News: 1584511364

Hospitals _will_ be overwhelmed.

And there is also likely to be a shortage of staff who know how to use the gear.

I am reminded of the moment where they cobbled together an air filter adapter with gaffer tape, specimen bags and cable ties, thousands of miles from earth. In a leaky tin can.

There is, of course, the danger of us indulging the how difficult can it be school of engineering...

As far as staff is concerned, I am confident that five minutes of discussion between the seasoned nurse and the new intern is likely to alleviate the issue. Once the machine is in place and working, I would think the flurry of activity is over. At that point, the nurse can leave immediate surveillance to the intern and go set up someone else.

The real issue is being overwhelmed. Right now, in France, we are consigned to our homes and should not go out unless we have a very good reason. That might seem a bit excessive, but when I look at [1]WHO's SitRep from yesterday and check the graph, I can see that Europe in general is now replacing China as reservoir for the virus.

So yes, now is the time to keep everyone at home because now is when the virus is poised to do the maximum amount of damage and spread its influence to the point where our hospitals will be overwhelmed.

The response is European-wide, some countries like Austria have actually locked their borders down. It's the only way if we don't want to count our dead by the tens, if not hundreds, of thousands.

It's not the common cold. It's much worse than that.

[1] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200317-sitrep-57-covid-19.pdf?sfvrsn=a26922f2_2

It's not the common cold. It's much worse than that.

Very informative. Had you not added that sentence to the end of your comment this fact would have passed us all by entirely.

Flu kills 0.1% of people it infects. Coronavirus is much more infectious and kills 3.7%. In Italy, where the population is generally older than ours, their death rate is around 10%.

Even the best case scenarios for containment are a bloodbath.

Without wishing to minimise the seriousness of this particular coronavirus, the actual death rate is still pretty much unknown because we have no idea how many people have caught it and have either no symptoms or very mild ones. It could be that real death rates are much lower than we think so far, but the only way we will know for sure is by adopting the WHO's "test, test, test" strategy. And until we have hundreds of millions of cheap, quick and accurate test kits available that's not going to happen.

On a related note, I read a report this morning about a new, rapid test being produced in Japan that was described as "100% accurate when testing people without the virus". Well, I think pretty much anyone could make a test like that.

That's probably a translating error, or it could be testing for the presence of antibodies for the virus, rather than the virus itself.

There are two distinct death rate, one for intensive care hospital treatment with ventilators, and one without. Current estimates put these two numbers at about 1% and 4% of the people who are infected. There is speculation that the death rate may be lower due to undiagnosed cases, however the evidence of the "Diamond Princess" cruse ship, where I think everyone was tested, is along these lines. Out of roughly 700 cases there have been 7 deaths and 14 people are still in a serious/critical condition. I recall that at its peak there were 32 serious/critical presumably many if not all of which would have died without treatment.

There's no doubt the total number of cases is much bigger than the official numbers in most countries.

I am convinced the number of dead is higher too. In Spain they found more cases when they tested all with double pneumonia for the virus, and I expect a fair number has been filed as flu/pneumonia/whatever because no test was carried out.

And in China they just resorted to incinerating bodies, wthout testing them. There's videos of people using flamethrowers on dead bodies in the streets. China's infection and death rates must surely have been covered up.

Coincidentally, whatever North Korea is doing is working - as they've announced that no one in the country has the virus.

There seem to be plenty of people claiming it isn't worse than a common cold including a commentard here the other day. Maybe that passed you by.

I don't really know, as it's basically impossible to get tested here in Washington State unless you're already dying, or are firmly in one of the "risk groups," which I'm not. Out of 7.4M+ people, we've tested about 14,000.

If that is indeed what I've been fighting off the last week and a half, I will say that for me, the symptoms were somewhat worse than a common cold, but not completely awful. Malaria was worse (yes, I had that, when I was 14).

