OSV Ireland was formed by Colin Keogh, Conall Laverty & David Pollard, with the goal of building a focused team in Ireland to begin development of a Field Emergency Ventilator (FEV) in partnership with the Irish Health Service. To date we have formed a team of engineers, designers and medical practitioners to develop new, low resource interventions, all working collaboratively online. Bag Valve Masks (BVM), 3D printed and traditionally manufactured components are being considered to maximise potential manufacturing capabilities. We will also include other challenges and problems as they arise from frontline healthcare workers, which we will encourage our volunteers to tackle.
We have a core developer team publishing open source designs with ongoing communication with medical professionals regarding needs requirements, testing and validation processes. The developer team is led by OpenLung in Canada in collaboration with an Irish based engineering and operations team. The developer team is led by Trevor Smale, Dr. Andrew Finkle, and David O’Reilly from OpenLung as well as Conall Laverty and Dr. Keith Kennedy from Ireland. Work is well underway with hundreds of worldwide contributors.
Yes, we assume blueprints have now been shared and that production is scaling up - but it has required a lot of time, effort, communication and bargaining.
That said, open source alone is not a panacea. Questions should be asked of open source designs:
- Do the designs meet regulatory standards for the market(s) they are intended for?
- Is the quality assurance process equally open, so that manufacturers & recipients can verify whether products are authentic and fit-for-purpose?
It looks like the OSV project are aware of these questions and provide their working assumptions and information about work-in-progress on their homepage.
https://news.ycombinator.com/item?id=22624959
To pull out some pertinent details:
Ventilators for covid19 seem to be mostly for inflammation and fluid in the lungs (aka pneumonia), not lung or chest paralysis.
If you need a ventilator due to inflammation or fluid build up, you can do other things to address those issues.
If you are doing home care for serious lung issues, a downside of mechanical intervention is that you probably don't know how to adequately sterilize your equipment. This means nasty stuff grows on the equipment and then this nasty stuff gets delivered directly into the lungs.
So I'm not thrilled to pieces to see the emphasis on "ooh, shiny!" homemade technical solutions in place of non-invasive home care.
You can do lung clearance without mechanical intervention. This can make a ventilator unnecessary.
You can do lung clearance easily on your own in the shower by standing with your feet shoulder-width apart or a bit wider, bending over as far as you can and coughing hard.
If you bring up a lot of fluid from the lungs, it looks and feels a whole lot like vomiting. My sons and I call it "puking up a lung."
Inflammation can be combated with commonly available non drug remedies, like caffeine, lettuce, avoiding pro inflammatory foods (avoid peanut oil like the devil himself made it for you, limit or avoid bacon as it is hard on the lungs).
Etc.
Please see my previous remarks about best sleeping positions, etc.
I am very concerned that homemade ventilators are going to become a source of secondary infection and this secondary infection will be worse than covid19 because it will be bacterial or fungal and it will be antibiotic resistant.
If I had any idea how on Earth to start a counter movement, I would be all over it. I have no idea how to do that, so I occasionally leave a comment on HN giving some of my thoughts, which isn't likely to exactly catch fire. This is today's comment in that vein.
It sounds like a lot of these vents will end up in the hands of medical professionals. We're looking at a future with warehouses or stadiums full of sick individuals, and also a future where everyone will be pulled from every specialty to work on COVID-19, so there is some evidence that trained professionals and patients will outnumber commercial ventilators. Depending on how many people get sick at once, we could easily end up in a situation where the patients waiting outside are so numerous that they could consume as much equipment as anyone could put together, no matter how much the real manufacturers ramp up production.
Keeping invasive equipment adequately sterile is hard to do, even in a hospital. It's just the nature of the beast.
To be clear, I'm extremely not thrilled at the global acceptance that "we need a zillion ventilators" instead of "we need non invasive alternatives and we need to educate the world as to what they are."
It's well known this is a problem with this kind of equipment. I'm aghast that the medical establishment isn't freaking the fuck out at the need to find some answer better than ventilators because widespread use of ventilators has a rather high probability of leading to the development of new antibiotic resistant infections for funsies, just as we think the worst is behind us.
I'm not sure coughing in the shower is going to do it for someone about to die from hypoxemia?
A primary source sure, but likely nothing compared to unnecessarily dosing livestock with antibiotics, and well, large portions of India. [1] 67% of folks in India in an albeit small study exhibited antibiotic resistance.
> To be clear, I'm extremely not thrilled at the global acceptance that "we need a zillion ventilators" instead of "we need non invasive alternatives and we need to educate the world as to what they are."
Indeed.
[1] https://economictimes.indiatimes.com/news/science/most-healt...
This sounds like very suspicious folk advice, maybe based off a handful of data mined studies. I appreciate the tip about coughing up a lung though.
