Edit: this development looks very promising for 'sub-intensive' cases -- adapting decathlon masks to provide positive air pressure (to help reinflate lungs) without intubation or leaking contaminated exhaust: https://www.isinnova.it/easy-covid19-eng/. Some emerging theories of pathology suggest that lung function can be increased by reinflating collapsed alveoli with constant pressure: https://emcrit.org/pulmcrit/cpap-covid/
Non Hail-Mary Ventilators have only a 30% survival rate at 1 year mark:
https://www.ncbi.nlm.nih.gov/pubmed/8404197
Incidentally, that's exactly why medical systems to not stockpile ventilators. Under reasonable condition, the number of ventilators closely mirrors the expected number of Hail Mary procedures done at a given time and some spare units.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
Plus you need nurses and doctors to intubate the patient and setup and monitor the actual ventilator. The machine itself is a small part of the equation.
I think the focus on ventilators is somewhat misleading. If you need mechanical ventilation, you're a goner anyway, and your bed and healthcare staff could be better used on someone else. The 'lack' of a machine is just a very visible component.
The complications of ventilators and whatever lasting damage is caused by the disease itself; will be killing a significant portion of the recovered population, will it not?
Also put that in context with the fact that Italy reported that the majority of death is with people which have preexisting conditions/other illnesses.
If they do, then less hospitalization, and less ICU / ventilator needs.
If Chloroquine doesn't end up working, basically we need to find something that does, because that is the only feasible way to get us out of this mess. We have shuttered the economy because the healthcare system can't handle so many people needing hospitalization. The only scalable way around that is to find a treatment that significantly lowers the need for hospitalization.
This isn't quite true.
Taiwan, Singapore and S. Korea have not 'shut-down' their economy, and they have tamed the problem.
Massive and widespread testing, assertive isolation and tracking of individuals who test positive can work on some level.
Combined with some other things like maybe keeping 'big gatherings' or 'social gatherings down', requiring people to wear masks on trains, busses, airplanes - we may be able to reasonably suppress Corona without a medical discovery.
No, building a ventilator is like building an engine because you need to go to the store - you're missing so much of the solution to the problem. I've also posted before [1] on why they are a terrible idea to waste time on "designing".
That said, ventilators I believe are already a solved problem for COVID. We have tens of thousands in the strategic stockpile, and production capacity is being ramped up hopefully to meet demand. This is exactly how these stockpiles were intended to work.
1.Montreal offers $200k prize for cheap and easy to build ventilator design - https://news.ycombinator.com/item?id=22637540
2. https://app.handelsblatt.com/unternehmen/industrie/medizinte...
3.https://www.srf.ch/news/schweiz/knappheit-wegen-coronavirus-...
The struggle to ramp up production is a desperate one, and this is one case where IP is killing people - there are several consortia in the UK that are ready to manufacture, but need a certified design they could build.
I think we probably agree that industrial production is the way forward, but the numbers are not particularly comfortable.
I don't think anyone views them quite as starkly as that.
In the 1930s polio epidemic there was a shortage of "iron lung" respirators, which were expensive to produce. Edward Both invented a plywood version, which was cheap and easy to produce. A re-purposed car factory then churned them out by the thousand.
Is a negative pressure ventilator relevant for COVID-19 treatment? (Any knowledgeable medicos here who can offer a critique?) If so, couldn't they be churned out by the thousand in a short space of time (ie. days)? My understanding is that the tooling is comparable to that used to produce a kitchen cabinet. They can even be manually operated in the absence of a motor or control system.
In a diffuse infection a patient begins to lose both lung area (due to shunting) and the thickness of the diffusion barrier increases (due to inflammation). To help overcome this you want to increase pressure and oxygen concentration.
An iron lung helps ease the work of breathing by reducing thoracic pressure and thus creates a larger pressure gradient for inspiration. However, it does not cause an absolute partial pressure of oxygen change compared to the atmosphere.
Unfortunately, to bind haemoglobin in physiological lung conditions we need partial pressure of oxygen around 100mmHg. My guess is that an iron lung does not help increase the partial pressure of oxygen so it will do little but ease the work of breathing (which is better than nothing!).
So standard pressure at sea level is 29.92inHg, a 737 MAX can sustain 39k ft altitude indefinitely I suppose, where the exterior air pressure would be 7.66inHg. The cabin is normally pressurized to the equivalent of 8k ft, giving 26.63inHg. The fuselage could withstand a pressure differential of 26.63inHg - 7.66inHg = 18.97inHg (at least, possibly more).
That’s 63% higher than regular pressure at sea level. Not bad.
If you gave each patient a full economy row, that’s about 60 patients per plane, so 48k patients across 800 grounded 737 MAXs.
That said, you’re describing a bariatric chamber, and they do exist (they perform surgeries in some).
If your whole body is inside, there is no pressure diferential to inflate your lungs.
Am I missing something?
