
Risky hack could double access to ventilators - spookybones
https://www.vice.com/en_us/article/qjdm53/this-risky-hack-could-double-access-to-ventilators-as-coronavirus-peaks
======
bitexploder
This is really neat. It seems a lot of the risk is how specific lung
capacities and conditions interact with the ventilator and how much oxygen
someone needs. My question to any MDs reading this: how often do you have to
tweak ventilator volume for patients using one? What is the feedback loop?
Blood oxygen levels?

~~~
theturingnerd
(physician here) Vents can be quite tricky to get right; primarily because as
disease progression continues on many things change. We are always trying to
balance the deleterious effects of the intervention (in this case, the vent)
with the goals of care.

What most people don't know is that vents cause a lot of injuries on their
own. (See ARDS). Hypoxemic respiratory failure is serious stuff, and it's
almost always not the only insult we're dealing with. So, it's about balance.

In the feedback loop is a lot of things. Certainly, oxygen saturation is a
core measure, but we are also thinking about things like hypercapnia (and
acidosis); overall perfusion status (blood circulation); infection management;
etc.

Gas exchange is important, but there are a lot of things that have to go right
for the lungs to take oxygen in, get it into the right transport, and get
carbon dioxide back out. You can over-optimize for any of those at the expense
of the other (see: hypercapnia).

In short, it's complex and there isn't a solid formula that will work for
every patient. It's actually the subject of a lot of debate on details (some
of it quite passionate in our Critical care / pulmonology community). This is
why we call it PRACTICING medicine ;)

~~~
djsumdog
What do you think are the risks of cross contamination in this setup (let's
say, just for 2 people sharing one unit)? She mentions how, in a situation
where you'd have to use this, they'd have the same infection. What if they
have different secondary infections or different types of pneumonia?

The example of the Vegas disaster is different because they were all gunshot
victims; they were healthy, but wounded. I hope we would never need to see if
these would be effective.

~~~
markmichalski
MD here. There is an inhalation and exhalation tube for each patient; the
exhalation tubes would be in continuity using the described configuration.
However, at least for part of the transmission route, viral particles would
have to move against flow. So there is likely some cross-contamination.

All that being said in the situation where this is deployed I think it would
be a risk most providers would take.

------
Mvandenbergh
Interesting. This has been done before (after LV shooting) but has
conventionally been considered as an intervention suitable for treating mass
trauma. That's because people who are otherwise in good health are easier to
ventilate than people with stiff, non-compliant lungs caused by inflammatory
viral ARDS.

Ventilating people with ARDS is hard. You have to use low, carefully
considered tidal volumes and essentially allow the patient to be hypercapnic
(CO2 higher than ideal), sometimes quite severely. You're doing a delicate
dance between ventilating in a way the lungs can take and maintaining blood
gases compatible with life.

~~~
fifteenforty
As you say, we have many patients already in our ICUs who need ventilation,
but aren’t /difficult/ to ventilate.

Perhaps they could get the split ventilators and the COVID-19 patients could
get their own?

~~~
koheripbal
Yes, but the demand projected for ventilators seems to exceed the entire
existing supply, and obviously dwarf the uses for all other conditions
combined.

------
pbhjpbhj
Have governments made orders (legal or purchase) for manufacture of
ventilators by large scale companies?

Presumably ventilators are a relatively niche product - what's in them that
the World's industrial complexes can't ramp up production of within a couple
of weeks?

I imagine it's the pumps that's the limiting factor? Given humanity already
has the working tested, established designs.

Can't governments requisition the design, turn the original factories in to
test only, or construct and test, centres. Instruct the mega-corps, publicly,
which parts they are to make and by when ...

In the West we throw away tens-of-thousands of highly engineered products
every day; surely we can step up now?

~~~
mellavora
I keep seeing people asking "Why can't we just quickly spin up technology X?"
where this is here ventilators, otherwise vaccines, etc...

without much awareness of how much specialization goes into almost _every_
aspect of _every_ job. Hell, even fast-food workers-- a skilled grill operator
at McDonalds -- take time to train up.

