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Ventilator maker: we can ramp up production five-fold (forbes.com)
143 points by rectang 12 days ago | hide | past | web | favorite | 135 comments

"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.

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.

Convention centers and empty hotels, they should be getting proactively turned into field hospitals very soon.

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?

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.

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.

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.

Best estimates are that the US has roughly 90,000-150,000 cases right now. You multiply number of deaths by 1500. That assumes doubling every five days and 1% fatality.

> every state has infected people

West Virginia does not have any confirmed cases.

The chances they don't actually have any cases is so close to nil that it's negligible.

cementing their status as the #1 flyover state


> 2.2 million people in the United States could die.


> The latest study available estimates there are about 62,000 ventilators in hospitals nationwide.

It's also important to keep in mind that some of those ventilators are already in use for non-COVID-19 cases. Our healthcare system has to deal with COVID-19 on top of what it's already dealing with.

I understand that people are making extreme estimates, and I'm making good money off of their panic, but it's about time for a sober and level-headed look at how the past couple of weeks have stood up to what those people were predicting a couple of weeks ago.

China had about the same number of infections 3 weeks ago as it does today, for example. And their most extreme lockdown measures are waning.

We'll see what happens in a few months, but it looks like a lack of information causing people to assume the worst.

> I'm making good money off of their panic

Stop profiteering off a misery, if you've been hawking over priced toilet paper you're exploiting people in their time of need.

> We'll see what happens in a few months, but it looks like a lack of information causing people to assume the worst.

Assume and prepare for the worst - the US government has had a critical shortage of test kits and it's nigh on impossible that the case numbers we've seen are accurate. Trump has previously specifically and openly acted to keep the numbers artificially low[1] along with generally showing a large amount of concern over the appearance of things to the detriment of dealing with the actual crisis.

The actual numbers are worse than they look right now - everyone outside of the US trusts the US's numbers as much as we trusted China's numbers, the government (though this time almost certainly through incompetence rather than maliciousness) is not a trusted reporter of real data.

Also, stop profiting off of misery.

1. Specifically "[...] would like to have the people come off. I’d rather have the people stay, but I’d go with them. I told them to make the final decision. I would rather—because I like the numbers being where they are. I don’t need to have the numbers double because of one ship that wasn’t our fault." https://www.motherjones.com/kevin-drum/2020/03/trump-keep-em...

I'm slowly buying into stocks as the market plummets due to people's irrational panic, which is a vote of confidence in the mid-term future.

What are you talking about, "profiting off misery"? I'm profiting off of predictable herd behavior, and putting my money where my mouth is.

Are you? Better start selling stocks if you really believe what you're saying, right?

Ah sorry - given your comment above I assumed you were one of the folks reselling supplies.

One analysis showing how we’re likely to far, far exceed ventilator capacity in the US


We have at least a 10 day backlog on an asymptomatic disease that is exponentially growing. If 4-5k are infected now, and the 10 day backlog is largely with the virus spreading unchecked, were probably in the 100k actual carriers already.

People are having a really hard time with this - every argument I see about 'oh it's not that bad' seems to be missing that we already have the next 1-2 weeks of infected walking around, totally oblivious to their nature as ticking time bombs. Few seem to realize anything we do now will be at best apparent in 2-3 weeks of exponential growth.

But the measures are decreasing the base of exponentiation. If it can be pushed below one, the spread can be stopped - until a second wave or until there is medication or enough testing capacity to test eryone with a cold. With an estimated 2.5 people infected by every person absent any measures, it seems possible to reduce it to < 1.

Yes, it absolutely can, and hopefully our changes ARE helping - but everyone needs to realize the lag time between stimulus and response. My thoughts are really more about those people who don't see it as a big deal now - if we do the right things we can stop this, but if we don't do those right things right now it's going to grow, and by the time it hits those people's "oh no, this is a problem" mark, we're going to have another 2 weeks of growth before THEIR changes come into effect. We can't let the "oh, it's not a problem right now" people dictate the course of this pandemic.

So people say, but China's infection numbers have not grown over the past 3 weeks.

Nature doesn't do exponential curves; they're inherently unsustainable. It does logarithmic ones, which look exponential when you extrapolate from the right point on the graph.