Planes are horribly cramped and if you filled every seat you would be violating social distancing while filling them with sick people.
I can think of a few other criticisms, but those are probably the most defensible concerns.
Would that accomplish the same goal as a ventilator?
> While the standard for a conventional ventilator uses a mask or nose tubes and follows current guidelines, the pandemic ventilator is at a standard from the 1970s and requires a patient be intubated, the medical word used to describe putting a tube through someone's mouth and into their airway.
Do intubated patients need more attention from nurses/doctors? It certainly sounds harder then putting on the mask.
How it compares to managing a mask day to day? I honestly don't know, that's something an ICU nurse/respiratory therapist would know.
If we get way more machines but those machines require a lot of intensive monitoring we could wind up with plenty of machines but not making any progress on the fatality rate.
Source: my sister is a nurse at a hospital treating dozens of COVID-19 patients.
"We're talking about a device that we want to
have available in the worst case conditions and strangely
enough, COVID-19 is not the worst case envisioned," he
said.
Perhaps in 3, or 5, or 20 years....
Maybe we'll be thankful that COVID-19 was sort of a "training wheels" pandemic... something that helped to prepare us for the even worse pandemics that are sure to follow.
Deaths due to COVID-19 will be staggering, but it's somewhat mild as far as possible pandemic scenarios go. Imagine if it had mortality rates comparable to ebola, TB, etc.
When this blows over, the world should be better prepared for the next one, with better procedures.... emergency stockpiles of ventilators, masks, etc.
(Or at least we will be... until we go ten years without a pandemic... and all those stockpiles get liquidated in order to help some politician to balance a budget or whatever...)
No one goes to work with a mild case of Ebola.
HIV/AIDS, several hepatitis variants, and tuberculosis approach thiS, as might syphilis in earlier times.
Kyle Harper's The Fate of Rome explores the notion that new diseases don't simply emerge, but co-evolve with their host populations and environments. The implications are disturbing.
https://lareviewofbooks.org/article/how-the-environment-topp...
This is the first world pandemic in a hundred year, why should it become common ?
I think people who are actually working on ventilators should seriously consider going for a simpler design .. it might be this or might be something else. The person in this article also said he is happy to give the design away.
I think if the Malaria Med+Antibiotics treatment from the French study don't work (we'll know in about a week I think), we need to move to a war footing and start producing ventilators. My back of the envelope math has scared the crap out of me (best case 500K Canadians dead, worse case 3 million).
I really hope someone who can make a difference sees this.
I've left some comments here on the possibility of doing lung clearance in the absence of sufficient numbers of ventilators:
https://news.ycombinator.com/item?id=22640905
I don't really care to argue it with anyone. Please go find somewhere else to vent your spleen about how stressful this is. My recommendation is and has always been: If you have no other option and you are going to die because of it, you can try this.
That's it. That's my entire point. All the accusations that I'm up to something nefarious and dangerous are completely unfounded.
Take care. Try to not stress too much. Thank you for trying to be part of the solution.
More prosaically, I think I've reduced durations of basic colds by deliberately coughing early on. Needs more experiments, but as you said side effects are minimal, so you may as well try. I'm starting to think this is a family of life hacks that should be much more widely known.
It was a brief reference without enough details to be sure that he was referring to clearance methods similar to our the same as what you reference, but it sounds as if this may be part of therapy already. So well in line with what you have described.
Best wishes to you and your family in these trying times.
We should assume they won't work. War footing time is now.
War time devices must be simpler (easy to make and do field repairs on). We just need the first one.
10 "in stock," $3,124.01 each.
There's also another model MCV200, 10 "in stock," $5,091.71 each.
Anyone got $95 grand lying around?
Edit: btw, in 2006/2008, the AARC recommended to the White House and/or HHS to buy 10k additional ventilators for the SNS, but the govt failed to do so. Now, the US, is for lack of better adjectives, royally-proper fucked.
https://www.aarc.org/wp-content/uploads/2018/08/issue-paper-...
(I'm not a doctor and my only source of knowledge on this is other hacker news comments)
IANAD, but it's not just a problem of matching people in the current pool. You also have to plan for incoming patients. Having the parameters of the ventilator not perfectly match the patient likely affects the probability of survival in a smooth way (with in some bounds).
So now the problem becomes minimizing the total death by maximizing the average likelihood of survival. You have to take the patient ventilator parameters into account (tidal volume, lung-compliance, weaning, etc) , as well as information about the distribution of those likely to be sick at the same time (which will change over time based on behavior).
For example, if one could hypothetically spray alcohol everywhere inside someone's lungs, would that kill the infection?
If so, could a liquid/gas mixture be developed to deliver the right virus-killer substance directly to the lungs?
Does anyone here know about PFCs-breathing treatments?[0]
0: https://www.realclearscience.com/blog/2019/08/15/can_humans_...
Thank you to the people that took the time to answer the question and explain why these ideas are not currently feasible.