No, we cannot quickly undo the 20 years of systematic dismantling of our core
infrastructure. We are in for a very rude wake-up call.

And then, once we are awake, and are dealing with our new realization on the
complexity of our economy, where every part depends on every other part
functioning, and trying to get this restarted with a significant number of the
parts NOT working...

Then we realize that the economy is embedded in an even bigger system called
"life on earth" which we have degraded and destroyed on a much larger scale
than our economy.

If you think the weakness in our society which the virus uncovers are a big
deal, you simply lack the full picture.

~~~
pbhjpbhj
I see creation of a vaccine very differently to production of one of a range
of existing ventilators.

There are many companies using things like 6D CNC machines with high accuracy
that can essentially spit out a part for which there's a definition (and we
can 3D scan parts to micrometer accuracy with laser scanners); many
electronics companies can make "any" circuit to some extent (I'm guessing
ventilators use generic components, some circuits might be generic - like
valve controllers, whatever, certainly display controllers I'd expect to be
generic). Parts like keys, cases, outside the gas flow/control path are
probably injection moulds that factories could pop out a million of within a
week (once the dies are duplicated).

A skilled grill worker takes a while to train, but any grill worker given
McDo's recipe could make you a functioning BigMac in an hour. I'm not asking
for a new product to be designed (one effort - opensourceventilator.ie - are
doing exactly that, making a modified BVM system).

Still looks like production could produce output in weeks rather than months.

~~~
salawat
The problem isn't production.

It's mass automated production. Once you take the human out of the picture to
get a machine to do the work you've now involved a programmer, CNC operator,
roboticist. and an industrial engineer at a minimum just to get the rough task
doable.

We could probably have a fully human operated production line up and going
relatively quickly, but getting the machines all cut over and integrated so as
to do it themselves is _hard_.

Look, thought experiment. You ever watch that show, "How It's Made"? They
literally make entertainment out of watching the end result of the final
outcome of integrating all of these stages of the fabrication process.

But if you have ever watched it, did it not strike you as interesting that
they never seem to do an episode with regards to the production of the very
industrial equipment automating the fabrication process?

They can't/won't because it is bloody hard, error prone, and freaking
expensive. Once you've got it, you're gold, but it is by no means a short
route getting there.

------
mrob
Is negative pressure ventilation any use in treating Covid-19? Iron lungs are
easier to build than positive pressure ventilators. I imagine many HN readers
could build something like a Both respirator[0] in their garage over a
weekend. Using negative pressure ventilation might be a better option than
trying to attach multiple patients to a positive pressure ventilator.

[0]
[https://en.wikipedia.org/wiki/Both_respirator](https://en.wikipedia.org/wiki/Both_respirator)

~~~
JshWright
No, in the case of ARDS, you need positive pressure (especially "back
pressure" during exhalation) in order to keep the alveoli open.

[https://en.m.wikipedia.org/wiki/Positive_end-
expiratory_pres...](https://en.m.wikipedia.org/wiki/Positive_end-
expiratory_pressure)

~~~
fifteenforty
We are talking about negative pressure mechanical ventilation. Positive end
expiratory pressure is just one way of splinting open alveoli. Maintaining
recruitment and V/Q matching in ARDS can be achieved in multiple ways,
including negative pressure mechanical ventilation.

~~~
JshWright
Interesting, I'd be curious to know more. My understanding of NPV is that it's
primarily useful in cases when the lungs are generally "functional" and some
other issue is preventing adequate ventilation.

------
fifteenforty
There are lots of problems with this, but I think it is possibly a better move
than some of the home-built ventilators you see floating around.

I’m biased though: I’ve designed a 3D printed improvement on this idea that
potentially allows you to ventilate multiple patients with different
pressures: [https://www.prusaprinters.org/prints/25808-3d-printed-
circui...](https://www.prusaprinters.org/prints/25808-3d-printed-circuit-
splitter-and-flow-restriction-d)

~~~
markmichalski
Fellow MD trying to help with engineered solutions.

Perhaps check this out as well; someone used a common valve from a hardware
store to titrate pressures up and down:
[https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be](https://www.youtube.com/watch?v=eSVbwWANqRI&feature=youtu.be).