Basically, my O2 levels dropped to about 93-94 when resting, and pulse went to about 100-110 (again, at rest), shooting up a bit from there if I walk around a bit. I've had a horrible cough, especially when laying down, but generally only a "productive" cough in the morning. For a few days, it felt a bit like someone had cinched a belt around my chest, which is far different from any cold I can remember having. I was wicked tired, sleeping 12+ hrs/day, my body ached, and I had a number of headaches mostly due to the coughing, I believe. In my case, only a slight fever (highest I measured it at was 100.5 F, but generally just in the high 98s while I'm usually right about 97.5).

So for me, it's not *much* worse than a common cold. A little worse, but not much. But I'm starting to feel much better, and will probably never actually know for sure if it was COVID-19 or not, because there's still not really any way for average people here to get tested.

Small positive news: Here in Portugal the veterinary meds have pointed out that they have a fair number of ventilators in their clinics, of the same models at used for humans. And that their first 2 years of course is common with real medics, and they are happy to help out.

Of course, their first assumption is that the patient is a horse....

https://www.pinterest.co.uk/pin/483151866244504269/

Its not just set and forget, with a very sick patient their stats will have to be regularly monitored and the machine likely adjusted frequently in response to their symptoms in a way that wouldn't be obvious to someone whose just had a 5 minute chat....

I am not a medic though

Hospitals _will_ be overwhelmed.

"OK Doomer" /snark

Seriously though there's too much FEAR going on out there. Sure, hospitals will need ventilators for some of their patients, and the potential for overwhelming hospitals DOES exist. The thing is, only the _sickest_ patients are initially going in for treatment, which skews the numbers quite a bit. It causes an inaccurate picture of the situation which THEN prompts "the doomers" and "the panickers" to do what they do.

I would expect that within the next month you'll see a significant drop in the number of new cases for various reasons, just like has been the case in China already.

All that needs to happen is a _slowing_ _down_ of the spread, and some preparation [i.e. having the equipment available at the hospitals]. Older ventilators may not have all of the same features, but apparently they were good enough "back then" to help out. So yeah, you use what you have.

"DON'T PANIC!" <-- like it says in the Hitchhiker's Guide

I rarely feel like upvoting you, but this time absolutely.

Ignoring the snark, what do you base your beliefs on?

What exactly should prevent an Italian situation elsewhere, bearing in mind that while they have an aging population, they also have better health care than most places.

South Korea is one of the few places that seem to manage, and the approach is different from Europe and US

But I don't agree with pollyanna optimism.

Bob, what I'm seeing in the trends from California and New York does not show a slowdown of the infection rate. It's still rising on the same exponential curve as it it did in Italy 21 days ago (I make the doubling rate in California to be 3 days right now). The bite comes when the curve hits Day 14 or so.

Der Spiegel ran some commentary from Italian health workers two days ago. Writes an anesthesiologist in Rome:

"We know from colleagues in Milan that they have stopped accepting corona patients who are over 70 years old and have pre-existing conditions. People of that age who have pulmonary or lung disease or have an advanced-stage tumor are no longer being hooked up to ventilators. Under such conditions, we doctors suddenly are forced to make decisions about life or death. It is terrible."

Take a look, Bob: [1]https://www.spiegel.de/international/world/coronavirus-in-italy-reports-from-the-frontlines-of-covid-19-a-3434cf83-e947-4aaa-9ee7-da15bac5a24e

Here's my problem with saying "OK, Doomer". Look at the kids partying on Orange Beach, listen to Devin Nunes telling everyone to go out to a restaurant. Wrong. People need to take this quite seriously. Pretending that it's all gonna blow over in a month is BS -- it's been 23 days since Italy hit 300 known cases, and the infection continues to grow in Italy, with a doubling rate of about 4.5 days.

