[BostonCard]

<snip>
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.

With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.

National discussion pre-empted, per HHS bulletin released today (from NYTimes update): Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/...-28-20.pdf

Doug White who used to be at UCSF has spent his career thinking about allocation of limited critical care resources in a pandemic situation, long before COVID-19 was even known.  Here he is interviewed with the editor and chief of JAMA:

https://www.youtube.com/watch?v=3xEsnPHP...dium=email

BC

---

At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?

The engineers and scientists don't much matter right now. We know how to build the Ventilators. It is production that is the issue, and in the next two weeks or so production will not change enough to matter. There is no "magic bullet" that will solve this problem. The idea that GM and Ford can do ANYTHING in less than a month is absurd on the face of it. They simply aren't nimble operations. There are lots of contract manufactures in the US that can "rapidly" tool up to build somebody else's design, but as anybody who has ever done this can tell you, a couple of weeks is just barley enough in the absolute best case to maybe start production of units to be validated by QA so real production can start. This all assumes that the required parts/raw materials are available. The parts suppliers for ventilators are already at capacity. They too would have to seek contract manufactures to increase output. In a month, there may be a noticeable increase in supply. In six months, for sure, all the ventilators you could ever want.

There would be advantages to engineers working to strip out unnecessary modes and simplify (and cheapen) ventilators.  In normal times, you might build a general purpose ventilator that can deal with any possible issue that comes up and can perform all sorts of complicated ventilation modes.  But in this case, you are building for speed and cost, so you strip out all unnecessary modes, all complicated UI's and include only the bare essentials (plus you want to make it easy to use in case you are short respiratory therapists in a crisis).

You can probably strip down a vent to have a power switch and four nobs: the percent oxygen (20 - 100%), the mode (whether the vent delivers a constant pressure or fixed volume), the backup respiratory rate, and the pressure or volume delivered, and you build it to recognize and alarm if there is an obstruction and if the tube gets disconnected.

BC

[BostonCard]

<snip>
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.

With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.

National discussion pre-empted, per HHS bulletin released today (from NYTimes update): Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/...-28-20.pdf

Doug White who used to be at UCSF has spent his career thinking about allocation of limited critical care resources in a pandemic situation, long before COVID-19 was even known.  Here he is interviewed with the editor and chief of JAMA:

https://www.youtube.com/watch?v=3xEsnPHP...dium=email

BC

---

At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?

The engineers and scientists don't much matter right now. We know how to build the Ventilators. It is production that is the issue, and in the next two weeks or so production will not change enough to matter. There is no "magic bullet" that will solve this problem. The idea that GM and Ford can do ANYTHING in less than a month is absurd on the face of it. They simply aren't nimble operations. There are lots of contract manufactures in the US that can "rapidly" tool up to build somebody else's design, but as anybody who has ever done this can tell you, a couple of weeks is just barley enough in the absolute best case to maybe start production of units to be validated by QA so real production can start. This all assumes that the required parts/raw materials are available. The parts suppliers for ventilators are already at capacity. They too would have to seek contract manufactures to increase output. In a month, there may be a noticeable increase in supply. In six months, for sure, all the ventilators you could ever want.

There would be advantages to engineers working to strip out unnecessary modes and simplify (and cheapen) ventilators.  In normal times, you might build a general purpose ventilator that can deal with any possible issue that comes up and can perform all sorts of complicated ventilation modes.  But in this case, you are building for speed and cost, so you strip out all unnecessary modes, all complicated UI's and include only the bare essentials (plus you want to make it easy to use in case you are short respiratory therapists in a crisis).

You can probably strip down a vent to have a power switch and four nobs: the percent oxygen (20 - 100%), the mode (whether the vent delivers a constant pressure or fixed volume), the backup respiratory rate, and the pressure or volume delivered, and you build it to recognize and alarm if there is an obstruction and if the tube gets disconnected.

BC