I've been thinking about how we might increase ventilation to one part of the
circuit if the pCO2 drops too badly--any thoughts there?

~~~
fifteenforty
Thank you for pointing this out! I’m trying work out how to get in touch with
this guy, unfortunately he has turned off all comments.

I’m not sure I understand your question: do you mean if the one patient is
getting hyperventilated? My suggestion is to set the pressure settings to
ventilate the poorly compliant compliant lung, then use the flow restrictor to
compensate on the more compliant lung.

------
609venezia
I thought I remembered reading somewhere recently that 2:1 is already in use
in some cases (maybe in Italy?), but I can't find a source.

Is there increased risk of ventilator failure with this approach? That seems
like it could be an additional terrible factor to weigh, because parts have
become so scarce.

~~~
pzlarsson
The 2:1 setup was used to save lives after a mass shootings in Las Vegas a few
years ago. They paired patiets of similar size, put them on the same
ventilator and double the flow rate.

It was mentioned in a blog post by an ER physician linked from hn back then.

~~~
enchiridion
The article for the interested. It's a tough but good read.

[https://epmonthly.com/article/not-heroes-wear-capes-one-
las-...](https://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-
saved-hundreds-lives-worst-mass-shooting-u-s-history/)

------
Herodotus38
I encourage anyone wanting to help to try and finds ways of manufacturing the
essentials of PPE that we need to limit spread, as that will have a much
bigger impact. Every hospital and clinic in my area is running out of masks
(both N95 and surgical), gowns, plastic goggles and starting to get into
issues with disinfectants. Having double ventilator use is a nightmare
scenario for various reasons. There are much better proactive things you can
make and donate, but please reach out to your local clinic or hospital and ask
first if they have guidelines or material information on what they need before
assuming.

~~~
bootlooped
It would be good if they found a way to decontaminate the masks so they could
be reused a finite number of times, instead of treated as totally disposable.
As far as what I've read, there are many things that can kill the virus:
hydrogen peroxide, alcohol, uv sanitizing lights, heat, time... Seems like you
could come up with a cheap and simple routine that would be 99+% effective, at
least for coronavirus specifically. Sure this isn't optimal, but a lot of
things aren't optimal these days.

~~~
earthtourist
That's been my question as well. Why doesn't spraying N95 masks with isopropyl
alcohol work?

1\. Spray mask with alcohol.

2\. Place in the sun or under UV light.

3\. Wait as many hours/days as possible before reuse.

Seems better than re-using a highly contaminated mask day after day. I'm not
an expert so I could easily be wrong though.

~~~
notabee
All of those break down the mask fibers or screw up the electrostatic
qualities used to grab particles. There have been studies on it, but there's
not really an ideal way that doesn't damage the filtering capacity over time.

~~~
bootlooped
From what I understand the virus breaks down with time at room temperature
anyway, so you could possibly just get away with tossing them in a box for 10
days (or whatever time gets you 99+% virus breakdown). That would have minimal
negative effect on the filter material and elastic straps.

~~~
AstralStorm
Alternatively you could bake some masks, high enough temperature will kill the
virus. Or sanitize it with chlorine gas.

------
anonuser123456
People keep talking about ventilators. The only study I've seen w.r.t.
ventilator success for COVID-19 treatment showed something like 3% survival
for those mechanically ventilated.

Do we have more data showing they even move the needle?

~~~
markmichalski
This isn't right--almost all with beds in the ICU right now are mechanically
ventilated; >50% will survive.