My job, before I retired, included brief but intense bouts of industrial emergencies. I'm not great at it -- better at carrying water than leading the charge -- but what I know is this: take it seriously, look at the situation very coldly, keep thinking ahead, plan for the worst, and never count on a deus ex machina to save your ass. (It never does.) And no, don't panic. Panic is a scare-word that fools throw around. I never panicked, not that I remember, and I only knew one of my cohorts who might have, very briefly. Bless his scabrous soul, he did exactly what he had to do -- shut one gas valve -- before he got the hell out of danger.

When you say we'll have it under control in a month, that's pretending that a deus ex machina is gonna save our biscuits. It's pretending because China controlled the spread with a draconian regional quarantine around Wuhan, and strict social lockdowns elsewhere. We're not doing that. And I believe Americans cannot do that. And so we don't get to be China, or even South Korea.

Plan for the worst. Watch Italy.

[1] https://www.spiegel.de/international/world/coronavirus-in-italy-reports-from-the-frontlines-of-covid-19-a-3434cf83-e947-4aaa-9ee7-da15bac5a24e

Anything is worthwhile. If these Heath Robinson kitbashed systems save even one life on balance - they're worth it.

And ffs, we are in the middle of a worldwide medical emergency - companies will you KINDLY stop waving your patent and right-to-repair dicks about. You are NOT helping. Personally I'd take a list of any medical manufacturers acting like that and have them shut down permanently after this is over and the management team imprisoned for life. This is NOT a fucking game. Or maybe line up all their family members, channel good old Marius*, and have them decimated** until someone grows a conscience.

I have fibromyalgia and I had bronchopneumonia last year (which was an hour away from a collapsed lung when diagnosed) - I lost the best part of a stone in weight and had to take 300mg codeine just to move (because of muscle pain from the coughing). And I am *not* someone who is considered vulnerable yet I suspect this is perfectly capable of killing me and I'm relatively young.

Please do as you are told and don't play games with other people's lives.

And I wouldn't want to be you Boris. My fiancée is stuck in Ghana at the moment - her government have been better and faster on this than ours has. I mean no disrespect to the Ghanaian government when I say this, but that is fucking shameful on our part, and ironic since they used to be a colonial possession of ours.

* Famous Roman General who reformed the Roman Army. Roman soldiers subsequently nicknamed "Marius's Mules".

** Every 10th person executed.

"Anything is worthwhile. If these Heath Robinson kitbashed systems save even one life on balance - they're worth it."

I fully agree. Although it is understandable why medical professionals fear using uncertified products.

Rather than hoping for an open hw solution, people should demand for their states to act and to produce simple to use (hospitals are/will be running out of ICU professionals) and fast to manufacture ventilators, and other vital things too.

Any state with engineering and manufacturing resources should order engineers to do emergency work and confiscate (yes, they would get paid a reasonable rate for their efforts) materials and facilities to produce stuff we really need now. Like in a state of war. Any true leader would do this like yesterday and would not fear consequences for his/her political career. We don't want a Bring Your Own Ventilator situation within the next few weeks.

"And ffs, we are in the middle of a worldwide medical emergency - companies will you KINDLY stop waving your patent and right-to-repair dicks about. You are NOT helping."

Yes. Unfortunately, the patent waving and price gouging **coughepipen** has been going on for a while. Because of those dick wads, a great number of lives are lost and quality of life is decreased all over the world. Simply because of money and greed. If something good ever comes out of this horrible situation, I hope it will be better healthcare for everyone (I know, I'm being a bit naive now). I will never deny a reasonable, or even a high, reward for people's and companies' efforts. Still, the current situation in healthcare is too much.

This certainly is not a fucking game. Thanks for your post, Jemma.

Actually, the UK government are contacting companies across the UK to see who has the capabilities to manufacture ventilators. I received a call on Monday. I had to clarify that we use contract manufactures and could manufacture anything ourselves.

However, given the lack of manufacturing and assembly capabilities in the UK I'd be surprised if there are many companies left that could change production lines to make ventilators in a reasonable time period. This won't be helped by schools phoning for parents to collect children that cough once to keep them out of school for 14 days.