Logistic, not logarithmic. Exponential and logarithmic are the same thing seen from different angles.

Thanks, but the point is that there is a horizontal asymptote and people are acting like there isn't.

Two weeks ago I was constantly being told to just wait a couple of weeks, and I would see overflowing ICUs in the United States.

But here we are, and the only places that are overflowing in the States (and most other nations) are the newsrooms.

I think it would be clearer if you'd stop trying to use math terms entirely. Your point isn't that there's a horizontal asymptote, because a virus that kills everyone on Earth could still have one or two of those. Your point is that you think the growth rate is going to slow quickly and you are basing that on intuition rather than math,right?

Every analysis I've seen puts that peak sometime in June.

China is locked down hard. Every place you go, someone takes your temperature, and if you're feverish at all you're taken directly to a testing facility. If it turns out you have corona then you're in isolation until you're better.

If we do the same in the U.S. then it'll be valid to expect similar results.

It's certainly true that the virus will peak and decline naturally, but it does that because most of the population has been infected so it can't find fresh hosts. With 0.7% mortality that translates to over a million dead in the U.S.

All of the data says we're still no where near the inflection point, and describing the short term as a exponential seems to be the best way to get the point across.

Don't use China numbers as the kind of quarantine they implemented no other country did. Italy is the more realistic marker. And it is too soon to tell if the Italy lockdown was effective maybe 2 weeks after the lockdown comes down.

We have already seen the efficacy of "social distancing" in Codogno, Lodi, Italy; which was locked down earlier than the rest of the country. Cases are still increasing, but slower than they are in the surrounding areas.




China took aggressive and far earlier steps to contain spread.

We're far behind on mitigation, and we should expect a much larger spike in cases.

Things might be slowed down while quarantines are in force. The big question at the moment is what happens when those quarantines become unsustainable if, as seems very likely, we don't yet have mass vaccinations available.

>Where are you getting this "hundreds of thousands more people infected than you have ventilators" idea?

Where are you getting the idea that we should trust any data coming out of China?

South Korea, Italy? Sure.

Unbelievable that people are still not only buying the numbers but downvoting too.

Decades of easy living in the US has made the average native dangerously naive.

China is most likely going through a second wave of the infection either now or soon, as people return to work out of necessity to prevent supply shortages and food insecurity. Notice how they've totally locked everything down online - the internet was awash with leaked videos and tweets from people inside of china - but the government has clamped down on these dissenters hard enough to discourage the rest, apparently.

The CCP lies to save face. Its existence is predicated upon the fear and/or respect of the people it controls. It is not a free society.

>Unbelievable that people are still not only buying the numbers but downvoting too.

Much of Silicon Valley (and the coastal elite, in general) is in the pocket of the CCP. Is normal.

People will literally refer to Trump as a tyrant or "Hitler", but refuse to speak ill of Chinese leadership. It's crazy.

I don't know that I'd go that far but there is definitely a lot of influence, indirect mostly, and direct for those operating within China of course.

I can't find the % value but the stake that tencent owns in Reddit is a little concerning. That's a lot of propaganda potential.

Don't engineers solve one problem at a time? Training people to use ventilaors in 3 months seems doable to say the least. We use the bootcamps playbook.

And I like the idea to be ready for the next crisis, which will eventually come. In California, we have earthquake proof buildings, it would be sensible to have pandemic proof medical equipment.

We don't have 3 months we have less than 3 weeks. Plug the deaths and doubling time into the formula for exponential growth.

We've got until mid May, then time's up.

One possible scenario is that the pandemic dies down when the weather gets warmer and then comes back for a second wave in fall. (Several historical flu pandemics behaved like that.) Should that turn out to be the case, it would still be useful to build up a stockpile of ventilators to use 6 months from now.

It will solve one part of the equation. We can figure out the other parts in the 90-120 timeframe.

I think the point is you don’t have 90-120 days, you have 15-30.

I mean, don’t get me wrong, everything you can do is going to be another life saved – it’s just that that is because everything we can do is still not going to be enough to save everyone.