~~~
asah
Wuhan study of COVID showed 31/32 died:
[https://www.thelancet.com/journals/lancet/article/PIIS0140-6...](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(20\)30566-3/fulltext)

non-COVID mortality is typically a coin-toss:
[https://www.google.com/search?q=mortality+rate+ventilators](https://www.google.com/search?q=mortality+rate+ventilators)

~~~
anonuser123456
The lancet article is what I've seen.

I think early on, it was assumed ARDS was the worst outcome; your lungs
stopped functioning and ventilation would tide you over.

But the more we dig in, there are multiple systems failing and ARDS is just
one of many destructive processes going on.

This is one of the really important data points to work out. If almost
everyone ventilated will die... it makes no sense for hospitals to extensively
treat this way. Give people palliative care. It directs resources away from
other, more productive efforts... for example ... running clinical trails on
potential treatments to PREVENT ARDS/sepsis.

------
sjg007
This will become standard in about a month I bet

~~~
bitexploder
I hope not, but if this can save a few extra lives that would probably be
better than any hack I ever pulled off.

------
yread
There is quite some discussion of it here

[https://emcrit.org/pulmcrit/split-
ventilators/](https://emcrit.org/pulmcrit/split-ventilators/)

It has certain disadvantages (like not being able to trigger a breath on yiur
own)

~~~
Robadob
The video's here, in Italy, show the ventilators used with a bag over the
patient's head to create a bubble of positive pressure (and quarantine off
their head).

So presumably in a scenario like this it's less of a problem about 'triggering
own breath'.

[https://news.sky.com/story/coronavirus-they-call-it-the-
apoc...](https://news.sky.com/story/coronavirus-they-call-it-the-apocalypse-
inside-italys-hardest-hit-hospital-11960597)

------
nayuki
This sounds like a real-life kind of trolley problem (
[https://en.wikipedia.org/wiki/Trolley_problem](https://en.wikipedia.org/wiki/Trolley_problem)
).

------
tyingq
Makes me wonder if there's now a black market and/or hoarding for CPAP and
BiPAP machines. Not really a substitute for a ventilator, but better than
nothing if the hospital has nothing for you.

~~~
AstralStorm
You do need oxygen though, moistened and well tuned percentage to pressure.

Would require a modification to the mask or hose for most of these machines.
(One way valve from O2 source at least.)

------
ummonk
The virus doubles in less than a week, so this hack (which is being used
extensively in Italy from my understanding) can only by you so much time to
stop its spread with mitigation measures.

~~~
grej
Depends on whether you flatten out the growth rate. It won't/can't keep
growing like that when everyone is sheltering in place.

~~~
Polylactic_acid
Seems likely. Italy is currently seeing a 13% increase per day while the US is
now very close to a 50% increase per day. There are news reports showing
beaches and bars in the US are still fully packed. It probably relates the US
culture of disregarding expert advice and doing the opposite to "own the
scientists"

~~~
speedgoose
People stop very fast when people they know start to get sick and die.

~~~
Findeton
When that happens, it's too late. Between the incubation period and the time
to death it's about three weeks. At a 20% increase per day that means that
even if you stop going out at that moment deaths will be multiplied by 46. If
the rate is 30%, the multiplier is 247.

~~~
btilly
Not quite that bad.

Current measured growth rates are closer to 15% per day (5 day doubling time).
And people's behavior changes not when people die, but when people get sick.
Which happens (depending on your sensitivity) only 1-2 weeks after exposure.

But the basic principle still applies. We are trying to buy as much time as we
can to ramp up emergency provisions. And are trying to avoid overwhelming
emergency rooms. By the time people's behavior modifies through direct
experience, it is too late.

Making this concrete I live in Orange County, CA. Population, 3.3 million.
Hospital beds, 6600 (source [https://www.hasc.org/orange-
county](https://www.hasc.org/orange-county)). I don't know how many ICU beds,
but
[https://www.accjournal.org/journal/view.php?number=630](https://www.accjournal.org/journal/view.php?number=630)
suggests it likely is about 6% of the total. So about 400ish.

Now walk that backwards. 400 people in ICU beds probably means 4000 people
with symptoms means less than 0.1% of the population with COVID. Except that
it is worse than that. We have those beds for normal stuff that goes wrong.
They aren't actually empty now.

Long story short, we start piling up excess dead bodies due to lack of
capacity long before most of us personally know anyone who actually shows
symptoms.