It seems like Vauxhall and Airbus at least have some of the capability and capacity required.

https://www.theguardian.com/business/2020/mar/17/uk-manufacturers-regear-factories-build-ventilators-nhs

Well, from an engineering perspective, Vauxhall should have either have plastic moulding machines, or be a big enough customer to a plastic moulding firm to be able to redirect output into making plastic parts for ventilators, *assuming that the mould tools required are available and are compatible with their setup*. Airbus has considerable experience in relatively small batches of electronic equipment being manufactured to a high standard, although they may well be outsourcing at least some of that.

The main things that might be missing from that combination are:-

1. whether they can source any unusual / bespoke electronics and actuators, which they won't have the capability to make in house.

2. How would the testing / verification of the ventilators be done

3. Getting a manufacturing licence in place. (Public pressure is likely to mean that this wouldn't be an insurmountable problem... although it might lead to insolvancy for the company that came up with the original design in the longer term.)

Reading the article it seems a lot of it is 3D printing of parts, which gets around a lot of the set-up problems. It also looks like they're working with current manufacturers which should go some way to addressing points 1-3.

Just being able to supply sufficient parts to the manufacturer to do the final assemble/test might be a big step forward.

"However, given the lack of manufacturing and assembly capabilities in the UK..."

This is a bit of an exaggeration... I live in the west midlands and there are engineering workshops all over the place. Not massive factories with fully automated production lines, maybe, but quite a few facilities with sophisticated tooling, quite a few very smart engineers and perhaps an even greater number of highly skilled technicians.

What we really need at the moment is legislation to stop anyone suing the health service should they feel the level of care or the equipment used was sub standard. The medics have enough to worry about without adding litigation to the list.

"stop anyone suing the health service should they feel"

Corona virus as a motivator for TORT REFORM? Sounds good to me!

(yeah that whole "*FEEL*" thing causes SO many problems...)

Do not let perfect be the enemy of good.

Thank you for reminding us. That is the attitude the world needs now.

Indeed, Good enough here means ??,000 machines that individually only have to work for 3-6 months, not running out of ventilators as the cases mount is the goal.

Europe can build 1M+ cars per month, the manufacture of 1M+ ventilators (per month) to a common design instead isn't beyond our capacity, BUT, the collective organisation & planning needs to happen fast.

Do not let perfect be the enemy of good.

Can we make these at home? Looks like parts from an upholstery cleaning device, maybe hooked up to an air-filter and some kitchen wipes? Remember Apollo 13 where they had to make an air scrubber after the oxygen tank blew up?

Dyson digital motors.

An air scrubber and a calibrated ventilator are two completely different beasts!

The Apollo 13 air filter only needed to filter air as it was passed into a cabin. A ventilator has to get just the right amount of air into someone's lungs, and then back out again, over and over again.

If you get that wrong you could seriously damage someone's lungs, especially as they'll already be ill in the first place.

not so much a joke really. It's amazing what a hackish mind and some "odd stuff laying around" can make happen.

The real challenge for Apollo13 was having the air filter fix performed by astronauts from 51 different congressional districts and involving majority first nation, minority and veteran owned companies, while also ensuring Boeing, Grumman and Rockwell made a profit on it

The ventilator issue was covered during yesterday's session of the Health And Social Care Committee. It was pointed out that it's not just a question of the ventilator itself. Mechanical ventilation uses drugs that paralyse breathing and the machine takes over, so it needs a secure oxygen supply, the appropriate drugs and trained staff.

https://parliamentlive.tv/Event/Index/cced67ec-c445-4698-a21b-7d9ff8a01354 starting at

Yes, you are correct, in extremis you need to paralyse the diaphragm (possibly a curare derivative) and have a crew to operate the system.

