www.thetimes.co.uk/article/chinese-scientists-destro...
No, wasting time is retrospective.
In technical terms, wasted time is a conclusion of the signals derived from waiting for those time.
In technical terms, wasted time is a conclusion of the signals derived from waiting for those time.
whiddershins(2)
leereeves(4)
That's a total fantasy when you consider rare earths. And they know it. The military can produce basically nothing without resources for China.
We detached this subthread from https://news.ycombinator.com/item?id=22625337.
Nope, rare earth elements are common pretty much everywhere. The only reason companies buy them from China is because they're cheaper due to their lower wages and lack of environmental protection.
When China limited export of rare earths, leading to a dispute with Western countries, all that happened was suddenly Western mining firms became viable and attracted investment. China then dropped the export limits and dropped the price to force those companies out of business.
When China limited export of rare earths, leading to a dispute with Western countries, all that happened was suddenly Western mining firms became viable and attracted investment. China then dropped the export limits and dropped the price to force those companies out of business.
Same thing the Chinese did with solar panels back in the early 2000s. Subsidise national production so it could run at a loss, forcing others out of business and cornering the market.
In some sense it's pretty obvious that a free market capitalist system will mostly lose in competition with a state regulated system, if the latter decides it is important to have control of a sector.
In some sense it's pretty obvious that a free market capitalist system will mostly lose in competition with a state regulated system, if the latter decides it is important to have control of a sector.
Ironically, around the same time, China was admitted to the WTO.
On the other hand China is giving us free money/stuff when they sell it below cost.
Yes, so on the short term that’s a benefit. But when it means the us/world doesn’t invest in a crucial piece of our infrastructure that would take many years to establish then it’s a net loss.
> In some sense it's pretty obvious that a free market capitalist system will mostly lose in competition with a state regulated system, if the latter decides it is important to have control of a sector through tying or dumping.
This is not really specific to state control -- it's a classic antitrust problem. A monopoly in one sector leverages it into control of another sector.
The problem being, what do you use for a remedy in this case? The US DoJ can't exactly break up the Chinese government.
This is not really specific to state control -- it's a classic antitrust problem. A monopoly in one sector leverages it into control of another sector.
The problem being, what do you use for a remedy in this case? The US DoJ can't exactly break up the Chinese government.
Yes, I know they are common.
That doesn't change the fact that I was right. There is basically no rare earth mining and refining in the US or anywhere in the Western world.
The refining capacity is all in China, and if China would stop allowing export it would absolutly cause an huge issue.
Adding mining and refinining capcity is a very significant challange.
That doesn't change the fact that I was right. There is basically no rare earth mining and refining in the US or anywhere in the Western world.
The refining capacity is all in China, and if China would stop allowing export it would absolutly cause an huge issue.
Adding mining and refinining capcity is a very significant challange.
Rare earths are like shale oil right now: The US has plenty capacity, it's just that the cost is higher than the market rate. It would take a short time to ramp up, but we could get them without China.
This is reported in the same way that the Google website debacle was -- someone offhandedly mentioned something, and this administration runs out to scream it from the mountaintops as an accomplishment. Look, they're doing stuff.
Maybe a proposal is to loosen FDA requirements during emergencies, and allow these ventilators to be sold on the free market after minimal testing (and sold with the understanding that they are as-is).
Seeing how inefficient and slow our health-care system is, I think the free-market approach may actually be better here.
Seeing how inefficient and slow our health-care system is, I think the free-market approach may actually be better here.
Ah yes, let's let a potential deadly thing go on the "market" and just hope it works. Because every first responder is going to take time to read reviews and ensure they thing they are wearing is actually going to work.
Meh, it's a hundred times better to let something be made in the next weeks out there that has 90% effectiveness than to disallow anything from being made because the testing process is too slow.
Maybe you're a bit oblivious to the problem, but the US has 160,000 ventilators and 372 million people. Even if only 1% need a ventilator we're over 3 million short.
Do the math buddy, before you get snarky.
Maybe you're a bit oblivious to the problem, but the US has 160,000 ventilators and 372 million people. Even if only 1% need a ventilator we're over 3 million short.
Do the math buddy, before you get snarky.
The WWII mobilization was a shitshow when it started. Kaiser Shipyards in Richmond, California turned out ships at an amazing rate [1] but it didn't begin that way. I remember hearing a story many years ago of what it was like when they first started. People were wandering around trying to figure out what to do, because nobody could read a blueprint. In the end some kid who had had a couple of years of college just sat down with older guys and they figured it out. (This was on NPR, sorry don't have the source.)
[1] https://en.wikipedia.org/wiki/Richmond_Shipyards