~~~
acqq
> _Current measured growth rates_ are closer to 15% per day (5 day doubling
> time)

Citation needed. In the US, via Wikipedia:

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_States)

    
    
       2020-03-17  5656 infected  96 dead
       2020-03-19 11980 infected 172 dead
    

That's doubling time of 2 days, not 5. When was it 5 days the last time? If
that 2 days continues, in two weeks: 1.5 million infected, 22000 dead. Also,
the data across the world show only: the typical doubling time once it really
starts going is 3 days, never 5, at least without the beneficial contribution
of lockdowns:

Italy dead:

    
    
       2020-03-16 1809
       2020-03-19 3405
    

It's 3 days doubling time there, and they started to quarantine municipalities
since February 22, and locked down the whole country on March 10.

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy)

Netherlands dead:

    
    
       2020-03-16  24
       2020-03-19  76
    

Doubling time faster than 3 days there. Not much of measures.

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_Netherlands)

So "the risky hack" this article is about buys one not more than 3 days under
the circumstances.

Speed of deaths is a good indicator because the number of those who die and
those who need an intensive care unit are very close.

A lot of countries aren't able to test as much as it would be needed, so the
number of "verified cases" which have less serious symptoms tends to be lower
than the actual numbers. But those who die and could have been exposed to the
virus and have matching symptoms are more consistently tested.

Main point: the US data can't be considered in vacuum, we know much more than
US was able to test due to their botched procedures. But across the world,
it's nowhere 5 days, as soon as the number of dead is more than a single
digit.

~~~
btilly
Epidemiological estimates and projections seem to be based on the 5 day
estimate. See [https://www.hpnonline.com/infection-prevention/screening-
sur...](https://www.hpnonline.com/infection-prevention/screening-
surveillance/article/21130206/covid19-predicted-to-infect-81-of-us-population-
cause-22-million-deaths-in-us) for an example. I am honestly not sure of all
the lines of evidence leading to that estimate, but I've seen it used a number
of times.

Measuring what is going on by confirmed cases measures ramping out of testing
more than the actual growth of the virus. Death figures are likely to be more
accurate. But note that we expect it to take 3 weeks before quarantines show
up in fatality figures. (A week for exposed to get sick, 2 more weeks before
they die.) Therefore Italy shouldn't yet see the benefits of quarantines.

~~~
acqq
What you cite is from: [https://www.imperial.ac.uk/media/imperial-
college/medicine/s...](https://www.imperial.ac.uk/media/imperial-
college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-
modelling-16-03-2020.pdf)

topic of which isn't the evaluation of the recorded growth across the world,
but to show that lax measures are problematic even using the slower growth
rates.

They specifically write just:

"Infection was _assumed_ to be seeded in each country at an exponentially
growing rate (with a doubling time of 5 days) from early January 2020, with
the rate of seeding being calibrated to give local epidemics which reproduced
the observed cumulative number of deaths in GB or the US seen by 14th March
2020."

That's what they use in their model to demonstrate the point.

They never claim it's accurate or quote any sources for that number, because
they just use that very "optimistic" value for the demonstration purposes: to
show that even with that number, it's not reasonable not to implement serious
measures. That's how mathematical proofs are constructed: you construct the
lowest bound which doesn't have to be accurate, just to be obviously lower
than the actual numbers, and show that even then some assumption doesn't hold.

I'm claiming here that that is not a "current _measured_ rate."

> But note that we expect it to take 3 weeks before quarantines show up in
> fatality figures.

That's why I've stated about Italy: "they started to quarantine municipalities
since February 22." It's not that they let it waiting for "herd immunity" like
UK or NL. It was less than 4 weeks ago.

    
    
        2020-02-22     2 dead
        2020-03-19  3405 dead
    

with 3 days doubling time they would have today 2048 dead. It doesn't appear
to be possible to be slower than 3 days. With 5 days doubling time they would
have now just 128 dead, with 4 days doubling time 256 dead. It's that easy to
calculate.

That's the Italian "current measured rate" for a month now.

------
liquidify
They kept giving reasons why this might not work...