You are still going to need these in 90-120 days. There is the potential for a horrible situation soon, but that doesn't mean they shouldn't make an effort. I would only argue against, if the effort was somehow detrimental to the next 15-30 days.

All social contact has a cost.

Projecting out, we'll be overrun in 15-30, but we'll still be overrun in 90-120.

How about you provide some other ideas instead of poo pooing this?

> 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.

The wrinkle being that, in Roosevelt's era, the car factories were right here in the United States. It's much harder for the U.S. government to commandeer a factory in China.

It'd be interesting to see how much of the actual production of Medtronic, GE Healthcare, Allied Healthcare, etc. takes place within the United States.

> Roosevelt commandeered the car factories...

Roosevelt also commandeered Americans with Japanese ancestry to live in concentration camps.

These sorts of powers are dangerous, an I doubt and edict that extreme would be very effective, it's just this feeling of we have to do something. What the government needed to do two months ago was place very large orders with all the manufacturers and pay enough so they're being made 24/7. The ramp-up time for much more is probably too long, and the peak need will be April-June, hopefully less after that. I doubt you could retool and train a random factory fast enough for that.

Taking over a factory and putting people in concentration camps aren’t even close to the same thing.

I would bet a lot that the production lines weren't running 24x7 or anywhere near it for ventilators. They're probably batch builds. i.e. 1-4 weeks of production every X weeks.

Scaling production != building new lines/factories, just reprioritizing, for significant uptick in units shipped.

But you have to hope that those production lines aren't also providing mission critical goods.

The cost to doing this seems like a rounding error, even if it's not useful, isn't it? And if we can't use them, we can send them elsewhere to places that end up peaking later.

>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.

> Call on them to do what

If the problem is lack of ventilator production capacity, the "Tool up like WW2" proposal would be to take Vortran's designs and expertise making things like the go2vent [1], and get them made in Lego's factories.

And if to make that happen the government has to hand out a few solid gold cadillacs, medals or eminent domain orders then so be it.

(Obviously, Vortran and Lego are just examples; the point is in WW2, what the war effort wants the war effort gets)

[1] https://www.vortran.com/go2vent

FDR issued Executive Order 9024. Which established the War Production Board.


> The WPB directed conversion of industries from peacetime work to war needs, allocated scarce materials, established priorities in the distribution of materials and services, and prohibited nonessential production.[3] It rationed such commodities as gasoline, heating oil, metals, rubber, paper[4] and plastics. It was dissolved shortly after the defeat of Japan in 1945, and was replaced by the Civilian Production Administration in late 1945.

> In 1942-45, WPB supervised the production of $183 billion worth of weapons and supplies, about 40% of the world output of munitions. Britain, the USSR and other allies produced an additional 30%, while the Axis produced only 30%. One fourth of the US output was warplanes; one fourth was warships. Meanwhile, the civilian standard of living was about level.

It was the WPB that coördinated all contracting and procurement through 12 regional offices and 120 field offices... At a time when the very basic tenets of information theory, and subsequent digital communications, had just begun to gestate in the heads of Claude Shannon.

Joseph Stalin said in 1943 at the Tehran Conference:

> Without American production the Allies could never have won the war.

Basically, it's been done before. You don't need to look far for inspiration: the historical record basically hands us a blueprint.

Of course they are going to stand behind your president and give short speeches... if literally everybody is just accepting that as a given without actually pushing back on the whole thing, holding people accountable now and demanding proper statesmanship.

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?

>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.

There’s a giant emergency stockpile in the US which includes ventilators and other material managed by the federal government. They already talked about distributing them if they become needed, during different press conferences.

But otherwise I’m agreeing with you that there are better ways than flooding orderbooks for federal stockpiles. Like subsidies, capitalization, and removing red tape for both hospitals and manufacturers.

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.

The government should pay for them. It can print or borrow money if it needs to, inflation be d-ed, but it should but them.

>> In WW2 Roosevelt commandeered the car factories to build planes and tanks.

They also built things like machine guns.

The problem now, is the car factories have so much automation. The lines are specifically built to build one thing, the robots are designed to do one thing. You can't run a tank down a Ford Focus paint line.

