
Ventilator maker: we can ramp up production five-fold - rectang
https://www.forbes.com/sites/baldwin/2020/03/14/ventilator-maker-we-can-ramp-up-production-five-fold
======
makomk
"in a 90 to 120 day period", and "Ventec is a fairly small player". A five-
fold increase in production of a company that's not making many ventilators to
start with, in 3-4 months, isn't going to do a whole lot even before you get
into the problem of finding the staff to actually run the things correctly and
not kill the patients.

~~~
rectang
If you have hundreds of thousands more people infected than you have
ventilators, every ventilator you add is a potential life saved.

As for adding staff, now is _also_ the time to be thinking about how to ramp
that up.

~~~
leggomylibro
But not even China has 100,000 people infected, and their rate of new
infections is slowing down. Italy still has <30,000 cases. And in both cases,
the number of people requiring ventilators is obviously much lower.

Where are you getting this "hundreds of thousands more people infected than
you have ventilators" idea? We've already had a couple months of the virus
spreading at this point, maybe it's time to start making more realistic
estimates?

~~~
bildung
When China started the lockdown of Wuhan in Jan 23, they had 830 cases, and
almost all concentrated in one location. Even with the hard lockdown they were
at over 70k infected people in Feb 16, before the infection rate slowed.

The US already is at over 5k, every state has infected people, and there is no
proper lockdown to speak of in any state, only "strong recommendations".
Assuming the same growth rate, the US will be at 440k infected in 24 days, but
sadly without the reduced infection rate after April 12.

~~~
makomk
When China started the lockdown of Wuhan on Jan 23, they may only have had 830
confirmed cases - but the number of confirmed cases was basically limited by
the rate at which they could test people turning up at hospitals with severe
symptoms and continued to be so for quite a while, from what I can tell.
There's a more interesting figure buried in the WHO's final report from their
joint mission to China: at some point, someone went and retested old samples
taken from people in Wuhan with flu-like symptoms, 20 per week. They found no
positives before January, 1 in the first week of January, and 3 in the second
week. Those are not pretty numbers.

~~~
bildung
But was this different to the US? I don't follow the US news that closely, but
my impression was that testing capacity is only significantly growing since
yesterday.

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arbuge
> The seven-year-old, 135-employee Ventec is a fairly small player in a market
> dominated by Medtronic (under the Puritan Bennett brand), GE Healthcare and
> Allied Healthcare in the U.S., and Hamilton Medical, Getinge, Drägerwerk and
> Philips Healthcare in Europe. Kiple estimates that worldwide production
> capacity is in the range of 40,000 to 50,000 units a year, but some of this
> output is of machines not suitable for intensive care units.

Forget about start ups and tiny companies now. The government needs to call on
the big players here - those mentioned in the quote above look like a good
start. Not just for ventilators but for everything else like masks and gowns
that will be needed. And field hospitals capable of handling massive numbers
of people. Something will need to be done about training and deploying large
numbers of medical staff quickly too.

In WW2 Roosevelt commandeered the car factories to build planes and tanks. It
didn't hurt the car factories as far as I know - the government paid them in
full. We sorely need a leader of that caliber at this time with the vision and
capacity to make bold moves like that.

~~~
whatshisface
> _The government needs to call on the big players here_

Call on them to do what, stand behind the President in a press conference and
give short speeches? They manufacture ventilators for hospitals, and it's the
hospitals who pay for them.

~~~
dmix
War time measures like taking over private factories to produce armaments is a
significant ask, especially when factoring in timelines of a few months turn
around (at best). It’s a fair question.

I personally don’t see how filling up small companies orderbooks with a giant
federal order makes sense when other countries like Italy and Germany have a
real and active shortage today, while the US still has capacity. Ramping up
production as we face a second wave is going to be happening regardless.
There’s more than enough demand globally and from the various hospitals
already. Adding more orders on top of it doesn’t exactly make things run more
smoothly, there should be plenty of capital readily available for them to
expand.

Supporting the hospitals/industry in their purchasing and production efforts
and clearing red tape is something that could help now. Which I believe is
what the giant stimulus and relief packages include already?

I guess people won’t be happy unless they buy it all up themselves first then
donate it to the most needy, or hoard it more efficiently than others?

~~~
whatshisface
> _I personally don’t see how filling up small companies orderbooks with a
> giant federal order makes sense when other countries like Italy and Germany
> have a real and active shortage today_