Aspirin (or at least salicylic acid compounds) is in wintergreen and willow bark. Opioids are derived from poppy sap, and eating too many poppyseeds will make you test positive for opium metabolites. Digoxin for heart failure and atrial fibrillation comes from foxgloves.
Coffee, specifically, has tons of data pointing to it improving cardiovascular health including this massive meta-analysis covering 1,279,804 people [1]. This meta-analysis shows a reduction in inflammation from consuming coffee [2].
[1] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....
When you repeat such an experiment on large sample sizes with no control over the other myriad of environmental influences on the subjects, even after attempting to control for confounding factors you're still going to end up with extremely noisy data made effectively useless by just as many contradicting studies which find no effect. You see it all over the place - eggs and cholesterol, coffee harm/benefit, wine harm/benefit. These studies are all intimately highly flawed because they are empirical soft sciences with very little control over the large number of chaotic interactions among and within their subjects.
So when people say things like "drink coffee and eat lettuce to control inflammation during COVID infection" without a disclaimer, they're being [unknowingly] irresponsible, to say the least. Especially considering the dose of active compound in something like lettuce is likely to be totally insignificant.
Sleeping positions are irrelevant.
A positive pressure mask or cannula with O2 concentrator or supply is likely sufficient, not necessarily a full blown ventilator, and is much easier to sterilize. Still, it does carry risks. And it's the O2 concentrator part that's expensive.
Adding to that -- as someone with a lifetime of lung issues: physiotherapists can help you cough up fluid/phlegm from your lungs. These are called "Airway Clearance Techniques" (ACTs). Depending on where the buildup is, we may be talking breathing techniques (e.g. deep inhale, hold, huff out), percussion etc. The goal is to bring up the gunk to the upper airway so it can be coughed out. Some of these techniques are easy to learn and perform on your own.
I don't know how useful or safe these are during viral infections, but I suspect "better out than in" applies equally well to all kinds of fluid in your lungs?
If you think doing lung clearance might cause actual vomiting as well, don't do it in the shower.
Instead: Get naked, stand over your toilet and cough into the toilet. Then shower before getting dressed again.
Don't skip showering. Store your clothes away from where you will be coughing/puking so they don't get blow back.
Don't assume once a day is sufficient. Doing lung clearance multiple times a day is not unreasonable during a life-threatening health crisis.
If you can't bring it up, drink something and eat something salty. This will help you cough it up.
If you roll over and it provoked a coughing fit, you probably have fluid sloshing around in your lungs. It's a good idea to attempt lung clearance at that time.
It's more or less free (though it could drive your water bill up). It just takes a few minutes. The only known side effect is breathing easier.
Okay, okay. I sometimes get dry skin from showering 500 million times. It's less annoying than not being able to breathe.
Try to not fall in the shower though. Getting bruised up would not be a good thing.
In other words, the US president (he is the only one authorized to do it) needs to activate the Defense Production Act, and get existing companies to mass produce existing designs. Something similar needs to happen elsewhere. This is a matter of days or weeks, not months.
Please gently correct me if I have this wrong.
As for political organization, I would think that almost takes care of itself if someone presents a turn-key, scalable solution.
This is an excellent foray of opensource into a space thats currently extorting people to live, i.e medical industry
This is wrong - it's 15-20% of identified, diagnosed and subsequently monitored infected people, isn't it?
I thought there was a mass of unidentified infected people, and even basically diagnosed but told to just deal with it at home with no further contact as they're low risk and minimal symptoms, and (obviously) 0% of these groups are going into hospital? This is what Wikipedia says at the moment.
Or am I wrong?
A lot more ventilator are going to be needed, not in % but in hard cold real absolute number. Isn't that more important ?
Yes - I think we should challenge misleading information wherever we see it in this situation. Fighting panic is part of the problem and bad numbers cause panic.
I mean, if we don't really care that the numbers aren't accurate because it's more important to emphasise why the project is important, we might as well go all the way and say 99% of people need a ventilator and really sell the project.
There was a news report recently implying a 50/50 survival rate, due to this same kind of assuming everyone realises that you're talking about some group that's already in a bad way, but not actually saying that in the text.
Plus, we don't know when the site was set up. Two weeks ago ? Four weeks ago ? Our collective knowlegde is changing every day. Could just be they have been busy and did not find the time to update it ?
And finally, blueprint for a cheap OSS FEV will always be useful. COVID or not.
Indeed, and your information is wrong and misleading, stop it. You listed no sources and are going on "I thought..." You thought wrong.
But you are also right that people are needed to administer those. No doubt about that. As is also true a person can administer several of those machines.
And, just because something tries to address A only (and not B and C), does not mean we should not do it because B and C. Separate issues. Beside, to train people, you need spares to train on.