Well they are also built to be modular and support changes in cars over the years. So I don't think it would be that bad.

Won’t be strong enough to move a tank though if designed for a focus...

The parts needed are mostly in the engine: mass air flow sensor, oxygen sensor, electric turbo assist

Hello! Please take a moment check out opensourceventilator.org and get in touch if you can contribute to this initiative.

We know how to make ventilators. What we need to do is make them at scale.

True. And finding a way to do that is part of our initiative. If you would like to contribute to it please get in touch :)

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.

> 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?

Yeah, I really don't understand it. We knew there was a serious problem by mid-jan. The federal gov could have known by early Jan by sending someone to Wuhan. We are almost 90 days from then. I assumed (incorrectly) that we would have already ramped mask/glove/sanitizer/ventilator production and would just now be getting the supply.

I'm kind of in shock at how exposed we all are.

The states have effectively been going it alone this whole time.

I heard through the grapevine that the feds deliberately put the brakes on UPMC working on their own COVID-19 testing. They've been an active hindrance.

EDIT: via Pittsburgh Post-Gazette https://www.post-gazette.com/news/health/2020/03/14/covid-19...

At 20 patients a day (aiming for 100 by the end of the week) this isn't an industrial scale testing scheme, but given how slow we've been that's still a significant chunk of testing capacity and it would've been great for Pittsburgh to have access to it sooner.

And yesterday, Trump reiterated that states will be going alone in the future. He's refusing any responsibility to have a coordinated action plan.

“Respirators, ventilators, all of the equipment — try getting it yourselves,”


Yes Trump said in one of the press conferences that he gave states permission to bypass the federal gov to buy what they need directly from manufacturers.

That's a... charitable interpretation.


> “Respirators, ventilators, all of the equipment — try getting it yourselves,” Mr. Trump told the governors during the conference call, a recording of which was shared with The New York Times. “We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”

Distributing these is the sort of thing the federal government can do far more effectively than an "every man for himself" approach.

Are you saying states can’t buy directly from the manufacturer like he said to the governors and announced in a national press conference, in a response to a question by reporters about states buying it themselves? That’s what the person above was asking.

Not making an opinion on its efficacy... although I guess every discussion of US needs giant political asterisks these days so it doesn’t get derailed.

I'm saying that's going to create bad outcomes, like when everyone individually tries to stock up on toilet paper.

You wind up with some people having two years worth, and others using the empty cardboard tube in desperation.

...so you think they shouldn't be able to buy it by themselves without it going through federal distribution channels first? Ignoring whether they can or not today.

I think the federal government should be calling every manufacturer of respirators, ICU beds, ventilators, etc. and making it clear they will pay for every item they can possibly produce at absolutely maximum output.

Not sure we can find a citation for that? Govt is notoriously criticized for inefficiency during crisis.

Government is notoriously criticized for overreacting and inefficiency during non-events by people who don't understand that crises occasionally happen.

Government is our best chance for a good outcome in a real crisis.

"New York has plenty, Ohio needs a bunch" is precisely the sort of coordination that the Feds are there for.

And "Ohio Governor calls New York Governor, who dispatches a truck to Ohio" is also coordination. Where each understands local conditions on the ground and can perform the necessary tasks to actually get something done.

The worse it gets, the less willing states will be to do that.

No one wants to be the governor who gave supplies to another state when the next election comes up.

> Why don't the feds see the urgency here?

Because the United States is a collection of fifty sovereign states, not a centralized government. Why is the EU not taking EU-wide action here, and leaving responses up to constituent governments?

This is demonstrably not true. The constitution clearly states that federal law is supreme in the US. That means the states are not sovereign.

>The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

That's the 10th amendment. Pretty sure it says the exact opposite of what you just stated.

It agrees with what I said. Calling states sovereign means they answer to no higher authority. The constitution clearly states that the federal government is a higher authority than state governments. The 10th amendment basically means that powers the federal government has not claimed belong to the states - but federal law is still supreme, and the federal government can always claim more powers through amendments.

How are those amendments passed? By state representatives and senators.

The _only_ powers the Federal Gov. has are those granted by the constitution. They cannot go claiming powers not specified therein.