But, the federal government doesn't order ventilators. That's not how the US
system works, we don't have an NHS like the UK.

~~~
jhayward
Not only does the federal government order ventilators, it is specifically
mandated to stockpile them for a public health emergency.

The President also has emergency powers under the Stafford Act to (1) put
government orders at the "head of the line" for any manufacturer, and (2) to
pre-fund production of materials or products necessary to protect the public
or national interest in an emergency.

------
eezurr
My thoughts on this virus. I am NOT an expert (no where close. But if people
respond it will shed some light for everyone):

* Since the federal government has be slow to respond, I am beginning to wonder how much of our emergency supply chain is NOT located within the US. In a pandemic situation, every country is going to be looking after their population first. We may have lost the capacity.

* The expected death count is 1-2 million. Our country is full of people with preexisting conditions.

* Heart Disease: 22,000,000. Death rate due to Coronavirus: 10%

* Diabetes: 34,200,200. Death rate due to Coronavirus: 7.3%

* Chronic Respiratory Disorder: 16,000,000. Death rate due to Coronavirus: 6.3%

* High Blood Pressure: 108,000,000. Death rate due to Coronavirus: 6.0%

* Cancer: 1,735,000. Death rate due to Coronavirus: 5.6%

Granted, there is a lot of overlap, but even if we just use High Blood Prease,
that's 6,000,000 deaths alone (multiplied by expected spread of virus e.g.
70%). This excludes death rates for all healthy people over 60.

All sources are from coronavirus related wikipedia articles and .gov sites
dedicated to American health statistics.

------
rectang
> _What’s the U.S. government doing about a potential shortage here? Not much,
> it seems._

> _The ventilator industry is getting a burst of desperate orders from China
> and Italy._

Why don't the feds see the urgency here? Is it not predictable that the US
will be in the same situation shortly?

If the feds won't take action, can state governments work around them and
order directly?

~~~
pdonis
The government is not the one who should be seeing the urgency here. Hospitals
and other health care facilities should. They are the ones who should be
placing orders for ventilators.

If the hospitals and other facilities need _funding_ to help with that, that's
something governments might be able to help with. But it's still the
facilities themselves that should be forecasting an obvious future need and
taking steps to meet it.

~~~
rectang
From the article:

> _If there is a risk of a surge in need, and if it takes three months to
> boost part deliveries, somebody ought to be placing orders right now. But a
> hospital might well hesitate, given the perhaps equal risk that the extra
> machines will never be used. Who would eat the cost? That explains why the
> German order came from the government._

------
tcbawo
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/](https://emcrit.org/pulmcrit/cpap-
covid/). This source describes cases where oxygen supplementation could be
reduced or eliminated.

This development ([https://www.isinnova.it/easy-
covid19-eng/](https://www.isinnova.it/easy-covid19-eng/)) 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.

I don't know how many of these rapidly improvised ventilators can provide
constant pressure, but if the closed mask method could be used successfully to
prevent serious cases from progressing to ICU (or more importantly, keep
people in their homes a little longer), it could have a huge impact.

------
acd
We are going to need the ventilators by 2020-03-22 - 2020-04-10. We also need
to distribute oxygen tanks and regulators in the community.

~~~
beamatronic
And there may be a second bump in the fall. There’s no reason not to build out
our healthcare infrastructure.

------
growlist
I was reading about ventilators the other night. On the principle that surely
even a rudimentary ventilator is better than no ventilator, why can't we
revert to basic designs? 'Manley Mark II' and 'Bird Universal Medical
Respirator' are two that are cited on wikipedia. These were manufactured in
the 1950s. I can't see that it's that difficult to spool up a production line
for a similar model today.

~~~
ptero
> surely even a rudimentary ventilator is better than no ventilator

This is not a given. Ventilators damage alveoli, which (I am not a doctor, so
not 100% sure) I think is not recoverable. Thus increasing air flow with a
basic ventilator might do more harm than good, so whether it is worthwhile
depends on the patient.

That said, building _good_ ventilators should be very easy as well with the
modern industrial base.

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swader999
This is where emergency government powers to temporarily take over industry
and direct production would be appropriate.

~~~
Ericson2314
Yes. They should commandeer production enough to reel in vulnerable supply
chains too.

------
beamatronic
In the future, I see a robust economy built around communicable disease
prevention. This was a wake up call for the world. The free ride is over. But
this virus can’t overcome humans making a concerted effort to beat it.
Worldwide we see the need for increased sanitization and emergency treatment
and having lived though this we will all be properly motivated. There’s a lot
of jobs to be created and money to be made in our new health oriented economy.

~~~
concerned_user
In my humble opinion wake up calls were in 2003 SARS and 2009 H1N1, but we
decided to ignore those, now we get the real thing, that has improved and
evolved.

~~~
gnulinux
Maybe, maybe not. I predict we're not gonna take any lessons from this either;
10 years from now people are gonna write comments like this saying "2020
COVID19 was the wake up call, now we get the real thing, that has improved and
evolved".

~~~
Consultant32452
I think at the very least some regulations/restrictions have been lifted which
are never coming back. Examples might include allowing doctors to practice
telemedicine accross state borders and allowing local labs to create their own
tests without waiting for federal approval.

------
wefarrell
It's fortunate that this started out in China, where the bulk of manufacturing
takes place.

Hopefully they've been able to rapidly shift production to meet the upcoming
demand for respirators and other products this pandemic will need.

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2T1Qka0rEiPr
This might well be a very naive question, but, provided the peak rate of
infection differs between nations, could a part of this be solved by borrowing
from abroad?

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Ericson2314
Do build a bunch of these, and do create a nursing nation guard (though not
under military control please!) as soon as possible.

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shademaan
The bottleneck is a lack of people to actually use ventilators an not just a
lack of equipment though

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airbreather
what is the ifference between a ventilator and one of the $500 oxygen
generators that does 6 litres a minute of 30-40% O2?

And I mean in terms of practical outcomes of home use.

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obilgic
"... in 90 to 120 days"

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brutt
Italian doctor advice is to skip ventilator and go straight to intubation
instead, because intubation is used anyway later.

~~~
snowwrestler
Ventilators are how intubated patients breathe. That's what the tube is hooked
up to.