    
    
      * not tested in humans
      * cross infection potential
      * different sized people mess it up
    

... but I see no reason why any of these things would stop me from using this
in the real world. If things are bad enough that we need to do this, then we
should be able to find relatively similar sized people. Cross contamination is
not a concern when someone is dying here and now and likely has the same
disease as the guy next to him who is also dying. Priority 1 is save them.
Make their next of kin sign a waver or something, but save them. Lastly, who
cares if it hasn't been "tested"? It was used in the real world, in a real
life and death scenario, and it worked. I'd absolutely take my chances with it
given that the failed option is to pull people off and set it back to single
person mode. At least try.

Lastly, I would imagine that some common pressure regulation values could be
used to compensate for different sized people.

~~~
mlyle
It's not exactly "different sized people mess it up". It's not just different
lung capacities, but different lung _compliance_ \-- which also changes over
the course of disease.

Most simple pressure regulators will not fare well in the environment, either,
because of the bidirectional flow, etc.

The "Y" hack definitely has use, but finding matches and keeping patients
matched definitely means we will only be able to use it sparingly.

~~~
fifteenforty
The flow direction issue is partly addressed by the unidirectional valves in
many ventilators/anaesthesia machines. The bigger issue is staffing expertise,
I fear.

~~~
cwingrav
True. Unfortunately, there may be a wide amount of practical experience
shortly.

------
markhollis
This is another article seems to be written by someone who has deep knowledge
about this topic.

[https://emcrit.org/pulmcrit/split-
ventilators/](https://emcrit.org/pulmcrit/split-ventilators/)

Continuous mandatory ventilation (CMV) is required, however it is necessary to
accept permissive hypercapnia.

------
Hendrikto
If some untested and unapproved method like this is used and something goes
wrong, I would image that being a huge liability problem.

Good on them for trying to save human lives, but our legal system does not
always reward the ethical behavior.

~~~
Waterluvian
I would hope that our legal systems account for the context in which these
actions occur. It feels like a larger version of the Good Samaritan Act. They
might do harm but they're doing nothing else but trying to save lives. This
isn't carelessness or greed driving this behaviour.

Our laws are not a suicide pact and sometimes they must be broken.

------
riffraff
It was my understanding ventilators also do CO2/O2 analysis to understand how
to work on the fly, how would that work in this case?

~~~
djsumdog
I would assume those numbers would be meaningless. This is a hack, so the main
goal would be to simply keep as many people alive as possible.

------
yread
I've seen it discussed by intensivists on Twitter in January, that they've
used it during 2009 pandemic

~~~
qiqitori
Here's a tweet saying they're already doing it now:
[https://twitter.com/PeterAttiaMD/status/1240293938684018688](https://twitter.com/PeterAttiaMD/status/1240293938684018688)

~~~
Havoc
That's terrifyingly soon

------
gentleman11
I hope the legal framework does not lead to people like her getting sued over
their attempts to help

------
pizzaknife
i dont know if im stoked or depressed that "risky hack" manifested in my mind
after reading the title, as it has in irl

------
asdf333
if it comes to it, you can probably do three to a ventilator according to some
people in the industry i have spoken with

~~~
wcoenen
Despite the title, the article talks about hooking _four_ patients up to one
ventilator.

------
test6554
Middle-out! How could I have not seen this...

------
atdrummond
There are some odd quotes and grammatical mistakes in this article. For
example: “You wouldn’t want to put a patient with severe bronchospasm [sudden
contractions of bronchial muscles in the lungs] with a patient that does not
have bronchospasm because that would.” Likewise, one of the cited authors’
names, Babcock, is misspelled in the piece as Babcok.

I’m not qualified to assess whether this risk is worth it but I am surprised
that Vice’s editing is so shoddy. It certainly doesn’t engender faith in the
veracity/accuracy of their reporting.

~~~
surround
It looks like they have since fixed the errors you mentioned, yet they still
misspell the author’s name as “Babock.”

~~~
mushufasa
guess they prioritize shipping and just debug in production!

------
bhoover
Terrible choice of words for the headline. Adding two negative-persuasion
terms (risky hack) to bias the reader. What we need right now is encouragement
of innovation in all sectors, not some inflammatory headline scaring people.
Vice is not helping our combined effort.