However even a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

This has happened before - government officials getting a broom up their ass and killing people as a result - the Spanish flu in the UK is a prime example - the CHO of the British government was more concerned about fighting the war than pandemic flu, he ended up committing suicide from the guilt.

GOVERNMENTS if people are offering help, expertise and creative solutions accept it. We are not in a place where we can go by the book or by normal procedures.

a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

I like your thinking. It's also LESS STRESSFUL TO THE PATIENT if you don't have to paralyze parts of his body to keep him alive, ya know??? And if I am paying for it myself [which I would be], I'd want the less expensive, less biologically stressful, 'does not require a hospital bed' version, thankyouverymuch [assuming it would be sufficient]. After all, who needs a BMW when a Ford will do [and the Ford is afFORDable - ha ha bad PUNishment].

There used to be these things called "iron lungs". They worked.

However even a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

Hey, I'm set! If I get sick, all I need to do is run a hose from my case fans to a mask, and game until cured or dead!

[1]https://www.newstatesman.com/politics/health/2020/03/government-documents-show-no-planning-ventilators-event-pandemic

[1] https://www.newstatesman.com/politics/health/2020/03/government-documents-show-no-planning-ventilators-event-pandemic

Very relevant indeed. What a shame the press didn't see it as their job to pester the Government into doing something back in 2016 instead of now.

Oh right so that will end up with a photo of a ventilator attached to a hairdryer

Or how I built an enclosure for a ventilator

Back in the '80s and '90s there was a completely acrylic, power-free simple gas-pressure powered ventilator that was commonly used in field hospitals. Simple time-cycled, pressure-limited ventilation, suitable for folk who can't breath adequately on their own. No mains, no batteries. Any company with expertise in injection moulded plastic could make hundreds of these per day. There are a couple of specialist valves that would need to be bought in, but apart from that, easy to mass produce. Perfect for Dyson.

Patients with more difficult ventilation requirements would be moved on to the clever electronic ventilators that hospitals already have, and it would be easy to train retired nurses and doctors to monitor the patients on the simple ventilators, while the experts worked on the seriously ill patients.

During the 1950 polio epidemics, when hundreds of patients with paralysed chests needed assisted ventilation, medical students hand-ventilated patients in hospital corridors rather than let them just die.

We know what to do, we just have to sweep away the objections and obstacles.

During the 1950 polio epidemics, when hundreds of patients with paralysed chests needed assisted ventilation, medical students hand-ventilated patients in hospital corridors rather than let them just die.

I do wonder how many hand ventilators we have available. Obviously these could be made much more quickly than the automated type.

30 seconds with a nurse yelling "Squeeze this like so and then let go, and repeat every x seconds or your relative dies" would give most a better opportunity than simply being abandoned.

That said, when they start prioritizing patients and deciding to let the older sicker patients die to focus resources on the younger healthier ones, which will happen, the entire edifice of "universal healthcare free at the point of use" ends, and it ends forever. Thereafter healthcare reform will be top of everyone's agenda and the NHS will have no place to hide.

The virus has it's biggest impact on the old and those with already compromised health & breathing problems. There won't be very many young healthy victims needing ventilators.

Re the power free ventilator, I think a British engineer inventor I worked with on some stuff came up with the idea for that, really as a portable ventilator. He made nothing out of the invention, but it did get produced and used by the 1000's.

He might be the sort of person needed to get a simple design out double quick, as he knows the engineering and design challenge and he's very hands on. I lost touch with him a couple of years ago and he was always very wary of the limelight and difficult to make contact with, but there might be someone on here who knows him/how to contact him.

His name is Peter Dearman, the fella behind the idea for a practical cryogenic liquid air plant for energy storage, and a liquid air engine for cars (which actually ended up as a viable product to replace diesel chillers on lorries). He's made b**ger all out of this venture either, but has got his name plastered all over it, which is I suppose some compensation.

https://dearman.co.uk/

https://en.wikipedia.org/wiki/Cryogenic_energy_storage

.