That is in direct contradiction with this statement: > powers the federal government has not claimed belong to the states

The Fed Gov. can't just claim supreme power. That's exactly what the 10th amendment is intended to address.

I think you’re disingenuously interpreting what I have said. The federal government is the ultimate authority in the US. That is established in the Supremacy Clause: https://en.wikipedia.org/wiki/Supremacy_Clause. This fact directly contradicts the premise the original commentator made - specifically, that the states are “sovereign”, as the Supremacy Clause clearly contradicts.

Fair enough, I agree states aren't sovereign. The wiki link you posted states this:

> However, federal statutes and treaties are supreme only if they do not contravene the Constitution.

That's the exact point I was trying to make

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.

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.

No, the government should be doing this. God willing, not every hospital will need every ventilator at once, but at some point they may, and that's why it needs to be a shared, transferable resource. They are going to need a way to deploy a hundred ventilators to a stadium or conference center, and that just makes sense to come from a government, instead of scrounging from various hospitals.

I think its reasonable to expect the gov to step in here, and order the ventalators or at least enter in to contracts to pay for them if they are not used.

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/. This source describes cases where oxygen supplementation could be reduced or eliminated.

This development (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.

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.

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

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.

> 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.

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

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

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.

Lessons are generational. Unfortunately. For example, the rhetoric from anti-vaxers would be unthinkable to people from the generation that lived through polio.

I am hopeful that this pandemic will take the wind out of the sails of the antivax cult for at least a few generations.

I will absolutely guarantee you that some folks will cling to it even harder - anti-vaxxers have a hell of a lot of delusion to draw on and I've often seen discussion lines from them about the "benefits to long term health of getting the disease" while ignoring the benefits of simply getting vaccinated for it.

I'm afraid you're sadly ignoring the power of willful ignorance.

The education system failed these people.

The education system failed all of us - it's left us needing to deal with these folks.

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.

Just like an alarm clock, some nations have hit snooze and others have woken up. It's pretty clear who is ready (Taiwan, HK, SK) and who is not.

Note: I think it's fair to say, SK is/was ready or has responded well, patient 31 notwithstanding.

I think the USA needs to work on the basics, but other nations will have so interesting advanced strategic decisions. i.e. Does ventilator design changes frequently? Does it make sense to have an on-demand factory or just build up a stockpile of ventilators that can be distributed as needed?

If we regularly have virus outbreaks, will we usually need ventilators, or is this something specific to COVID-19? Is viral pneumonia a common effect of these kind of viruses?

The first DIY ventilator tutorial I saw mentioned the avian flu, so I assume so

Always fight the last war! /s

What if we created a more sanitary world, eliminated the seasonal flu too, and it was all for nothing!

> ...a more sanitary world

Be careful what you wish for: https://en.wikipedia.org/wiki/Hygiene_hypothesis

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".

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.

If the following calamity will not fix USA healthcare I don't know what will.

Anytime someone questions a healthcare investment, from now on, it must be met with “this will happen again”.

To many people those were crying wolf rather than wake up calls.

The wolf is not leaving anytime soon. In fact, there will always be a wolf. There are wolves roaming your neighborhood now. And if you take care of 1, it will be replaced. The page has turned and what we need is daily neighborhood wolf suppression now.

We had plenty of calls, just nobody woke up.

Doubtful. It just doesn't make sense to prepare for these 1 in 100 year things, especially when the next pandemic virus will likely meet a much better healthcare system, perhaps one with broad-acting antivirals. Like, this pandemic will likely not kill as much as the 1918 spanish flu simply due to better medicine.

"It doesn't make sense?" A "much better health care system"?

I encorange you to think what,would happen in a scenario where airborne ebola is burning through the world at the same time as most of our antibiotics start to fail due to resistance.

It's so horrendous to think about. I can't belive you think it's not worth preparing for. You reckon the USA should scrap its military until an invading force turns up on the west coast?

I think we're in a window where we know enough to detect it quickly and monitor the spread, but vaccine production is slow.

This looks completely different if, in 10 years, we can produce vaccines in months, not years.

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.

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?

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

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

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.

"... in 90 to 120 days"

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

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

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