------
_ZeD_
"Risky hack" is not something I want to apply during a sanitary emergency

~~~
appleflaxen
it's all about tradeoffs

of course you don't want to

but in italy, fatalities increased because there aren't enough ventilators.

US is days away from that point

so if it's a matter of no ventilator or a dirty ventilator, most people will
take the dirty vent.

after all: the sanitary crisis is for Coronavirus, and you already have it.

~~~
_ZeD_
I was wondering about he infamous Liston's most famous case

[https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_fa...](https://en.wikipedia.org/wiki/Robert_Liston#Liston's_most_famous_cases)

------
blackrock
Cross infection?

F! This solution might be worse than the disease.

~~~
lostlogin
More than one person needs the only ventilator. Could you explain how they are
worse of sharing a ventilator than being dead?

~~~
Taek
There is a material risk that you are more likely to lose both than just one.
I'm sure that having patients share a ventilator increases the risk of death
over each having their own. How big that increase is determines whether or not
the strategy is valuable.

------
Continuous
This is ridiculous!

Hacks are ok with web and app deployments where you are able to patch and fix
to your heart's content and the damage is not life threatening.

I have worked with the medical industry, the amount of formal validation and
verification that goes through on software is insane compared to what we have
in the "move fast and break things" world.

Even if it is "temporary" and "desperate" I would stay away from this
mentality as much as humanly possible.

~~~
jariel
This is completely the wrong attitude.

Different circumstances with different levels of risk, require the ability to
adapt.

Nobody is suggesting 'sharing ventilators' would be normal practice because in
normal circumstances we want to make sure that equipment is 99.999% reliable.

But as you imply, this requires extensive testing and regulation. Within these
regulations are also significant safety margins that can be exploited if
conditions change. If we can multiply the usage and maintain 99.99%
reliability, then this is probably a risk worth taking.

Also - if you've worked in the medical industry, you know how vastly
overpriced and bureaucratized everything is.

The situation of 'not enough ventilators' is literally happening right in
front of us, and it is causing death.

The risk tolerance for utilizing the gear in such a manner is such that it may
very well be possible to create better outcomes.

The individuals involved are medical practitioners who are well versed in the
equipment, procedures, and inherent moral dilemmas, they're not fools.

This is exactly the kind of procedural innovation required in times of crises
- hopefully, a few doctors and especially the Engineers from the manufacturer
can be involved. The people who built the gear may be able to give a much
better articulation of the actual risks involved, and they may even be able to
mitigate, for example 'the risk will be power consumption' or 'the risk will
be this specific valve which could wear and break' thereby implying the 'new
operational procedure' would involve daily checking of said valve etc..

The world is facing crises we absolutely must be adaptive while trying to
quantify risk and outcomes.

~~~
salawat
>Also - if you've worked in the medical industry, you know how vastly
overpriced and bureaucratized everything is.

Quality guy here,though not in medical devices... Yet. Still trying to get up
to speed on all the regulations; but I know enough to be able to vouch for
_some_ of the bureaucracy around the industry.

The risks in medicine being what they are, when launching into any novel
space, there is simply no substitute for A) data and B) audit trail.

Your data varies from lot numbers of source material from suppliers
(contamination happens), batch numbers of parts (and revision numbers of the
process involved in making that batch) from manufacturers, to serial numbers
matched up to individual patients in order to be able to implement some form
of high-level statistical process control, and rapid intervention when things
go wrong in order to figure out why, what you can do about it, and who else
may be at risk. No one wants to be the one told "whoops, someone goofed, and
that thing we put you on is trying to kill you," anymore than anyone in the
chain from treatment inception, to installation wants to hear that they missed
something, and even worse, get caught not knowing what to do about it.

That means paperwork, signalling mechanisms, and procedures involved with
marshalling whatever response is to follow, which is not at all a trivial
process to orchestrate, and while all of us wish there wasn't so much
bullshit, there are plenty of examples where "falling asleep on the job" has
led to catastrophic outcomes.

I can't necessarily say I that justifies the overriding though. The markups
are ridiculous, but without access to the books, I can't really discount it
either.