There's no evidence supporting the theory that large numbers of asymptomatic people offset the figure of 20% of patient being severe cases. Hospitalizations and death skyrocket in Covids infected areas, we know what this thing looks like at scale. Plus Who report, pattern of infection, China and Korea eliminated visible cases and haven't seen many more etc.
You are wrong according to the statistics that came out of Korea - if there was an invisible group of asymptomatic, Korea's infection rate couldn't have been controlled. [2]
This destructive belief has persisted for a while because it made sense for various flu epidemic and gave the comforting idea most infections would be harmless. But is now with us at scale and all the evidence points to a rough 20%, 1-in-5 hospitalization rate [3]. I wish actual authorities would spend more time debunking this (even get fully clear on it themselves).
[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...
[2] Look at covid19info.live and look at the South Korean statistics. There's reason to think Korea found most if not all infection. Similar reasoning also applies to China.
[3] Edit: Discussion of CDC study: https://thehill.com/policy/healthcare/488325-cdc-data-show-c...
This is beyond ridiculous and you have no basis for making that assertion. As of last Saturday, In South Korea, as of the weekend only 248,000 people out of a population of 50,000,000, with 8,086 +ve cases and 72 deaths.
There is significant evidence that not only are most cases mild, but often asymptomatic.
https://www.sanitainformazione.it/salute/scovare-i-positivi-...
In English:
https://mobile.twitter.com/andreamatranga/status/12397748625...
> According to Crisanti, the director of the virology lab of U Padua, as little as 10% of #COVID2019 carriers show any symptoms at all. He sampled repeatedly the entire 3k+ population of Vo ', one of the initial clusters.
https://grapevine.is/news/2020/03/15/first-results-of-genera...
> 700 have been tested. Kári says that about half of those who tested positive have shown no symptoms, and the other half show symptoms have having a regular cold.
https://www.repubblica.it/salute/medicina-e-ricerca/2020/03/...
> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion". The Professor of Clinical Immunology of the University of Florence Sergio Romagnani writes
> But is now with us at scale and all the evidence points to a rough 20%, 1-in-5 hospitalization rate [3].
No. It doesn't. That link doesn't say why they were hospitalised. In America if your insurance is good enough you can be referred for little to no reason.
But this finding is not extrapolated to mean that the vast majority won't require hospitalization. There's a reason. When the virus is growing exponentially, most people have just gotten the virus and haven't gone the 2-3 weeks typical for becoming so sick that you require hospitalization. Exponential growth means 3-week old cases are rare. A weekly doubling time 1/16 of the cases of the cases are three weeks old. If 1/5 of those cases require hospitalization eventually, you will wind-up with only 1/80 of those cases seeming to require hospitalization if you're just taking a survey.
Some of my references are extrapolating things (correctly) but others are citing recognized authorities. Your entire argument is basically incorrect extrapolation based on not taking into account exponential growth.
This article widely read article summarizes the quandary we're in and how to extrapolate the current data.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
People need to read it and stop with the destructive misinformation.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
The cruise liner and the 3000 pop Italian village are the well studied exposed populations so far I think and they indicate a big asymptomatic percentage.
Note that both South Korea and China outside Wuhan do extensive contact tracing and testing of people an infected individual can be determined to have interacted with, so they pick up a good deal of asymptomatic cases too.
Edit: I should have said "a large enough group of asymptomatic to push the fatality and sickness rate way".
Yes, there can a majority asymptomatic but that doesn't mean that 20% of the overall don't wind-up needing serious medical attention also.
Hopefully, you can read the comment I replied to and see the context
> But on Tuesday, a World Health Organization expert suggested that does not appear to be the case. Bruce Aylward, who led an international mission to China to learn about the virus and China’s response, said the specialists did not see evidence that a large number of mild cases of the novel disease called Covid-19 are evading detection.
> “So I know everybody’s been out there saying, ‘Whoa, this thing is spreading everywhere and we just can’t see it, tip of the iceberg.’ But the data that we do have don’t support that,” Aylward said during a briefing for journalists at WHO’s Geneva headquarters.
It's like saying 90% of basketball players require casts because, from the set who end up in ambulance, 90% of them have a broken arm. That doesn't mean 90% of basketball players require casts, and it certainly doesn't mean they need them all at once.
There was a study posted here recently that said as many at 86% of people were asymptomatic, then only some sliver of those with symptoms end up needing to go to hospital in the first place -- and 20% of that group that tests positive for the virus ends up needing a ventilator and 5% of them end up dead.
Net-net close to a 0% fatality rate under 29, 0.1% under 49.
Still gonna feel like crap tho.
If we acquiesce to 70% of the US getting nCoV-19 as the epidemiologists are suggesting that would require 50 million ventilators. There are about 70,000 in the US. So we'd need almost 1000X as many ventilators as we have.
If that were true we've have the national guard locking people inside their houses, and the UK wouldn't be contemplating giving nCov-19 to everyone young to foster herd immunity.
Will these open source designs save many lives? I doubt it. Large scale manufacturers working with existing vent makers will do a much better job. But... if it gets thousands of people thinking about artificial ventilation, we might get a lot of interesting new ideas that we can use in the decades to come.
Any other time, yes. In a time of widespread panic? Dangerous.
People are going to try to build and use these at home in an act of desperation to "do something", and end up killing their loved ones.
This effort may well save no one in this crisis. It could still benefit by making future ventilators cheaper, serving as prior art on bullshit patents that people try to get on basic components of a ventilator in the future, and so on. This will very likely allow the health care system to funnel money into more effective life saving efforts in the future.
Who the hell cares if you build a ventilator and try it then? They're going to die anyways. You are doing nothing except increasing their chance of survival by acting instead of waiting.
Should you use this while hospital beds are still available? Obviously not. But any care is better than no care and being treated by a Wikipedia doctor is better than being treated by no doctor when you're already on your deathbed.
In totality, however, furthering things like DIY ventilators (like DIY open-heart surgery) can cause more harm than good.
We've got governments, experts and professionals mobilizing to prepare for this, let's allow them to do their jobs. This is what they've trained for.
Do hobbyists rigging together servo motors to prepare for a worst-case scenario really interfere with the soon-to-be overwhelmed professional medical industry workers attempts to do their jobs? The only reason I can think of to be against this would be kind of like doing a trust fall, voicing against independent work to signal personal trust in the capacity of the medical system. Of course, that would be a purely social reason, not really helpful for saving lives or improving the system.
This to me seems much simpler and more reliable than ventilators with their own fan. But I don’t have a good way of reaching anyone. I’ve created a thread on my website with my sources, thinking, and some questions. If anyone knows about this please reply here or there and let me know. Thanks.
https://reboot.love/t/coronavirus-towards-a-cheap-and-easy-t...
However, I'm also getting the sense from reading about these efforts that creating pressurised air is the easiest part of the setup. You need to control that pressure with a precision unlike any other application of air pressure. Just alternating high and low pressure isn't going to work, for example: you need to slowly ramp up pressure, then slowly release, on a specific schedule. Every patient also has individual needs, to the point where even for two people of the same gender and similar age/weight, the settings ideal for one might kill the other, and vice versa.
If I understand it correctly, these machines use feedback loops with sensors for blood oxidisation, acidosis, the elasticity of the lung, and other factors. Without such mechanisms, you'd be constantly adjusting the settings––consider a heating system or AC where you can't set the desired temperature, but only flow rate and power of the heating/cooling instrument. You need constant attention to keep such a setup within a comfortable range. And that attention will also be in short supply when hospitals are overrun.
So there are four main ways for breathing machines to be powered: 1) By compressed air from a wall port (majority of ICU machines)
2) With bellows (anesthesia machines)
3) Turbine, either dynamic or constant speed with a proportional valve (home use or patient transport)
4) Piston
Let's assume that we use a pneumatic device driven by centrally purified air as that is simplest. The parts then are:
-Gas blending to mix O2 and HP air. In many designs this is done using two solenoid valves.
-A fast, precise, and accurate proportional solenoid valve. This turns the constant pressure into the desired waveform
-another valve for controlling exhalation pressure. Can be another proportional solenoid, alternatively a manually adjustable valve to ensure constant minimum end exhalation pressure (PEEP)
-Flow sensor (range of options, typically variable orifice or hot wire anemometer but other type exist)
-Pressure sensor (silicon waver transducer)
-Overpressure valve
-O2 sensor (highly desirable, arguably you can estimate from O2 blending settings but that will work better on a very well characterised design which this would not be. Anyway O2 sensors are widely used so this will never be a constraint.
-Piping to connect it all together
-A control and alarm system to drive desired waveform based on user settings and sensors
-Patient circuit: Humidifier / heat exchanger, patient valve (one time use), viral filters for intake and exhalation air (one time use), ET tubes (one time use) Probably the limiting factor as far as parts go are the valves since this is a niche application. Here's the problem: as a civilisation, if we had to make a hundred million vents by the end of the year it would be easy. Expensive, sure, but not that hard in an emergency. It is much harder to make an extra 50,000 in a few weeks because it just takes time to turn the machinery of mass production in a different direction.
Let me know if you want me to send my list of ventilator reading. I'm not an expert either, just trying to soothe my Corona-madness by thinking about building things.
Making these antivirals as useful as possible is of great importance, and that means going all in on mass producing a quick and reliable and broadly applicable diagnostic test.
I would much rather see open source projects targeting diagnostic tests or manufacturing nasopharyngeal swabs. Admittedly, this is much harder to achieve for people not involved in life science research or without access to virological specimens.
